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Research for Review - Monthly Update

Below is a listing of research articles and abstracts that may be useful as you care for patients, their families and yourself. The abstracts below are printed or adapted from the original articles published. They are to be used by nurses and staff for educational purposes only. They are not to be not to be reproduced or sold without the expressed permission of the Authors.

November, 2021

Morley, G., Field, R., Horsburgh, C. C., & Burchill, C. (2021). Interventions to Mitigate Moral Distress: A Systematic Review of the Literature. International Journal of Nursing Studies, 103984.

Background: Moral distress is a pervasive phenomenon that can negatively impact healthcare professionals and has been well studied in nursing populations. Much of the evidence suggests that it is associated with intention to leave high acuity areas and the profession. Despite the increasing amounts of research to explore the causes and effects of moral distress, there is limited research on interventions that mitigate the negative effects of moral distress.

Objectives: The aims of this systematic review were to: (a) identify and examine interventions developed to address moral distress experienced by health care professionals (b) examine the quality of the research methods and (c) report on the efficacy of these interventions.

Design: We conducted a systematic review of interventional studies developed to mitigate moral distress. Data Source: Medline, Embase, PsycINFO, CINAHL and Cochrane were searched for relevant studies (July 2019- September 2019). Additional bioethics databases and reference lists were also hand-searched.

Review methods: The first author reviewed all retrieved titles and abstracts with a low tolerance for borderline papers based on inclusion and exclusion criteria, and those papers were reviewed and discussed by all authors to determine inclusion. Quality appraisal was conducted on the included studies using narrative synthesis to compare the findings. Data were extracted and compared by all authors and then reviewed by the first author for consistency.

Results: Sixteen papers were included for full text review and the following interventions identified: educational interventions of varying length and breadth; facilitated discussions ranging from 30 to 60 minutes; specialist consultation services; an intervention bundle; multidisciplinary rounds; self-reflection and narrative writing. Researchers reported statistically significant reductions in moral distress using pre and post surveys, including one mixed methods program evaluation (n = 7). The qualitative program evaluation provided participant quotations to suggest their program was beneficial. There were no statistically significant findings in the other studies (n = 8). All studies had limitations in design and methodology presenting significant threats to validity.

Conclusion: Designing rigorous research studies that measure the impact of interventions aimed at mitigating moral distress continues to be challenging. The primary reason being that moral distress is a subjective ethical phenomenon with a number of different causes and effects. This calls for interventions that are flexible and sensitive to individual’s needs. To build an evidence-base, interventions should also be measurable and research methods need to be scientifically rigorous. To achieve rigor and innovation, researchers should clearly justify their methodological choices.

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Bong, H.E. (2019). Understanding moral distress: How to decrease turnover rates of new graduate pediatric nurses. Pediatric Nursing, 45(3), 109-114.

Summary: For the past 10 years, the United States has been experiencing a critical shortage of registered nurses (RNs), and data suggest this trend will continue through 2025. Compensation for RN burnout cannot be achieved by simply hiring new nurses because the rate of graduation is less than the rate of need. During this period of critical shortage, federal healthcare reforms, most notably the Patient Protection and Affordable Care Act (PPACA) of 2010, have placed additional demands on physicians and nurses. These trends have led to increased RN dissatisfaction, moral distress, and subsequent turnover. Literature reviews, case studies, and methodological pieces regarding moral distress in new graduate pediatric nurses were studied, and 34 articles were analyzed; articles before 2010 were excluded unless considered a sentinel piece. Results show new graduate pediatric RNs experience moral distress as they transition from academia to the professional setting, which leads to rates of new graduate RN turnover that outpace nurses of all other tenure. With the goal of decreasing RN turnover, this article briefly examines factors that contribute to moral distress in new graduate pediatric nurses and explores unit-based interventions to reduce levels of moral distress. Interventions found to decrease moral distress include early detection of moral distress, fostering feelings of nurse engagement, participation in ethics education, promotion of mindfulness, and the creation of pediatric palliative care teams within hospital units.

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Traudt, T., Liaschenko, J., & Peden-McAlpine, C. (2016). Moral agency, moral imagination, and moral community: antidotes to moral distress. J Clin Ethics, 27(3), 201-213.

Summary: Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically occur in all end-of-life circumstances, nor does every critical care nurse suffer its damaging effects. What are the practices of these nurses? What specifically do they do to navigate around or through the distressing situations? The nursing literature is lacking an answer to these questions. This article reports a study that used narrative analysis to explore the reported practices of experienced critical care nurses who are skilled at and comfortable working with families and physicians regarding the withdrawal of aggressive treatment. A major finding was that these nurses did not report experiencing the damaging effects of moral distress as described in the nursing literature. The verbal communication and stated practices relevant to this finding are organized under three major themes: (1) moral agency, (2) moral imagination, and (3) moral community. Further, a total of eight subthemes are identified. The practices that constitute these themes and subthemes are further detailed and discussed in this article. Understanding these practices can help mitigate critical care nurses’ moral distress

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October, 2021

De Rooij, B. H., Park, E. R., Perez, G. K., Rabin, J., Quain, K. M., Dizon, D. S., Post, K. E., Chinn, G. M., McDonough, A. L., Jimenez, R. B., van de Poll-Franse, L. V., & Peppercorn, J. (2018). Cluster Analysis Demonstrates the Need to Individualize Care for Cancer Survivors. The oncologist, 23(12), 1474–1481.

Summary: In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of health care needs among cancer survivors by (a) identifying and characterizing subgroups based on self-reported health care needs and (b) assessing sociodemographic, clinical, and psychosocial factors associated with these subgroups. Methods. We conducted a cross-sectional self-administered survey among patients presenting for routine follow-up care for early-stage cancer at our academic medical center. Latent class cluster analysis was used to identify clusters of survivors based on survivorship care needs within seven domains. Multiple logistic regression analyses were used to assess factors associated with these clusters. Results. Among 292 respondents, the highest unmet needs were related to the domains of side effects (53%), self-care (51%), and emotional coping (43%). Our analysis identified four clusters of survivors: (a) low needs (n 5 123, 42%), (b) mainly physical needs (n 5 46, 16%), (c) mainly psychological needs (n 5 57, 20%), and (d) both physical and psycho[1]logical needs (n 5 66, 23%). Compared with cluster 1, those in clusters 2, 3, and 4 were younger (p < .03), those in clusters 3 and 4 had higher levels of psychological distress (p < .05), and those in clusters 2 and 4 reported higher levels of fatigue (p < .05). Conclusion. Unmet needs among cancer survivors are prevalent; however, a substantial group of survivors report low or no health care needs. The wide variation in health care needs among cancer survivors suggests a need to screen all patients, followed by tailored interventions in clinical care delivery and research.

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Alfano, C. M., Mayer, D. K., Bhatia, S., Maher, J., Scott, J. M., Nekhlyudov, L., Merrill, J. K., & Henderson, T. O. (2019). Implementing personalized pathways for cancer follow-up care in the United States: Proceedings from an American Cancer Society-American Society of Clinical Oncology summit. CA: a cancer journal for clinicians, 69(3), 234–247.

Summary: A new approach to cancer follow-up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow-up care pathways, depending on the type(s) and level(s) of resources needed for patients’ long-term care, is in use in the United Kingdom and other countries and has been shown to meet patients’ needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow-up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow-up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus-based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients’ risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self-managing their health, setting expectations with patients from diagnosis onward for the need for follow-up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.

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Post, K.E., Berry, D., Shindul-Rothschild, J., Flanagan, J., (2021). Patient Engagement in Breast Cancer Survivorship Care. Cancer Nursing, 44(5), E296-E302.

Summary: Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE. Objectives: The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors. Methods: A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy–General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS. Results: The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P = .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P = .001). Conclusions: Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE. Implications for Practice: Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.

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Mayer, D. K., & Alfano, C. M. (2019). Personalized Risk-Stratified Cancer Follow-Up Care: Its Potential for Healthier Survivors, Happier Clinicians, and Lower Costs. Journal of the National Cancer Institute, 111(5), 442–448.

The growth in the number of cancer survivors in the face of projected health-care workforce shortages will challenge the US health-care system in delivering follow-up care. New methods of delivering follow-up care are needed that address the ongoing needs of survivors without overwhelming already overflowing oncology clinics or shuttling all follow up patients to primary care providers. One potential solution, proposed for over a decade, lies in adopting a personalized approach to care in which survivors are triaged or risk-stratified to distinct care pathways based on the complexity of their needs and the types of providers their care requires. Although other approaches may emerge, we advocate for development, testing, and implementation of a risk-stratified approach as a means to address this problem. This commentary reviews what is needed to shift to a risk-stratified approach in delivering survivorship care in the United States.

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September, 2021

Gonzalez-Guarda, R. M., Williams, J., Lorenzo, D., & Carrington, C. (2021). Desired characteristics of HIV testing and counseling among diverse survivors of intimate partner violence receiving social services. Health & Social Work, 46(2), 93-101.

Summary: Despite recent calls to integrate HIV testing into social services addressing intimate partner violence (IPV), few studies have reported on survivors’ perspectives regarding the desired characteristics of this integration. The purpose of this study was to describe desired characteristics of HIV and sexually transmitted infection (STI) testing services from a survivor’s perspective. A qualitative descriptive approach was taken to describe the perspectives of IPV survivors who may or may not have accessed this service. Four focus groups were conducted with a diverse sample of English and Spanish speakers (N ¼ 25) who sought services through a family justice center and associated shelters. Focus groups were recorded, transcribed, and analyzed using conventional content analysis. Three themes were identified, including (1) peace of mind; (2) interacting stigmas and traumas; and (3) making testing easy, comfortable, and tailored. The findings of this study have the potential to influence survivor-centered practices

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Scott, J., Cousin, L., Woo, J., Gonzalez-Guarda, R., & Simmons, L. A. (2020). Equity in Genomics: A Brief Report on Cardiovascular Health Disparities in African American Adults. The Journal of Cardiovascular Nursing

Summary: African Americans are more likely to die from cardiovascular disease (CVD) than all other populations in the United States. Although technological advances have supported rapid growth in applying genetics/genomics to address CVD, most research has been conducted among European Americans. The lack of African American representation in genomic samples has limited progress in equitably applying precision medicine tools, which will widen CVD disparities if not remedied. Purpose: This report summarizes the genetic/genomic advances that inform precision health and the implications for cardiovascular disparities in African American adults. We provide nurse scientists recommendations for becoming leaders in developing precision health tools that promote population health equity. Conclusions: Genomics will continue to drive advances in CVD prevention and management, and equitable progress is imperative. Nursing should leverage the public's trust and its widespread presence in clinical and community settings to prevent the worsening of CVD disparities among African Americans.

