‘It is a disease which comes and kills directly’: What refugees know about COVID-19 and key influences of compliance with preventive measures

Background Refugees are at increased risk for COVID-19 infection in part due to their living conditions, which make it harder to adopt and adhere to widely accepted preventive measures. Little empirical evidence exists about what refugees know about COVID-19 and what they do to prevent infection. This study explored what refugee women and their health care workers understand about COVID-19 prevention, the extent of their compliance to public health recommendations, and what influences the adoption of these measures. Methods In October 2020, we conducted 25 in-depth interviews with facility and community health care staff (n = 10) and refugee women attending antenatal and postnatal care services (n = 15) in Eastleigh, Nairobi. Findings While researchers found a high level of awareness about COVID-19 and related prevention and control measures among refugee women, various barriers affected compliance with such measures, due in part to poverty and in part to rampant misconceptions informed by religious beliefs and political narratives about the virus. Conclusions These findings indicated that Kenya’s Ministry of Health needs to institute a concerted and continuous education program to bring refugee communities up to speed about COVID-19 and its prevention. In addition to disseminating information about the need to wear masks and repeatedly wash hands, supplies—masks, soap and access to water—need to be made available to poor refugee communities. Future research could explore which measures for disseminating factual information work best in refugee populations with different cultural norms and how best to target interventions to these groups.

COVID-19 Infection among the Health Care Staff at Frontier Medical and Dental College and Hospital

Background: First case of pandemic COVID-19 was diagnosed in December 2019 in China from where it spread throughout the world. In Pakistan, first case was diagnosed in February 2020 which resulted in a complete and several smart national lockdowns. National Command and Operation Center (NCOC) and Ministry of Health published guidelines for patient’s treatments during pandemic which includes: 1) providing only emergency Treatments 2) Patient’s pre-admittance Questioning, 3) Increasing intervals between appointment, 4) prevent crowding in waiting rooms, 5) Wearing masks at all times. 6) Wearing PPE. Methods: Data from all clinical departments of Frontier Medical and Dental College and Hospital Abbottabad was collected between March and December 2020 which included Number of; 1) Patients treated 2) Medical Staff 3) patients with positive COVID-19 reports 4) healthcare workers suffering from COVID-19. And 6) Post treatment Virus Infected patients. Results: 291 health care staff including 135 medical and dental doctors, 4 dental hygienists, 82 paramedics and 70 Administrative staff worked during the study period and 3280 procedures were performed. Out of these, thirty-eight (38) staff members treated 190 verified COVID-19 patients. During the study period 6 dentists (2.06%) and 9 (3.09%) medical doctors, 2 (0.7%) assistants and 3 (1.03%) admin staff were tested positive for the virus. Conclusion: Present study highlights the importance of education and stickiness to the infection control guidelines thus minimizing the risk of transmission of corona virus among the Healthcare professionals in hospitals. Keywords: COVID-19; Infection control, PPE, NCOC

High Throughput Metagenomic Analysis Exposes Mobile Phones as Potentially Hazardous Microbial Platforms Warranting Robust Public Health and Biosecurity Protocols

Introduction. Advancements in technology and communication have revolutionised the 21st century with the introduction of mobile phones and smartphones. These phones are known to be platforms harbouring microbes with recent research shedding light on the abundance and broad spectrum of organisms they harbour. Mobile phone use in the community and in professional sectors including health care settings is a potential source of microbial dissemination.Aim. To identify the diversity of microbial genetic signature present on mobile phones owned by hospital medical staff.Methods. Twenty-six mobile phones of health care staff were swabbed. DNA extraction for downstream next generation sequencing shotgun metagenomic microbial profiling was performed. Survey questionnaires were handed to the staff to collect information on mobile phone usage and users’ behaviours.Results. A total of 11259 organisms derived from 26 phones were found with 2096 genes coding for antibiotic resistance and virulent factors. These organisms corresponded to 5717 bacteria, 675 fungi, 93 protists, 320 viruses, 4456 bacteriophages. The survey of medical staff showed that 46% (12/26) of the participants used their mobile phones in the bathroom.Discussion/conclusion. Mobile phones are vectors of microbes and can contribute to microbial dissemination and nosocomial diseases worldwide. As fomites, mobile phones that are not decontaminated may pose serious risks for public health and biosecurity.