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Williams, J. R., Gonzalez-Guarda, R. M., Halstead, V., Martinez, J., & Joseph, L. (2020). Disclosing gender-based violence during health care visits: A patient-centered approach. Journal of interpersonal violence, 35(23-24), 5552-5573.

Summary: The purpose of this study was to better understand victims’ perspectives regarding decisions to disclose gender-based violence, namely, intimate partner violence (IPV) and human trafficking, to health care providers and what outcomes matter to them when discussing these issues with their provider. Twenty-five participants from racially/ethnically diverse backgrounds were recruited from a family justice center located in the southeastern United States. Two fifths had experienced human trafficking, and the remaining had experienced IPV. Upon obtaining informed consent, semi structured, in-depth interviews were conducted. Interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to examine interview data. Five primary themes emerged. Three themes focused on factors that may facilitate or impede disclosure: patient–provider connectedness, children, and social support. The fourth theme was related to ambiguity in the role of the health care system in addressing gender-based violence. The final theme focused on outcomes participants hope to achieve when discussing their experiences with health care providers. Similar themes emerged from both researcIPV and human trafficking victims; however, victims of human trafficking were more fearful of judgment and had a stronger desire to keep experiences private. Cultural factors also played an important role in decisions around disclosure and may interact with the general disparities racial/ethnic minority groups face within the health care system. Recognizing factors that influence patient engagement with the health care system as it relates to gender-based violence is critical. The health care system can respond to gender-based violence and its associated comorbidities in numerous ways and interventions must be driven by the patient’s goals and desired outcomes of disclosure. These interventions may be better served by taking patient-centered factors into account and viewing the effectiveness of intervention programs through a behavioral, patient-centered lens.

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Stafford, A. M., Nagy, G., Gonzalez-Guarda, R., & Draucker, C. B. (2020). The Influence of Peer Relationships on Latina Adolescents' Experiences with Depressive Symptoms. Journal of Pediatric Nursing, 55, 250-257.

Purpose: Previous research has demonstrated that peers may play an integral role in the development of depressive symptoms among Latina adolescents; however, little is known about the function of peers in the ongoing management of depressive symptoms for Latina adolescents. The purpose of this study was to describe how peers influence Latina adolescents' experiences with the onset and ongoing management of depressive symptoms.

Design and methods: Qualitative descriptive methods were used in conducting semi-structured interviews with twenty-five young Latinas (ages 13–20) who had a history of depressive symptoms during adolescence. Participants were asked to describe their experiences with depressive symptoms and how they interacted with others in relation to their depressive symptoms. Thematic analysis methods were used to identify common themes in how peers influenced Latina adolescents' experiences with depressive symptoms.

Results: Latina adolescents experienced tensions with peers in the development, disclosure, and self-management of depressive symptoms.
Peers were: 1) allies and bullies;
2) confidants and betrayers; and
3) up-lifters and downers.

Conclusions: Peer relationships can be a source of risk and resiliency for Latina adolescents throughout the process of experiencing depressive symptoms.

Practice implications: Interventions preventing or treating depression among Latina adolescents should capitalize on the strengths of peer relationships, while recognizing that peers may also contribute to risk.

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August, 2021

Black, J. M., & Kalowes, P. (2016). Medical device-related pressure ulcers. Chronic Wound Care Management and Research, 3, 91-99

Summary: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of oxygen delivery devices. A hospital program designed to reduce the number of pressure ulcers from medical devices was successful. The program involved the development of a team that focused on skin, the results were then published for the staff to track their performance, and it was found that using foam dressings helped reduce the pressure from the device. The incidence of ulcers from medical devices has remained at zero at this hospital since this program was implemented.

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Brophy, S., Moore, Z., Patton, D., Tom, O., & Avsar, P. (2021). What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review. Journal of Tissue Viability.

Summary: Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019–January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.

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Brophy, S., Moore, Z., Patton, D., Tom, O., & Avsar, P. (2021). What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review. Journal of Tissue Viability.

Summary: Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019–January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.

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Barakat-Johnson, M., Lai, M., Wand, T., Li, M., White, K., & Coyer, F. (2019). The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. Journal of wound care, 28(8), 512-521.

The objective of this review was to synthesize the literature and evaluate the incidence, prevalence and severity of medical device-related pressure injuries in adult intensive care patients.

Research methodology
Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure injury as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using 12 statistic.

Thirteen studies were included in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas stage 2 followed by stage 1 were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose.

While medical device-related pressure injuries are common in intensive care patients, it is an understudied area. Inconsistency in the staging of medical device-related pressure injuries, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.

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Stellar, J. J., Hasbani, N. R., Kulik, L. A., Shelley, S. S., Quigley, S., Wypij, D., & Curley, M. A. (2020). Medical Device–Related Pressure Injuries in Infants and Children. Journal of Wound, Ostomy and Continence Nursing, 47(5), 459-469.

PURPOSE: The purpose of this study was to describe medical device–related pressure injuries (MDRPIs) in hospitalized pediatric patients. DESIGN: A prospective, descriptive study.

SAMPLE/SUBJECTS AND SETTING: The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place.

METHODS: Two nursing teams, blinded to the other’s assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first.

RESULTS:RESULTS: Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development.

CONCLUSION: Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.

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July, 2021

Dong, T. A., Sandesara, P. B., Dhindsa, D. S., Mehta, A., Arneson, L. C., Dollar, A. L., ... & Sperling, L. S. (2020). Intermittent fasting: a heart healthy dietary pattern?. The American journal of medicine, 133(8), 901-907.

Summary: Dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, have been shown to improve cardiac health. Intermittent fasting is another type of popular dietary pattern that is based on timed periods of fasting. Two different regimens are alternative day fasting and time restricted eating. Although there are no large, randomized control trials examining the relationship between intermittent fasting and cardiovascular outcomes, current human studies that suggest this diet could reduce the risk for cardiovascular disease with improvement in weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting may exert its effects through multiple pathways, including reducing oxidative stress, optimization of circadian rhythms, and ketogenesis. This review evaluates current literature regarding the potential cardiovascular benefits of intermittent fasting and proposes directions for future research.

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Brewer, J. A., Ruf, A., Beccia, A. L., Essien, G. I., Finn, L. M., Lutterveld, R. V., & Mason, A. E. (2018). Can mindfulness address maladaptive eating behaviors? Why traditional diet plans fail and how new mechanistic insights may lead to novel interventions. Frontiers in Psychology, 9, 1418.

Summary: Emotional and other maladaptive eating behaviors develop in response to a diversity of triggers, from psychological stress to the endless external cues in our modern food environment. While the standard approach to food- and weight-related concerns has been weight-loss through dietary restriction, these interventions have produced little long-term benefit, and may be counterproductive. A growing understanding of the behavioral and neurobiological mechanisms that underpin habit formation may explain why this approach has largely failed, and pave the way for a new generation of nonpharmacologic interventions. Here, we first review how modern food environments interact with human biology to promote reward-related eating through associative learning, i.e., operant conditioning. We also review how operant conditioning (positive and negative reinforcement) cultivates habit-based reward-related eating, and how current diet paradigms may not directly target such eating. Further, we describe how mindfulness training that targets reward-based learning may constitute an appropriate intervention to rewire the learning process around eating. We conclude with examples that illustrate how teaching patients to tap into and act on intrinsic (e.g., enjoying healthy eating, not overeating, and self-compassion) rather than extrinsic reward mechanisms (e.g., weighing oneself), is a promising new direction in improving individuals’ relationship with food.

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Epstein, M., Söderström, M., Jirwe, M., Tucker, P., & Dahlgren, A. (2020). Sleep and fatigue in newly graduated nurses—Experiences and strategies for handling shiftwork. Journal of clinical nursing, 29(1-2), 184-194.

Aims and objectives: To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided.

Background: For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk.

Design and Methods:Semi-structured interviews were conducted with nurses (N = 11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed.

Results: Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function.

Conclusion: The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. Relevance to clinical practice: This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses

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May, 2021

Salm Ward, T. C., McPherson, J., & Kogan, S. M. (2021). Feasibility and acceptability of a tailored infant safe sleep coaching intervention for African American families. International journal of environmental research and public health, 18(8), 4133.

Summary: Background: Approximately 3600 infants die suddenly and unexpectedly annually in the United States. Research suggests limitations of current behavioral interventions to reduce the risk for sleep-related deaths among African American families living in under-resourced neighborhoods. Guided by the theory of planned behavior and the socio-ecological model, the My Baby’s Sleep (MBS) intervention intends to reduce the risk for sleep-related infant deaths while addressing complex needs of African American families living in under-resourced neighborhoods. Objective: To assess feasibility and acceptability of MBS, a 7-month intervention that includes four home visits and multiple check-ins via phone and text message. Methods: This was a single-arm feasibility and acceptability study with quantitative and qualitive measures. African American families were recruited from community agencies that served an under-resourced metropolitan area. Results: Eight families (eight mothers, nine co-caregivers) completed the intervention. Families reported high acceptability of MBS content, process, and format, as evidenced by qualitative data and mean evaluation scores. Conclusion: MBS is feasible and acceptable among African American families living in under-resourced neighborhoods. These results suggest further investigation of MBS intervention efficacy in a large-scale randomized controlled trial.

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Bechtel, K., Gawel, M., Vincent, G. A., & Violano, P. (2020). Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths. Injury epidemiology, 7(1), 1-7.

Summary: Sudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. Objective: To understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments. Methods: We surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011–2015) and after implementation of the legislation (2016–2018). Chi-Square and Fisher’s exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation. Results: All 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law

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Vilvens, H. L., Vaughn, L. M., Southworth, H., Denny, S. A., & Gittelman, M. A. (2020). Personalising safe sleep messaging for infant caregivers in the United States. Health & social care in the community, 28(3), 891-902.

Summary: The purpose of our study was to better understand why parents/caregivers might not practice safe sleep behaviours. In autumn 2016, we conducted 'pulse' interviews with 124 parents/caregivers of children under the age of one year at a variety of local community events, festivals and meetings in cities with high infant mortality rates around the Midwestern US state of Ohio. Through an inductive approach, pulse interviews were analysed using thematic coding and an iterative process which followed for further clarification of themes (Qualitative Research in Psychology, 2006, 3, 77; BMC Medical Research Methodology, 2013, 13, 117). The six major themes of underlying reasons why parents/caregivers might not practice safe sleep behaviours that were identified in our coding process included the following: (a) culture and family tradition, (b) knowledge about safe sleep practices, (c) resource access, (d) stressed out parents, (f) lack of support and (g) fear for safety of baby. Using the descriptive findings from the pulse interviews, qualitative themes and key informant validation feedback, we developed four diverse fictional characters or personas of parents/caregivers who are most likely to practice unsafe sleep behaviours. These personas are characteristic scenarios which imitate parent and caregiver experiences with unsafe sleep behaviours. The personas are currently being used to influence development of health promotion and education programs personalised for parents/caregivers of infants less than one year to encourage safe sleep practices.

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April, 2021

Blake, H., Bermingham, F., Johnson, G., & Tabner, A. (2020). Mitigating the psychological impact of COVID-19 on healthcare workers: a digital learning package. International journal of environmental research and public health, 17(9), 2997.

Summary: The coronavirus pandemic (COVID-19) will undoubtedly have psychological impacts for healthcare workers, which could be sustained; frontline workers will be particularly at risk. Actions are needed to mitigate the impacts of COVID-19 on mental health by protecting and promoting the psychological wellbeing of healthcare workers during and after the outbreak. We developed and evaluated a digital learning package using Agile methodology within the first three weeks of UK outbreak. This e-package includes evidence-based guidance, support and signposting relating to psychological wellbeing for all UK healthcare employees. A three-step rapid development process included public involvement activities (PPIs) (STEP 1), content and technical development with iterative peer review (STEP 2), and delivery and evaluation (STEP 3). The package outlines the actions that team leaders can take to provide psychologically safe spaces for staff, together with guidance on communication and reducing social stigma, peer and family support, signposting others through psychological first aid (PFA), self-care strategies (e.g., rest, work breaks, sleep, shift work, fatigue, healthy lifestyle behaviours), and managing emotions (e.g., moral injury, coping, guilt, grief, fear, anxiety, depression, preventing burnout and psychological trauma). The e-package includes advice from experts in mental wellbeing as well as those with direct pandemic experiences from the frontline, as well as signposting to public mental health guidance. Rapid delivery in STEP 3 was achieved via direct emails through professional networks and social media. Evaluation included assessment of fidelity and implementation qualities. Essential content was identified through PPIs (n = 97) and peer review (n = 10) in STEPS 1 and 2. The most important messages to convey were deemed to be normalisation of psychological responses during a crisis, and encouragement of self-care and help-seeking behaviour. Within 7 days of completion, the package had been accessed 17,633 times, and healthcare providers had confirmed immediate adoption within their health and wellbeing provisions. Evaluation (STEP 3, n = 55) indicated high user satisfaction with content, usability and utility. Assessment of implementation qualities indicated that the package was perceived to be usable, practical, low cost and low burden. Our digital support package on ‘psychological wellbeing for healthcare workers’ is free to use, has been positively evaluated and was highly accessed within one week of release. It is available here: Supplementary Materials. This package was deemed to be appropriate, meaningful and useful for the needs of UK healthcare workers. We recommend provision of this e-package to healthcare workers alongside wider strategies to support their psychological wellbeing during and after the COVID-19 pandemic.

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Teall, A. M., & Mazurek Melnyk, B. (2021). An innovative wellness partner program to support the health and well-being of nurses during the COVID-19 pandemic: implementation and outcomes. Nursing administration quarterly, 45(2), 169–174.

Summary: Responding to the coronavirus disease-2019 (COVID-19) pandemic is likely to exacerbate anxiety, burnout, fatigue, and distress already being experienced by nurses in ever greater numbers. An innovative Wellness Partner Program was developed with an aim to enhance the health and wellbeing of nurses on the front lines during the COVID-19 pandemic and beyond. Nurses across the country opted in to the program, and were paired with advanced practice nursing (APN) graduate students who served as the nurses’ wellness partners. Areas emphasized in the program included (1) personalized support for wellness; (2) prioritizing physical activity, healthy eating, sleep, and stress management; and (3) establishment of strength-based, sustainable solutions to improve health and well-being. Partnerships were implemented for 188 nurses who were coached by 49 APN students; 104 nurses participated for 6 weeks. In the program evaluation, 98% of nurses shared that the wellness support program helped them engage in self-care and wellness, and 94.7% agreed or strongly agreed that The Wellness Partner Program helped them improve their mental and physical health. In the midst of the pandemic, nurses were supported to cope with stress, focus on self-care and wellness goals, and address challenges to their well-being.

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Zaçe, D., Hoxhaj, I., Orfino, A., Viteritti, A. M., Janiri, L., & Di Pietro, M. L. (2021). Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review. Journal of psychiatric research, 136, 319–333.

Summary: Considering the importance of evidence on interventions to tackle mental health problems in healthcare workers (HCWs) during pandemics, we conducted a systematic review, aiming to identify and summarize the implemented interventions to deal with mental health issues of HCWs during infectious disease outbreaks and report their effectiveness. Web of Science, PubMed, Cochrane, Scopus, CINAHL and PsycInfo electronic databases were searched until October 2nd, 2020. Primary-data articles, describing any implemented interventions and their effectiveness were considered pertinent. Studies were screened according to the inclusion/exclusion criteria and subsequently data extraction was performed. Twenty-four articles, referring to SARS, Ebola, Influenza AH1N1 and COVID-19 were included. Interventions addressing mental health issues in HCWs during pandemics/epidemics were grouped into four categories: 1) informational support (training, guidelines, prevention programs), 2) instrumental support (personal protective equipment, protection protocols); 3) organizational support (manpower allocation, working hours, re-organization of facilities/structures, provision of rest areas); 4) emotional and psychological support (psychoeducation and training, mental health support team, peer-support and counselling, therapy, digital platforms and tele-support). These results might be helpful for researchers, stakeholders, and policymakers to develop evidence-based sustainable interventions and guidelines, aiming to prevent or reduce the immediate and long-term effect of pandemics on mental health status of HCWs.

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March, 2021

Pierce, R. P., & Stevermer, J. J. (2020). Disparities in use of telehealth at the onset of the COVID-19 public health emergency. Journal of telemedicine and telecare, 1357633X20963893.

Summary: The coronavirus disease 2019 (COVID-19) pandemic resulted in an unprecedented expansion in telehealth, but little is known about differential use of telehealth according to demographics, rurality, or insurance status. We performed a cross-sectional analysis of 7742 family medicine encounters at a single USA institution in the initial month of the COVID-19 public health emergency (PHE). We compared the demographics of those using telehealth during the PHE to those with face-to-face visits during the same time period; we also compared the demographics of those using full audio-video to those using audio-only.

The likelihood of any telehealth visit in the first 30 days of telehealth expansion was higher for women, those age 65 years and older, self-pay patients, and those with Medicaid and Medicare as primary payers. The likelihood of a telehealth visit was reduced for rural residence and Black or other races. Among all telehealth visits, the likelihood of a full audio-video telehealth visit was reduced for patients who were older, Black, from urban areas, or who were self-pay, Medicaid, or Medicare payer status. Significant disparities exist in telehealth use during the COVID-19 PHE by age, race, residence and payer.

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Chunara, R., Zhao, Y., Chen, J., Lawrence, K., Testa, P. A., Nov, O., & Mann, D. M. (2021). Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. Journal of the American Medical Informatics Association, 28(1), 33-41.

Summary: Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19. Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results. Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58–0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients.

There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use. Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection—many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.

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Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020). Health Inequalities in the Use of Telehealth in the United States in the Lens of COVID-19. Population health management, 23(5), 368-377.

The use of remote health care services, or telehealth, is a promising solution for providing health care to those unable to access care in person easily and thus helping to reduce health inequalities. The COVID-19 pandemic and resulting stay-at-home orders in the United States have created an optimal situation for the use of telehealth services for non-life-threatening health care use. A retrospective cohort study was performed using Kantar’s Claritis database, which links insurance claims encounters (Komodo Health) with patient-reported data (Kantar Health, National Health & Wellness Survey). Logistic regression models (odds ratios [OR], 95% confidence intervals [CI]) examined predictors of telehealth versus in-person encounters. Adults ages ‡18 years eligible for payer-complete health care encounters in both March 2019 and March 2020 were identified (n = 35,376). Telehealth use increased from 0.2% in 2019 to 1.9% in 2020. In adjusted models of respondents with ‡1 health care encounter (n = 11,614), age, marital status, geographic residence (region; urban/rural), and presence of anxiety or depression were significant predictors of telehealth compared with in-person use in March 2020. For example, adults 45–46 years versus 18–44 years were less likely to use telehealth (OR 0.684, 95% CI: 0.561–0.834), and respondents living in urban versus rural areas were more likely to use telehealth (OR 1.543, 95% CI: 1.153–2.067). Substantial increases in telehealth use were observed during the onset of the COVID-19 pandemic in the United States; however, disparities existed. These inequalities represent the baseline landscape that population health management must monitor and address during this pandemic.

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February, 2021

Ludvigsson JF, Engerström L, Nordenhäll C, Larsson E. Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden. New England Journal of Medicine. 2021 Jan 6.

Summary: In mid-March 2020, many countries decided to close schools in an attempt to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (Covid-19). Sweden was one of the few countries that decided to keep preschools (generally caring for children 1 to 6 years of age) and schools (with children 7 to 16 years of age) open. This article presents data from Sweden on Covid-19 among children 1 to 16 years of age and their teachers. Data on severe Covid-19, as defined by intensive care unit (ICU) admission, were prospectively recorded in the nationwide Swedish intensive care registry. Included were all children who were admitted to an ICU between March 1 and June 30, 2020 (school ended around June 10) with laboratory-verified or clinically verified Covid-19, including patients who were admitted for multisystem inflammatory syndrome in children. Data on teachers were obtained from the Public Health Agency of Sweden. From March through June 2020, a total of 15 children with Covid-19 (including those with MIS-C) were admitted to an ICU (0.77 per 100,000 children in this age group), 4 of whom were 1 to 6 years of age (0.54 per 100,000) and 11 of whom were 7 to 16 years of age (0.90 per 100,000). Four of the children had an underlying chronic coexisting condition (cancer in 2, chronic kidney disease in 1, and hematologic disease in 1). No child with Covid-19 died. Data from the Public Health Agency of Sweden showed that fewer than 10 preschool teachers and 20 schoolteachers in Sweden received intensive care for Covid-19 up until June 30, 2020 (20 per 103,596 schoolteachers, which is equal to 19 per 100,000). As compared with other occupations (excluding health care workers), this corresponded to sex- and age-adjusted relative risks of 1.10 (95% confidence interval [CI], 0.49 to 2.49) among preschool teachers and 0.43 (95% CI, 0.28 to 0.68) among schoolteachers.