Personalized Antibiotic Therapy for the Critically Ill: Implementation Strategies and Effects on Clinical Outcome of Piperacillin Therapeutic Drug Monitoring—A Descriptive Retrospective Analysis

Therapeutic drug monitoring (TDM) is increasingly relevant for an individualized antibiotic therapy and subsequently a necessary tool to reduce multidrug-resistant pathogens, especially in light of diminishing antimicrobial capabilities. Critical illness is associated with profound pharmacokinetic and pharmacodynamic alterations, which challenge dose finding and the application of particularly hydrophilic drugs such as β-lactam antibiotics. Methods: Implementation strategy, potential benefit, and practicability of the developed standard operating procedures were retrospectively analyzed from January to December 2020. Furthermore, the efficacy of the proposed dosing target of piperacillin in critically ill patients was evaluated. Results: In total, 160 patients received piperacillin/tazobactam therapy and were subsequently included in the study. Of them, 114 patients received piperacillin/tazobactam by continuous infusion and had at least one measurement of piperacillin serum level according to the standard operating procedure. In total, 271 measurements were performed with an average level of 79.0 ± 46.0 mg/L. Seventy-one piperacillin levels exceeded 100 mg/L and six levels were lower than 22.5 mg/L. The high-level and the low-level group differed significantly in infection laboratory parameters (CRP (mg/dL) 20.18 ± 11.71 vs. 5.75 ± 5.33) and renal function [glomerular filtration rate (mL/min/1.75 m2) 40.85 ± 26.74 vs. 120.50 ± 70.48]. Conclusions: Piperacillin levels are unpredictable in critically ill patients. TDM during piperacillin/tazobactam therapy is highly recommended for all patients. Although our implementation strategy was effective, further strategies implemented into the daily clinical workflow might support the health care staff and increase the clinicians’ alertness.

COVID-19 among Nursing Staff: Settings and Regional Differences

<b><i>Background/Aims:</i></b> So far detailed insights into the nursing staff’s COVID-19 symptoms, testing, and results are missing. Therefore, this study aimed to describe the setting and regional differences in the occurrence of COVID-19 among nursing staff, analysing symptoms, testing, and their respective results. <b><i>Methods:</i></b> We used an online survey to conduct this cross-sectional study among Austrian nursing staff in different settings between May 12 and July 13, 2020. This article follows the STROBE statement. The survey includes demographic data, including age, professional qualification, e.g., nurse, nurse aid, and in which federal state and setting the participants work. In addition, we asked for COVID-19 symptoms and (result of the) testing. We used descriptive statistics as well as bivariate analysis to calculate the differences. <b><i>Results:</i></b> Nearly every sixth nurse reported experiencing COVID-19 symptoms. We found statistically significant differences between the settings and the federal provinces for the reported COVID-19 symptoms, but not the test results. In total, 1.6% of the participating nurses were tested for COVID-19, of which all were positive for COVID-19. <b><i>Conclusions:</i></b> In the future during a pandemic, health care staff should be comprehensively tested in all settings. Our results showed that shifting the perspectives from critical/acute settings to other settings, such as nursing homes, is needed.

An assessment of knowledge of basic research methods among primary health care workers in Riyadh region

Background: The knowledge of and attitude towards medical research among health care staff is an important factor in delivering health care services. We aimed to assess the knowledge of basic research methods and the attitude towards medical research among health care professionals.Methods: A cross-sectional study was conducted among the health care professionals working in primary care (including physicians, nursing staff, public health professionals and other paramedical staff). A pre designed, structured, closed ended, self-administered questionnaire was used to collect the data.Results: A great majority (80%) showed interest in participating in a research if offered opportunity. Most of the attitude items had the highest proportion (>80%) of positive response whereas the knowledge items ranged from as low as 14% (awareness of reference management) to as high as 56% (correct knowledge of consent). Although the proportion of correct responses among the physicians was higher in almost all the knowledge items, as compared to nursing and other heath staff but this difference was not observed to be statistically significant (p>0.05).Conclusions: While majority of the participants had good attitude towards medical research, their knowledge was found to be low in basic research methodology.