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Gilliam, W. S., Malik, A. A., Shafiq, M., Klotz, M., Reyes, C., Humphries, J. E., ... & Omer, S. B. (2021). COVID-19 transmission in US child care programs. Pediatrics, 147(1).

Summary: Central to the debate over school and child care reopening is whether children are efficient coronavirus disease 2019 (COVID-19) transmitters and are likely to increase community spread when programs reopen. We compared COVID-19 outcomes in child care providers who continued to provide direct in-person child care during the first 3 months of the US COVID-19 pandemic with outcomes in those who did not. Data were obtained from US child care providers (N = 57?335) reporting whether they had ever tested positive or been hospitalized for COVID-19 (n = 427 cases) along with their degree of exposure to child care. Background transmission rates were controlled statistically, and other demographic, programmatic, and community variables were explored as potential confounders. Logistic regression analysis was used in both unmatched and propensity score–matched case-control analyses. No association was found between exposure to child care and COVID-19 in both unmatched (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82–1.38) and matched (OR, 0.94; 95% CI, 0.73–1.21) analyses. In matched analysis, being a home-based provider (as opposed to a center-based provider) was associated with COVID-19 (OR, 1.59; 95% CI, 1.14–2.23) but revealed no interaction with exposure. Within the context of considerable infection mitigation efforts in US child care programs, exposure to child care during the early months of the US pandemic was not associated with an elevated risk for COVID-19 transmission to providers. These findings must be interpreted only within the context of background transmission rates and the considerable infection mitigation efforts implemented in child care programs.

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Bayham, J., & Fenichel, E. P. (2020). Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. The Lancet Public Health, 5(5), e271-e278.

The coronavirus disease 2019 (COVID-19) pandemic is leading to social (physical) distancing policies worldwide, including in the USA. Some of the first actions taken by governments are the closing of schools. The evidence that mandatory school closures reduce the number of cases and, ultimately, mortality comes from experience with influenza or from models that do not include the effect of school closure on the health-care labour force. The potential benefits from school closures need to be weighed against costs of health-care worker absenteeism associated with additional child-care obligations. In this study, we aimed to measure child-care obligations for US health-care workers arising from school closures when these are used as a social distancing measure. We then assessed how important the contribution of health-care workers would have to be in reducing mortality for their absenteeism due to child-care obligations to undo the benefits of school closures in reducing the number of cases. For this modelling analysis, we used data from the monthly releases of the US Current Population Survey to characterise the family structure and probable within-household child-care options of US health-care workers. We accounted for the occupation within the health-care sector, state, and household structure to identify the segments of the health-care workforce that are most exposed to child-care obligations from school closures. We used these estimates to identify the critical level at which the importance of health-care labour supply in increasing the survival probability of a patient with COVID-19 would undo the benefits of school closures and ultimately increase cumulative mortality. Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5–29·1) of the health-care workforce needing to provide care for children aged 3–12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8–15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent. School closures come with many trade-offs and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures.

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December, 2020

Kileel, EM, Rivard, C, Fitch, KV, Looby, SE. Eliciting perspectives of the key study population: An effective strategy to inform advertisement, content and usability of an online survey for a national investigation. Contemporary Clinical Trials Communications. 19 (2020) 100585.

This short communication demonstrates how conducting a focus group with members of a proposed study population of interest can help inform the suitability of study interventions and appeal of recruitment strategies prior to study commencement. People living with HIV (PLWH) were recruited to participate in a focus group to elicit feedback on the content and design of an online survey on sweetener knowledge and consumption; and usability of the survey which was ultimately launched nationally. Ten participants (age 55 years, 60% male, 70% from diverse racial and ethnic backgrounds, 60% income < $25,000) attended and rotated through three stations and completed questionnaires to evaluate survey content, advertisement imagery and taglines, and ability to access and navigate the survey platform. Participants also engaged in open dialogue to discuss potential community and web-based recruitment strategies familiar to PLWH. Findings from the focus group helped investigators identify and select advertisement and recruitment strategies that were appealing to PLWH, refine and improve clarity/layout of the survey content, and enhance usability of an online survey intended for PLWH in the United States, age 18 years and older. Prospectively engaging individuals from a key study population in the early phase of study development is an effective strategy to assist in the development of study interventions and recruitment/ advertisement materials designed for a specific population.

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Jones, R, Lacroix, LJ, Porcher, E. Facebook advertising to recruit young, urban women into an HIV prevention trial. AIDS Behavior. 2017 Nov; 21(11):3141-3153.

Advertising via Facebook to elicit involvement in clinical trials has demonstrated promise in expanding geographic reach while maintaining confidentiality. The purpose of this study is to evaluate Facebook advertising to reach at-risk, predominately African American or Black women in higher HIV prevalence communities for an HIV prevention clinical trial, and to compare baseline characteristics to those recruited on-the-ground. Maintaining confidentiality and the practical aspects of creating and posting ads on Facebook are described. The advertising strategy targeted multicultural affinities, gender, age, interest terms, and zip codes. We report on results during 205 days. A total of 516, 498 Facebook users viewed the ads an average of four times, resulting in 37,133 clicks to the study website. Compared to 495 screened on-the-ground, 940 were screened via Facebook ads, of these, half (n =477, 50.74%) were high risk, and of those at risk, 154 were randomized into the 6-month clinical trial. Black women comprised 71.60% (n=673) of the total screened online. Roughly twice as many Black women screened via Facebook compared to on-the-ground, yet, the percentage at high risk was similar. Preliminary data suggest that the extent to which ad headlines and photos tap into authentic social experience, advertising on Facebook can extend geographic reach and provide a comparative sample to women recruited on-the-ground.

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Zanni M, Fitch K, Rivard C, Sanchez L, Douglas P, Grinspoon S, Smeaton L, Currier JS, Looby SE. Follow YOUR Heart: development of an evidence-based campaign empowering older women with HIV to participate in a large-scale cardiovascular disease prevention trial. HIV Clinical Trials. 2017 Mar;18(2):83-91.

Women's under-representation in HIV and cardiovascular disease (CVD) research suggests a need for novel strategies to ensure robust representation of women in HIV-associated CVD research. To elicit perspectives on CVD research participation among a community-sample of women with or at risk for HIV, and to apply acquired insights towards the development of an evidence-based campaign empowering older women with HIV to participate in a large-scale CVD prevention trial. In a community-based setting, we surveyed 40 women with or at risk for HIV about factors which might facilitate or impede engagement in CVD research. We applied insights derived from these surveys into the development of the Follow YOUR Heart campaign, educating women about HIV-associated CVD and empowering them to learn more about a multi-site HIV-associated CVD prevention trial: REPRIEVE. Endorsed best methods for learning about a CVD research study included peer-to-peer communication (54%), provider communication (46%), and video-based communication (39%). Top endorsed non-monetary reasons for participating in research related to gaining information (63%) and helping others (47%). Top endorsed reasons for not participating related to lack of knowledge about studies (29%) and lack of request to participate (29%). Based on survey results, the REPRIEVE Follow YOUR Heart Campaign was developed. Interwoven campaign components (print materials, video, web presence) offer provider-based information/knowledge, peer-to-peer communication, and empowerment to learn more. Campaign components reflect women's self-identified motivations for research participation – education and altruism. Investigation of factors influencing women's participation in HIV-associated CVD research may be usefully applied to develop evidence-based strategies for enhancing women's enrollment in disease-specific large-scale trials. If proven efficacious, such strategies may enhance conduct of large-scale research studies across disciplines.

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November, 2020

Pandean, V., Morris, L.L., Brodsky, M.B. et al. (2020). Critical care guidance for tracheostomy care during the COVID-19 pandemic: a global, multidisciplinary approach. American Journal of Critical Care, 29, e1-e12. Doi:

Abstract: Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of 2019 coronavirus (COVID-19) for respiratory/mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers (HCP) during COVID-19 pandemic.

Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A team analyzed and prioritized findings to develop recommendations. Aerosol-generating procedures are commonly performed by nurses and other HCP, such as suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Viral testing of bronchial aspirate via tracheostomy may inform HCP when determining the protective equipment required.

Use of standard personal protective equipment that includes an N95/FFP3 mask with/without surgical mask, gloves, goggles, and gown are required when performing aerosol-generating procedures for patients with or at risk for COVID-19. The need for protocols to reduce risk of transmission of infection to nurses and HCP is evident. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of transmission of COVID-19.

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Harris, C.A., Evans, H.L., Telem, D.A. (2020). A practical decontamination framework for COVID-19 front-line workers returning home. Annals of Surgery, 272, e129-e131. DOI: 10.1097/SLA.0000000000003990

Abstract: Virus transmission is a concern for front-line healthcare workers and these workers are grappling with how to best limit the spread to their families. The purpose of this article is to synthesize scientific evidence, agency guidelines, and best practices to create framework for healthcare workers returning to their home.

Discussed in this are viral transmission on surfaces, porous materials, and environmental variation and the best solutions for cleaning these surfaces. A home to work checklist encompassing CDC and WHO website guidance, is provided that address precautions to take during work hours, transit to home, home arrival, and maintenance.

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Blake, J.W.C., Giuliano, K.K. (2020). Flow accuracy of IV smart pumps outside of patient rooms during COVID-19, AACN Advanced Critical Care, e1-e7. DOI:

Abstract: With the highly contagious COVID-19 in the acute care setting, front-line clinicians have implemented practice changes to address patient care awhile simultaneously reducing personal exposure risk to COVID-19. Because infusion (IV) pumps cannot be controlled without direct device interactions, the use of longer-than-usual extension tubing allows for placement and operation of IV pumps outside the patient’s room and is permitted by the FDA during this pandemic.

Most commonly used IV pumps (ie Baxter Sigma) are peristaltic pumps that use rollers to propel fluid forward. This article discusses the impact of longer-than-usual extension tubing on flow rate and flow rate accuracy in the form of decrease intake pressure and increase output pressure. Troubling is that the IV pump will continue to display the intended flow rate making errors difficult to detect. The significant increase in tubing dead volume increases priming rates, and elevation of risk for air in line and medication adhering to longer length of tubing making medications doses under infused.

A discussion of clinical implications, ways to mitigate effects and dosing considerations. Nurses can take steps to decrease risk of flow inaccuracies and other complications to support safe remote IV pump medication administration.

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October, 2020

Thurman, W. A., Johnson, K. E., & Sumpter, D. F. (2019). Words Matter: An Integrative Review of Institutionalized Racism in Nursing Literature. Advances in Nursing Science, 42(2), 89-108.

Summary: In health care, as in society, racism operates on multiple levels and contributes greatly to health and social inequities experienced by black Americans. In addressing racism, however, health care has primarily focused on interpersonal racism rather than institutionalized forms of racism that are deeply entrenched and contribute to racial inequities in health. In order to meaningfully address health inequities, health care must extend its focus beyond the interpersonal level. The purpose of this integrative literature review is to identify how and to what extent peer-reviewed nursing literature and professional nursing organizations have explicitly addressed institutionalized racism. A systematic search of relevant nursing literature published since 2008 yielded 29 journal articles that focused on black Americans’ experience of institutionalized racism in health and health care; the articles explicitly named racism as institutionalized, institutional, systemic, systematic, or structural. This review summarizes author-identified implications of institutionalized racism for nursing education, research, and practice, and offers suggestions for use by the nursing profession to dismantle racist policies, practices, and structures.

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Cottingham, M. D., Johnson, A. H., & Erickson, R. J. (2018). “I can never be too comfortable”: Race, gender, and emotion at the hospital bedside. Qualitative Health Research, 28(1), 145-158.

In this article, we examine how race and gender shape nurses’ emotion practice. Based on audio diaries collected from 48 nurses within two Midwestern hospital systems in the United States, we illustrate the disproportionate emotional labor that emerges among women nurses of color in the white institutional space of American health care. In this environment, women of color experience an emotional double shift as a result of negotiating patient, coworker, and supervisor interactions. In confronting racist encounters, nurses of color in our sample experience additional job-related stress, must perform disproportionate amounts of emotional labor, and experience depleted emotional resources that negatively influence patient care. Methodologically, the study extends prior research by using audio diaries collected from a racially diverse sample to capture emotion as a situationally emergent and complex feature of nursing practice. We also extend research on nursing by tracing both the sources and consequences of unequal emotion practices for nurse well-being and patient care.

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Koschmann, K. S., Jeffers, N. K., & Heidari, O. (2020). “I can't breathe”: A call for antiracist nursing practice. Nursing outlook.

Summary: The killing of George Floyd by a police officer in Minneapolis, Minnesota during the Coronavirus disease 2019 pandemic brought the effects of structural racism on Black Americans into focus. Black Americans are dying from Coronavirus disease 2019 at a higher rate, and are also more likely to be the victims of police killings. Nurses are in a unique and powerful position to confront structural racism, but doing so requires taking on an antiracist approach to nursing practice. This call to action offers a starting place for all nurses.

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Weitzel, J., Luebke, J., Wesp, L., Graf, M. D. C., Ruiz, A., Dressel, A., & Mkandawire-Valhmu, L. (2020). The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time. Advances in Nursing Science, 43(2), 102-113.

Summary: The remnants of colonialism manifesting as structural violence, racism, and oppression continue to plague our society as evidenced by the persistence of health inequities, particularly for minority populations in the United States. As a profession bound by moral and ethical mandates, nursing must resist and deconstruct oppression in all its forms. Nurses, informed by critical race theory, intersectionality, and historical trauma, can become formidable allies with marginalized populations in the fight for social justice and health equity.

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August 31st, 2020

American Nurses Association (2020). Revised position statement on immunizations, Adopted: ANA Board of Directors, ANA July, 2020. Nursing Practice & Work Environment Department and LT. Steven G. Pochop, Jr. ANA members. This position statement supersedes the Position Statement on Immunizations, July 21, 2015. 8515 Georgia Avenue, Suite 400 Silver Spring, MD 20910

Summary: Historically, the American Nurses Association (ANA) has strongly supported immunizations to protect the public from highly communicable and deadly diseases such as measles, mumps, diphtheria, pertussis, and influenza (ANA, 2019; ANA, 2015; ANA, 2006), and has supported mandatory vaccination policies for registered nurses and health care workers under certain circumstances. Considering several recent and significant measles outbreaks in the United States, as well as the global pandemic of COVID-19, ANA has reviewed our current position statement for clarity and intent and examined present best practices and recommendations from the broader health care community. Based on that review and the recommendation of ANA’s 2019 Membership Assembly, a revised and updated position statement was developed to clarify ANA’s position and incorporate current best practices (CDC, 2019a).

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Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., Srouji, S. & Sela, E. (2020) Vaccine hesitancy: the next challenge in the fight against COVID19. European J journal Epidemiology (Aug 12, 2020).

Summary: Vaccine hesitancy remains a barrier to full population inoculation against highly infectious diseases. Coincident with the rapid developments of COVID-19 vaccines globally, concerns about the safety of such a vaccine could contribute to vaccine hesitancy. We analyzed 1941 anonymous questionnaires completed by healthcare workers and members of the general Israeli population, regarding acceptance of a potential COVID-19 vaccine. Our results indicate that healthcare staff involved in the care of COVID-19 positive patients, and individuals considering themselves at risk of disease, were more likely to self-report acquiescence to COVID-19 vaccination if and when available. In contrast, parents, nurses, and medical workers not caring for SARS-CoV-2 positive patients expressed higher levels of vaccine hesitancy. Interventional educational campaigns targeted towards populations at risk of vaccine hesitancy are therefore urgently needed to combat misinformation and avoid low inoculation rates.

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International Nurses Association (ICN) (e2020). The Role of Nurses in Immunisation: A snapshot from OECD countries. ICN, CIE, CII 3, place Jean-Marteau, 1201 Geneva - Switzerland - Tel.: +41 22 908 01 00 Fax: +41 22 908 01 01 - e-mail: - web:

Summary: In collaboration with the National Nursing Associations (NNA), 15 of the 36 OECD (Office of Economic Cooperation and Development) countries were invited to participate in a survey to determine the current state of nursing’s involvement in immunization in their countries, fifteen countries responded. The survey consisted of five key areas reflecting: 1) nursing’s overall role in, and preparation for immunization interventions; 2) prescribing immunization; 3) administering vaccination; 4) activities related to expanding nursing’s role in immunization; and 5) respondent information. In addition, further analysis was carried out to determine the degree of nurse immunization role engagement by country. The report provides in-depth data analysis on survey results and recommendations for use by nurses, globally.

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Pless, A., McLennan, S. R., Nicca, D., Shaw, D.M. and Elger, B.E. (2017). Reasons why nurses decline influenza vaccination: A qualitative study. BMC Nursing (2017) 16:20. DOI 10.1186/s12912-017-0215-5

Summary: The study explored reasons of non-vaccinated nursing staff for declining seasonal influenza vaccination. The annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients. Still, vaccination rates remain very low, particularly in nursing staff. While several studies have explored barriers for healthcare workers to get vaccinated, most have used a quantitative approach. Data were collected by in-depth individual semi-structured interviews with 18 nurses from a range of fields, positions in organizational hierarchy, work experience and hospitals in two German-speaking cantons in Switzerland. Interviews were transcribed and analyzed using conventional content analysis. Results: Three interconnected themes explaining why nurses decline influenza vaccination were identified: Firstly, the idea of maintaining a strong and healthy body, which was a central motif for rejecting the vaccine. Secondly, the wish to maintain decisional autonomy - especially over one's body and health. Thirdly, nurses' perception of being surrounded by an untrustworthy environment, which restricts their autonomy and seemingly is in opposition to their goal of maintaining a strong and healthy body. Conclusion: Nurses tend to rely on conventional health beliefs rather than evidence based medicine when making their decision to decline influenza vaccination. Interventions to increase influenza vaccination should be tailored specifically for nurses. Empowering nurses by promoting decision-making skills and by strengthening their appraisal may be important factors to consider when planning future interventions to improve vaccination rates. The teaching of evidence-based decision-making should be integrated on different levels, including nurses' training curricula, their workspace and further education.

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June 25, 2020

Aubley, C. Why healthcare systems need scalable remote visibility, security and remediation. HIMSS, 2020

Summary: The pandemic has forced hospitals and healthcare systems to turn themselves inside out in response to the unprecedented surge in demand. Practically overnight, healthcare providers have launched field hospitals to expand capacity, established drive-through test centers and begun treating less critical patients via telemedicine and virtual examinations. At the same time, these organizations are trying to ensure business continuity while protecting the health of their employees — resulting in a sudden, unplanned transition from primarily on-premises work to primarily a remote workforce.

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Gorman, J. Public Health Experts Reject President’s View of Fading Pandemic, New Your Times June 21 , 2020

Summary: Public health experts warned on Sunday that the coronavirus pandemic is not going away anytime soon. They directly contradicted President Trump’s promise that the disease that has infected more than two million Americans would “fade away” and his remarks that disparaged the value of evidence from coronavirus tests. A day after Mr. Trump told a largely maskless audience at an indoor rally in Tulsa, Okla., that he had asked to “slow down the testing” because it inevitably increased the number of confirmed coronavirus cases, infectious disease experts countered that he latest rise of infections in the United States is real.

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Quan-Xin L., Xiao-Jun, T., Qiu-Lin. S, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Clinical Medicine. https://doi

Summary: As of May 24, 2020, the coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, has affected more than 5 million people around the world. Most patients with SARS-CoV-2 infec- tions have reportedly had mild to severe respiratory illness with symptoms such as fever, cough and shortness of breath, which might appear 2–14 d after exposure. However, there are other patients who are diagnosed by a positive RT–PCR test but are either asymptom- atic or minimally symptomatic2–6. Increasing evidence has shown that asymptomatic individuals can spread the virus efficiently, and the emergence of these silent spreaders of SARS-CoV-2 has caused difficulties in the control of the epidemic. However, our understanding of the clinical features and immune responses of asymptomatic individuals with SARS-CoV-2 infection is limited. Here we describe the epidemiological and clinical characteristics, virus levels and immune responses in 37 asymptomatic individuals.IH

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Mullin M. MGH Emotional rollercoaster of providing COVID-19 care. American Nurse June 8, 2020

Summary: The COVID-19 pandemic is responsible for a variety of emotions, including fear, anxiety, anger, sadness, despair, and grief. But as a member of a nurse educator team for three pop-up “surge” ICUs, I feel those six emotions don’t even begin to explain what we have seen our team experience every day. The fear, anxiety, and anger are always first. These three ICUs were created by taking nurses from the post-anesthesia care unit, endoscopy, interventional radiology, cardiac cath lab, same day surgery, Mass Eye and Ear Institute, North Shore Medical Center, and anesthesia. The last time most of these nurses worked in an ICU or ED was anywhere from 3 months to 22 years ago. record (EHR) platform, which differs from that used in their “normal” nursing worlds. So yes, I see lots of fear, anxiety, and anger in their eyes, words, and actions in the beginning…and it’s understandable.