SELF-PERCEPTION OF PRIMARY HEALTH-CARE STAFF ABOUT PHYSICAL ACTIVITY ON PRESCRIPTION: A QUALITATIVE SEMI-STRUCTURED INTERVIEW

Rationale, Aims, and Objectives: Physical inactivity and sedentary levels represent one of the major threats to public health. Physical activity on prescription (PAP) is an emerging preventive and treatment resource for chronic diseases at Health-care Settings. This study aimed to analyze the self-perception at primary health-care (PHC) nurses and general practitioners (GPs) toward PAP implementation in PHC centers. Methods: Two semi-structured group interviews were performed separately, with five GPs and nurses working in the PHC system in the region of Madrid (Spain). An expert psychologist guided each semi-structured session. The interviews were transcribed verbatim and consensually analyzed using a mixed content analysis. Results: Half of the PHC staff considered themselves physically active and were convinced that physically active staff behavior could facilitate PAP with patients. Both GPs and nurses showed a lack of knowledge of exercise prescription but were interested in PAP and motivational training courses, as well as leadership or to collaborate under a multidisciplinary or interdisciplinary PAP approach. Some of the most relevant self-perceived PAP barriers were a confident method to measure sedentary and physical activity levels. Besides lack of staff awareness, time of consultation, and improving local community relationships and PAP policies strategies. Conclusions: There are some common self-perceptions, barriers, and facilitators among PHC nurses and GPs for PAP implementation. Following a socio-ecologic approach, this organizational data provides further insight to design a future cost-effective policy strategy to improve patient health and health-care system sustainability.

Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital

Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases. Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED. Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted. Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients. Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

The “disease” of violence against health-care workers is a wicked problem. Managing and preventing violence in health-care

Purpose This paper aims to illustrate the complexity of understanding and managing violent behaviour in health care. The authors will show how different perceptions of the reasons for violent behaviour, and linkages between violent behaviour and illness have contributed to the creation of a wicked problem and added significant complexity to the management of violence towards staff within health-care settings. This paper will conclude with a call for strong multi-disciplinary action to address this ongoing issue. Design/methodology/approach A narrative review was undertaken to explore the ways that violence has been perceived in health care and the ways in which the concept of violence has moved from being seen as a criminal issue to being within the realms of disease. This paper will show the importance of understanding who is perpetrating violence in health care, why and in what settings. It will expound on the idea that considering violence as a consequence of disease necessarily adds a layer of complexity to both individual and organisational responses to violence towards health-care staff. Findings Understanding the complexity in preventing and managing violence against health-care staff can assist policymakers and managers to develop multi-faceted approaches to violence prevention, including better recognition and understanding of perpetrators of violence. Originality/value This paper provides a unique perspective on thinking about violence in health care and the implications of its complexity.

Analysis of Supportive Care Needs and Related Factors of Colorectal Cancer Patients in China

Background: This study aimed to clarify the supportive care needs and related factors of colorectal cancer (CRC) patients in China through investigation and study, and then provide a reference for the formulation of relevant interventions and ultimately improve their quality of life.Methods: A cross-sectional survey was conducted in the oncology and radiotherapy departments of four first-class hospitals in Suzhou from January 2020 to September 2020. The survey tools included the general information questionnaire, Comprehensive Needs Assessment Tool in cancer for patients, M.D. Anderson Symptom Inventory, Hospital Anxiety Depression Scale, and Social Support Rating Scale. Spearman correlation analysis, univariate analysis, and multiple stepwise linear regression analysis were adopted to explore the influencing factors of supportive care needs.Results: A total of 403 CRC patients were included, with an average age of 58.83±10.86 years, including 257 males (63.77%); the average score of supportive care needs was 39.56±18.58, the scores of health care staff need and information needs ranked the top two. Spearman correlation analysis showed that the supportive care needs were positively correlated with symptom severity, symptom interference, anxiety, and depression. Univariate analysis displayed higher levels of supportive care needs among female, single/divorced/widowed, rectal cancer, and palliative care patients. Multiple stepwise regression analysis combining the results of correlation analysis and univariate analysis found that anxiety, symptom interference, symptom severity, and cancer type all affected the supportive care needs of CRC patients. The differences were significant, which can explain 35% of the variation.Conclusions: In the supportive care needs management of colorectal cancer patients, it is necessary to attach great importance to health care staff and information needs, focus on female, single/divorced/widowed, rectal cancer, and palliative care patients, and pay great attention to reducing the symptom burden, anxiety, and depression when formulating intervention strategies.