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National Institutes of Health. Expert U.S. panel develops NIH treatment guidelines for COVID-19. NIH. April 21, 2020

Summary: A panel of U.S. physicians, statisticians, and other experts has developed treatment guidelines for coronavirus disease 2019 (COVID-19). These guidelines, intended for healthcare providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are frontline clinicians caring for patients during the rapidly evolving pandemic. The guidelines are posted online ( and will be updated often as new data are published in peer-reviewed scientific literature and other authoritative information emerges.

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Stevis-Gridneff, M. E.U. may bar American travelers as it reopens borders, citing failures on virus. New York Times, June 23, 2020 Updated 4:23 p.m. ET

Summary: Based on how countries of origin are faring with new coronavirus cases. Americans, so far, are excluded, according to draft lists seen by The New York Times. European Union countries rushing to revive their economies and reopen their borders after months of coronavirus restrictions are prepared to block Americans from entering because the United States has failed to control the scourge, according to draft lists of acceptable travelers seen by The New York Times.

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June 18, 2020

Chen, Shu-Ching1; LAI, Yeur-Hur2; TSAY, Shiow-Luan3* Nursing perspectives on the impacts of COVID-19. Journal of Nursing Research: June 2020 - Volume 28 - Issue 3 - p e85 doi: 10.1097/NRJ.0000000000000389

Summary: The outbreak of the coronavirus disease (COVID-19) was first reported in Wuhan, China, in December 2019 (Chen, Zhou, et al., 2020; Wang, Hu, et al., 2020). It has since spread rapidly across China, Asia, the Middle East, Europe, North America, and other parts of the world ( There have been 3,579,479 confirmed cases and 248,445 confirmed deaths globally (latest update: May 4, 2020, Central European Time 10:00, World Health Organization). COVID-19 was declared a public health emergency of international concern on January 30, 2020 (World Health Organization, 2020) and is now a pandemic. The article describes the Characteristics , transmission and spread of the virus into a global pandemic and the impact of the illness on nursing research.

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Fallon, A., Dukelow, T., Kennelly, S.P. and O’Neill, D. COMMENTARY: COVID-19 in nursing homes. QJM: An International Journal of Medicine, 2020, 391–392 doi: 10.1093/qjmed/hcaa136, Advance Access Publication Date: 20 April 2020 From the Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin

Summary: One of the tragic legacies of Hurricane Katrina in public consciousness was the disproportionate loss of life among older nursing home residents. Given the similar lack of preparation and reserves in the nursing home sector in the course of many other natural disasters, the coronavirus disease 2019 (COVID-19) pandemic poses urgent questions as to whether healthcare systems and professionals have learned from these experiences. Older age and the presence of comorbidities are associated with increased risk of mortality in the current pandemic. The high prevalence of functional and cognitive impairment and behavioural symptoms add to the risk posed to nursing home residents, as well as environments which present barriers to infection control. In addition, healthcare professionals globally of all hues have neglected research, recruitment incentivization and quality improvement in nursing home care relative to other areas of clinical practice. This is further reflected by evidence of variable and often inadequate preparation for pandemics in the sector, as well as the absence of infection control from descriptions of the competencies of nurses in care homes. The authors support Early, collaborative advanced care planning, more formalized leadership and governance, and provision of education and support for residents and staff is essential.

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Hopkins, C., Surda, P., Whitehead, E., and Kumar, B., N. Early recovery following new onset anosmia during the COVID-19 pandemic –an observational cohort study Otolaryngology - Head and Neck Surgery (2020) 49:26,

Abstract: A rapidly evolving evidence suggests that smell and taste disturbance are common symptoms in COVID-19 infection. As yet there are no reports on duration and recovery rates. We set out to characterize patients reporting new onset smell and taste disturbance during the COVID-19 pandemic and report on early recovery rates. Methods: Online Survey of patients reporting self-diagnosed new onset smell and taste disturbance during the COVID-19 pandemic, with 1-week follow-up.

Results: Three hundred eighty-two patents completed bot an initial and follow-up survey. 86.4% reported complete anosmia and a further 11.5% a very severe loss of smell at the time of completing the first survey. At follow-up 1 week later, there is already significant improvement in self-rating of severity of olfactory loss. 80.1% report lower severity scores at follow-up, 17.6% are unchanged and 1.9% are worse. 11.5% already report compete resolution at follow up, while 17.3% report persistent complete loss of smell, with reported duration being 1 to over 4 weeks. This is reflected. In the overall cumulative improvement rate of 79% patients overall in the interval between surveys.

Conclusions: A review of the growing evidence base supports the likelihood that out cohort have suffered olfactory loss as part of COVID-19 infection. While early recovery rates are encouraging, long-term rates will need to be further investigated and there may be an increase in patients with persistent post-viral loss as a result of the pandemic. We further call for loss of sense of smell to be formerly recognized as a marker of COVID-19 infection.

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Marhione, M. Cheap drug is first shown to improve COVID-19 survival. The Associated Press, 6/15/20 AP medical writer Maria Cheng contributed reporting from London.

Summary: Researchers in England say they have the first evidence that a drug can improve COVID-19 survival: A cheap, widely available steroid reduced deaths by up to one third in severely ill hospitalized patients. The results were announced Tuesday and the British government immediately authorized the drug’s use across the United Kingdom for coronavirus patients like those who did well in the study. Researchers said they would publish results soon in a medical journal, and several independent experts said it’s important to see details to know how much of a difference the drug, dexamethasone, might make and for whom.

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Masson, G. Bean, M. Common steroid cuts COVID-19 deaths 35%; virus 12 times more deadly with underlying conditions — 6 updates. Becker Hospital Report, t.6-16 20

Summary: Patients with underlying health issues are 12 times more likely to die from COVID-19, according to the CDC's Morbidity and Mortality Weekly Report released June 15. The CDC examined data on more than 1.7 million COVID-19 cases and 103,700 related deaths reported by state and local health departments between Jan. 22 and May 30.Hospitalizations were six times higher for people with underlying health conditions, the most common being heart disease, diabetes and chronic lung disease. Five other COVID 19 updates provided within this document.

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June 11, 2020

Beusekom, M.V. Studies yield clearer picture of rare COVID-linked syndrome in kids. Center for Infectious Disease Research and Policy News, Jun 05, 2020

Summary: In a rapid communication published yesterday in Eurosurveillance, French researchers report 108 confirmed, probable, or possible cases of a rare multisystem inflammatory syndrome reported around the world in children with COVID-19. And a separate small prospective observational study published this week in BMJ suggests that the syndrome, called pediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS), is most common in those of African ancestry.

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Tanmoy, L., Kutscher, E. J. Routine physical exam? A long-standing staple of conventional medical practice looks increasingly outdated. Scientific America, June 5, 2020.

Tanmoy, L., Kutscher, E. J. Routine physical e xam? A long-standing staple of conventional medical practice looks increasingly outdated. Scientific America, June 5, 2020.

Summary: A physical exam during a doctor’s appointment is a familiar ritual. After taking a history of the patient’s symptoms, if any; checking off medication lists; and asking about social habits, among other things, the doctor will step away from the computer screen to perform this time-honored task. It leverages the powers of observation, palpation, percussion and auscultation (that is, listening to the body through a stethoscope) to understand the patient more fully. As an added benefit, it also touch. What many people may not realize, however, is that the physical has been on the decline for nearly two decades—with some referring to it as a “dying art.” Doctors have instead become increasingly reliant on blood tests and imaging technologies to diagnose and treat. Although many reasons exist for this change in medical practice, one of the biggest drivers is the time pressure imposed by insurance companies to keep exams brief. It is further exacerbated by bureaucratic strictures such as “efficiency and productivity reports” that track visit lengths and ding doctors for going over time. The advent of cutting-edge technology has also opened a wealth of visualization capabilities that can reveal problems that are invisible to the naked eye. This could be why there appears to be a generational decline in physical exam skills.

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Wan, W., Berger, M. Are asymptomatic people spreading the coronavirus? A WHO official’s words spark confusion, debate. The Washington Post, June 9, 2020

Summary: The World Health Organization moved Tuesday to clarify its position on whether people without symptoms are widely spreading the new coronavirus, saying much remains unknown about asymptomatic transmission. A comment by a WHO official on Monday — calling such asymptomatic transmissions “very rare” — touched off a furious scientific debate over the unresolved question and attracted widespread criticism of the organization. Less than 24 hours later, WHO convened a special news conference to walk back its comments, stressing that much remains unknown. But the comment from Monday had already spread widely and been seized upon by conservatives and others to bolster arguments that people do not need to wear masks or maintain social distancing precautions.

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Yager, P., Whalen, K., Cummings, B. Repurposing a pediatric ICU for adults. NEJM May 15, 2020, at MassGeneral Hospital for Children, Boston, MA.

Summary: Massachusetts quickly followed New York in becoming an epicenter of the Covid-19 pandemic, but just a handful of infected children required hospitalization. On April 2, 2020, the Massachusetts General Hospital incident command team determined that no pediatric patients at MassGeneral Hospital for Children (MGHfC), a hospital within a hospital, would use a ventilator, given the presence of other facilities where critically ill children could receive care and a greater need among adult patients. We transformed our 14-bed pediatric intensive care unit (PICU), transferring out the remaining two children and admitting adults within 72 hours. This rapid pivot to providing adult care required cooperation between institutions to regionalize pediatric critical care, difficult discussions with families, and intensive coordination of hospital services.

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Chou, R., Dana, T., Buckley, D. L., Selph, S. Epidemiology of and risk factors for coronavirus infection in health Care workers: A living rapid review on 5 May 2020,

Abstract: Health care workers (HCWs) are at risk for severe acute respiratory syndrome-coronavirus (SARS-CoV-2) infection. Purpose: To examine the burden of SARS-CoV-2, SARS-CoV-1, and Middle Eastern respiratory syndrome (MERS)-CoV on HCWs and risk factors for infection, using rapid and living review methods. Multiple electronic databases including the WHO Database of Publications on Coronavirus Disease and medRxiv preprint server (2003 through 27 March 2020, with ongoing surveillance through 24 April 2020), and reference lists.

Data Synthesis: 64 studies met inclusion criteria; 43 studies addressed burden of HCW infections (15 on SARS-CoV-2), and 34 studies addressed risk factors (3 on SARS-CoV-2). Health care workers accounted for a significant proportion of coronavirus infections and may experience particularly high infection incidence after unprotected exposures. Illness severity was lower than in non-HCWs. Depression, anxiety, and psychological distress were common in HCWs during the coronavirus disease 2019 outbreak. The strongest evidence on risk factors was on PPE use and decreased infection risk. The association was most consistent for masks but was also observed for gloves, gowns, eye protection, and handwashing; evidence suggested a dose–response relationship. No study evaluated PPE reuse. Certain exposures (such as involvement in intubations, direct patient contact, or contact with bodily secretions) were associated with increased infection risk. Infection control training was associated with decreased risk.

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June 4, 2020

Haskell, B., Schroer, M. and Zsamboky, M. Easing the psychological impact of COVID-19 for nurses. American Nurse. April 13, 2020

ABSTRACT: Nurses are at the forefront of the coronavirus disease 2019 (COVID-19) pandemic, providing life-saving care for affected patients. Psychological distress can be significant for nurses and other healthcare workers who provide direct care for these patients. To best support nurses, understanding the psychological effects of COVID-19 on them, the impact of secondary traumatic stress (STS), and ways to manage these effects during this stressful time is important.

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Jin, J-M., Bai, P., He, W., Liu, X-F. , Han, D-M., Yang, J-K. Gender differences in patients with COVID-19: Focus on severity and mortality. ORIGINAL RESEARCH. Front. Public Health, 29 April 2020 |

ABSTRACT: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Researchers extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003.

Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women’s (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.

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Masson, G. Racial disparities & COVID-19: Why it matters in healthcare. June 1, 2020, Becker Hospitals

ABSTRACT: Racial disparities in the U.S. affect every aspect of life, including healthcare. Amid the COVID-19 pandemic, individuals of color have been disproportionately affected by the virus. The article identifies eight key findings revealing the connection between race and healthcare. These include a) people of color have been disproportionately affected by COVID-19, b) COVID-19 infection, hospitalization and death rates within communities of color, c) racial injustice affects every aspect of life.

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Prime, H., Wade, M., & Browne, D. T Risk and resilience in family well-being during the COVID-19 pandemic. May 21, 2020. American Psychologist. Advance online publication.

ABSTRACT: The COVID-19 pandemic poses an acute threat to the well-being of children and families due to challenges related to social disruption such as financial insecurity, caregiving burden, and confinement-related stress (e.g., crowding, changes to structure, and routine). The consequences of these difficulties are likely to be longstanding, in part because of the ways in which contextual risk permeates the structures and processes of family systems. The current article draws from pertinent literature across topic areas of acute crises and long-term, cumulative risk to illustrate the multitude of ways in which the well-being of children and families may be at risk during COVID-19. The presented conceptual framework is based on systemic models of human development and family functioning and links social disruption due to COVID-19 to child adjustment through a cascading process involving caregiver well-being and family processes (i.e., organization, communication, and beliefs). An illustration of the centrality of family processes in buffering against risk in the context of COVID-19, as well as promoting resilience through shared family beliefs and close relationships, is provided. Finally, clinical and research implications are discussed.

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Resnick, S.G., Roe, D., Salyers, M.P. Rehabilitation and COVID19. Psychiatric Rehabilitation Journal in the Era of COVID-19 Editorial

SUMMARY: The global health crisis caused by the coronavirus pandemic (COVID-19) has brought about previously unimaginable changes to all of health care, including the field of psychiatric rehabilitation. Given these dramatic changes, the authors aise questions about how psychiatric rehabilitation will evolve and restate our steadfast commitment to publishing impactful research that shapes the field. The authors remain hopeful, knowing psychiatric rehabilitation practitioners, researchers, and participants are pragmatic, persistent, and resilient, and will find opportunities for creativity and innovation even during this difficult time.

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Scoloveno, R. Resilience and Self-Efficacy: An integrated review of the literature. Human Journals. Mar 2018, Vol 9 Issue 1

ABSTRACT: Resilience is the ability of individuals, families, and groups to successfully function despite significant life difficulties (Werner and Smith, 1982; Rutter, 1987; Brown, 2008). Resilience is also different from recovery. The term recovery connotes a trajectory where normal functioning gives way to a sub-threshold functioning and gradually returns to pre-event Levels. The purpose of this paper is to discuss the relevant theories that relate to the construct of resilience, conduct an integrative review of the empiric literature, and describe the state of the science, including gaps in the literature. The following online databases were searched for publications conducted between the years of 1970 to the present: Index Medicus (Medline); Cumulative Index to Nursing and Allied Health Literature (CINHAL0, and Psychological Information (PSYCH-INFO). While there is the extensive focus on children and adolescents in the resilience literature, there are relatively few studies investigating resilience among adults and older adults. Furthermore, the majority of research has its focus on individuals rather than on families, groups, and communities. There is also a lack of comparative studies between resilient children and adults, various cultural groups, and individuals of diverse socioeconomic levels. Nursing research in this area will contribute to theory development and nursing interventions for individuals facing adversities along the developmental continuum.

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May 28, 2020

Babbs, G. Caring for immigrant health. Public Health Post, May 18, 2020

Summary: More than 13 million disabled and older Americans rely on home health aides to address their basic needs. Home health aides help their clients with the tasks of daily living, like eating and showering, as well as clinical tasks, like taking blood pressure and leading physical therapy exercises. As the population gets a little older and a little sicker each year, disabled and older Americans rely more and more on home health aides. Up to 90% of older Americans want to age at home, and home health aides help them to do so. In the next 10 years, demand for direct care workers is anticipated to rise 34%, making it country. A recent study by Leah Zallman and colleagues examined the nativity status of direct care workers. In this study, direct care workers were people who worked in roles like nurses, nursing assistants, and home health aides.

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Banskota, S., Healey M., and Goldberg, E.M. 15 Smartphone apps for older adults to use while in isolation during the COVID-19 pandemic west, J Emerg Med., 2020 May; 21(3): 514–525. Published online 2020 Apr 14. doi: 10.5811/westjem.2020.4.47372 Author information Article notes Copyright and License information Disclaimer

Abstract: In January 2020, the first case of coronavirus disease 2019 (COVID-19) was identified in the United States. Shortly thereafter, visitation restrictions and guidance to reduce contact with older adults (OA), = age 65, were put in place at many facilities caring for OAs with the aim to protect them from infection.1–3 According to the World Health Organization, the case fatality rate for COVID-19 in older adults in China 80 years and older was 21.9% compared to 1.4% for people of all ages with no underlying health conditions.4 However, as many state and civic leaders are now debating lockdowns many OAs may lack the assistance they need at home or in facilities to meet their daily needs. Self-imposed and/or institution-imposed social distancing could make OAs feel isolated, anxious, and sorrowful over their loss of independence and connections to friends and family. OAs = age 65 are increasingly using mobile technologies (MT) for healthcare purposes.5 MTs such as applications (app) could help OAs stay connected to friends and family, remain active, and access resources to address their daily nutritional, physical, and mental health needs. Therefore, MTs and apps can be useful to OAs by limiting their need to leave their residences, and risk exposure to COVID-19 by helping them remain in contact with loved ones, have access to meal delivery services, electronic access to healthcare providers to see to their chronic health conditions, and physical and cognitive impairment aids.

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Bradberry, T. How successful people beat stress and avoid burnout, Talent Smart, May 2020

Summary: In times of extreme change, like we’ve faced the last couple of months, negative emotions begin to multiply and intensify. Emotions like anxiety, fear, and frustration can even begin to feel baked into our everyday lives. A recent survey of American workers during COVID-19 reported the following:, –70% of employees say that COVID-19 is the most stressful time ever in their working career, –88% of employees say they’re experiencing moderate stress or worse –62% of stressed employees say they lose at least an hour of productivity per day

When stress and negative emotions begin to take over on a daily basis, burnout waits just around the corner. Burnout saps confidence, positivity, and energy. It kills productivity and creativity, and it has been linked to serious, long-term emotional and physical health issues. According to a SHRM survey, burnout is also one of the top reasons people leave jobs.

The interesting thing about burnout is that even though all people experience stress and negative emotions, not everyone burns out in response. It is possible to navigate high stakes, long hours, and looming disasters in a way that protects you from emotional capsizing. The article focuses on Emotional intelligence and its ability to recognize and understand emotions in yourself and others, and your ability to use this awareness to manage your behavior and relationships. EQ is made up of four core skills, and each one plays a critical role in stress management.

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Gregg S. Meyer, G., Blanchfield, B.B., Bohmer, R. M. J., Mountford, J., and Vanderwagen, W.C. Alternative care sites for the Covid-19 pandemic: The early U.S. and U.K. experience. NEJM, May 22, 2020

Summary: Alternative care sites (ACS) are providing essential capacity to cope with the demands of the Covid-19 pandemic. There are several different approaches, outlined by the Federal Emergency Management Agency (FEMA), and each can be effective depending on the specific needs of a particular location. Early experience with these facilities in the U.S. and the U.K. have yielded valuable lessons about how to structure and operate them most effectively, and about how to integrate them with overall health care services in a region. As the global Covid-19 pandemic evolved, several countries faced a surge of acute and critically ill patients but had limited resources of space, staff, and stuff. One response has been the establishment of Alternate Care Sites (ACS), an approach that had been utilized previously (e.g., Ebola in West Africa). ACSs offered an opportunity to address potential capacity and capability gaps in healthcare systems during the Covid-19 pandemic. ACSs are defined in the U.S. by FEMA and the Centers for Disease Control as “structures of opportunity to provide a safe and comfortable setting where patients can be isolated and monitored during the Covid-19 pandemic.”2 Both the U.S. and the U.K. have established ACSs and here we explore the various care models employed, discuss the strengths and weaknesses of differing approaches, and explore the lessons to be learned from the early experience of these facilities.

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Yetmar, Z.A., Issa, M. , Munawar, S. ,Caroline Burton, M. C., Pureza, V., M., Sohail, R., Mehmood, T. Mayo Clinic College of Medicine and Science, Rochester, Minn. Inpatient care of patients with COVID-19: A Guide for Hospitalists. Am J of Med, (2020) 000:1-6. _ 2020 Elsevier Inc. All rights reserved.

Abstract: Since its emergence in December 2019, the virus known as severe acute respiratory syndrome coronavirus2 has quickly caused a pandemic. This virus causes a disease now known as coronavirus disease 2019, orCOVID-19. As an increasing proportion of the at-risk population becomes infected, and patients with severe illness are hospitalized, it is essential for hospitalists to remain current on how to best care for people with suspected or confirmed disease. Establishing a system for logistical planning, and accurate information sharing is strongly recommended. Infection control remains the ultimate goal. As such, health care workers should be educated on universal and isolation precautions, and the appropriate use of personal protective equipment. Social distancing should be encouraged to prevent the spread of infection, and creative and innovative ways to reduce contact may need to be considered. Moreover, it is imperative to prepare for contingencies as medical staff will inevitably get sick or become unavailable. Hospitalists have the difficult task of caring for patients while also adapting to the many logistical and social elements of a pandemic.

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Zamanian, R.T., Pollack, C.V., Gentile, M.A., Rashid, M., Christian Fox, J., Mahaffey, K.W., MD1,7, De Jesus Perez, V. Outpatient inhaled nitric oxide in a patient with vasoreactive IPAH and COVID-19 infection. Published May 2020, Descriptor Number: 9.34 Pulmonary Hypertension: Clinical Treatment

Summary: This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 ( For commercial usage and reprints, please contact Diane Gern (

Summary: Infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of respiratory illness COVID-19, is associated with significant pulmonary morbidity and acute respiratory distress syndrome (ARDS)-like illness (1). The unprecedented global COVID-19 pandemic is affecting the wellbeing of vulnerable patients, particularly the elderly and those with underlying cardiopulmonary diseases (2). As no specific anti-viral therapy is currently approved for COVID-19, treatment is supportive (at times intensive) and has severely stretched global hospital staffing and equipment capacity. Here we report on an outpatient management of a patient (Case Study) with concomitant idiopathic pulmonary arterial hypertension (iPAH) and COVID-19 disease using inhaled nitric oxide (iNO).

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May 20, 2020

Aghjayan, R. Combating COVID-19: Best Practices that clinicians need to now. Clinical Advisor: Infectious Diseases Information Center. March 13, 2020

As the number of global cases of coronavirus disease 2019 (COVID-19) rises, it is imperative that healthcare providers stay informed and prepared with the best clinical practices to combat the SARS-CoV-2 virus. Following appropriate guidelines and practicing proper technique will benefit both patients and clinicians and better prevent the further spread of the virus. It has been established that the virus mostly spreads from person to person via close contact or respiratory droplets. The Centers for Disease Control and Prevention (CDC) defines close contact with a patient with COVID-19 as being within 6 feet for an extended period of time or having direct contact with the patient’s bodily fluids (i.e., sputum, blood, respiratory droplets). 1 When treating patients in such close proximity, it is especially important to use personal protective equipment (PPE), which can help to reduce the risk of acquiring the virus.

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Falvey, J. R. Ferrante, L. E. Flatten- ing the disability curve: Rehabilitation and recovery after COVID-19 Infection, Heart & Lung (2020), doi:

Summary: The coronavirus-19 (COVID-19) pandemic has led to a surge of hospitalizations, many of which have required prolonged intensive care unit (ICU) stays and mechanical ventilation. ICU survivors, especially those who are mechanically ventilated, often suffer from new or worsening impairments in physical function, cognitive function, and/or emotional health collectively known as post-intensive care syndrome (PICS). These deficits may persist for months or years after a critical illness, and have substantial impact on outcomes important to patients such as quality of life, return to work, and disability in activities of daily living such as bathing or walking. The Awakening and Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle is critical to reducing the adverse consequences of critical illness. The early exercise and mobility component of this bundle is especially important in ameliorating the negative impact of ICU stays on physical function. Movement is medicine for patients in the ICU, and being unable to provide this critical treatment for vulnerable patients is likely to negatively impact recovery.

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Milligan, S. Acting with empathy during COVID-19. Becker Hospital Review, March 30b, 2020

Summary: Fear, frustration, panic, anger, confusion … we have all been dealing with these emotions (and many others) during the COVID-19 pandemic. The amount of media attention, whether social media or news media, keeps these emotions at or near the surface seemingly all the time. Our way of life has been impacted in ways we never anticipated or imagined. As a result of these significant disruptions, it is crucial for all of us to demonstrate empathy in each and every encounter — for our patients, our coworkers and ourselves.

Before sharing insight on acting with empathy for patients, co-workers and yourself, I want to make one thing clear: I am amazed at the courage of our teams. If courage is not the absence of fear, but the willingness to act despite the fear, then how could I use any other term to describe our teams? All over the country, our associates have faced these circumstances with poise and professionalism, and I will always remember that we acted courageously and were leaders in selfless acts, despite the fear and anxiety we are experiencing ourselves.

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Mooney, C., Dennis, B., Muyskens, J. Global emissions plunged an unprecedented 17 percent during the coronavirus pandemic. Washington Post, May 19 2020

Summary: This article reflects how recent changes in daily living have had a dramatic impact on the environment. The wave of shutdowns and shuttered economies caused by the coronavirus pandemic fueled a momentous decline in global greenhouse gas emissions, although one unlikely to last, a group of scientists reported Tuesday. As infections surged in March and April, nations worldwide experienced an abrupt reduction in driving, flying and industrial output, leading to a startling decline of more than 1 billion tons of carbon dioxide emissions. That includes a peak drop in daily emissions of 17 percent in early April, according to the study, published in the journal Nature Climate Change. For some nations, the falloff was much steeper. The reduction in release of toxins in the environment have created a healthier living space. Scientists fear that these changes could be short lived unless governments from around the world support reductions in the daily emission of toxins.

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Newbeck, L. Hansen, T., Jaarsma, T., Klompstra, L. & Gallagher, R. Delivering healthcare remotely to cardiovascular patients during COVID-19: A rapid review of the evidence. European Journal of Cardiovascular Nursing 0(0) 1–9 The European Society of Cardiology 2020 Article reuse guidelines: DOI: 10.1177/1474515120924530

Abstract: Although attention is focused on addressing the acute situation created by the COVID-19 illness, it is imperative to continue our efforts to prevent cardiovascular morbidity and mortality, particularly during a period of prolonged social isolation, which may limit physical activity, adversely affect mental health and reduce access to usual care. One option may be to deliver healthcare interventions remotely through digital healthcare solutions. Therefore, the aim of this paper is to bring together the evidence for remote healthcare during a quarantine situation period to support people living with cardiovascular disease during COVID-19 isolation. A PubMed, CINAHL and Google Scholar were searched using telehealth OR digital health OR m Health OR eHealth OR mobile apps AND COVID-19 OR quarantine search terms. Literature relating to cardiovascular disease AND quarantine was explored. Results: The literature search identified 45 potentially relevant publications, out of which nine articles were included. Three overarching themes emerged from this review: (1) preparing the workforce and ensuring reimbursement for remote healthcare, (2) supporting mental and physical health and (3) supporting usual care. To support people living with cardiovascular disease during COVID-19 isolation and to mitigate the effects of quarantine and adverse effect on mental and physical well-being, we should offer remote healthcare and provide access to their usual.

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Report Washington Post Staff. Where states are reopening after America’s shutdown Washington Post, May 18, 2020

Summary: At least 100 million people are moving around again. Public health officials warn that a deadly surge may follow. Most states and U.S. territories have eased restrictions on businesses and social activity, trying to restart economies battered by the novel coronavirus pandemic and weeks of stay-at-home orders, that affected some 315 million Americans.Public health experts warn that this increased activity is likely to cause a surge of new infections. “There is a real risk that you will trigger an outbreak that you may not be able to control” by reopening too quickly, said infectious-disease expert Anthony S. Fauci in Senate testimony May 12, “leading to some suffering and death that could be avoided.”

This article classifies states as having major, moderate and minor restrictions in place as governors update their guidance on business and social activity. Each state classification reflects what is known, as of May 18, 2020 Major restrictions: Personal care businesses, such as salons and barbers, gyms and most non-essential businesses remain closed. Restaurants and bars may not seat patrons. Face coverings and six-foot distancing are required, and public gatherings larger than ten are not permitted. Moderate restrictions: Many of the above businesses may reopen with limited capacity, while bars and gyms remain closed. Minor restrictions: Bars, theaters, casinos or concert halls may reopen, with larger groups permitted.

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May 13, 2020

Adamkiewicz, G., Zota, A.R., Fabian, M. P., Chahine, T., Julien, R., , J., and Levy,J. I. Moving environmental justice indoors: Understanding structural influences on residential exposure patterns in low-income communities. AJPH, PMCID: PMC322251PMID: 21836112 doi: 10.2105/AJPH. 2011.300119

Abstract: The persistence of racial/ethnic and socioeconomic health disparities in the United States remains a significant public health problem. One focus of the environmental justice (EJ) movement has been the contribution of the physical and social environments in shaping adverse health outcomes among poor communities of color. The emphasis of EJ has historically been on outdoor pollution sources such as industry or traffic, in part because of EJ's origins in addressing historical and continued institutional racism through the siting of industrial facilities, illegal and regulated dumping, and land use planning in communities lacking the political capital that would promote a more equitable distribution of risk.1–5

Although these outdoor sources can clearly influence health, disparities given uneven distributions across communities, 6, 7 an underappreciated EJ issue relates to disparities in indoor residential environmental quality. it has occurred largely outside of the EJ movement. As researchers attempt to inform activities, which may eliminate known and emerging disparities in environmental risks, addressing indoor environmental exposures will be critical, and doing so will require an understanding of the root causes of these uneven distributions. Although exposure disparities may be observed in multiple settings, the discussion and case study focus on urban, multifamily households to highlight some general principles and the unique challenges in these settings.

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Gonzalez D., Karpman, M., Kenney, G., and Zuckerman, S. Hispanic families: Hispanic adults in families with noncitizens disproportionately feel the economic fallout from COVID-19. May 6, 2020, Health Reform Monitoring Survey, Urban Institute Publisher

Summary: The COVID-19 pandemic is affecting Hispanic adults’ family financial security to a greater extent than other racial and ethnic groups. Hispanic adults disproportionately work in industries that are more likely to be affected by the COVID-19 pandemic. Additionally, Hispanic adults in families with noncitizens are disproportionately represented in industries affected by the outbreak, and therefore experience more negative unemployment impacts than families with no noncitizens. As of April 2020, nearly six in ten nonelderly Hispanic adults were in families where someone lost a job, work hours, or work-related income. Close to, half experienced some material hardship in the past 30 days. The findings from a national survey conducted by the Urban Institute and funded by Robert Wood Johnson (RWJ) Foundation reported import findings to inform health promotion Activities and community planning

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Himmelfarb, C. R. & Baptiste, D. Coronavirus Disease (COVID-19) Implications for cardiovascular and socially at-risk populations. Journal of Cardiovascular Nursing, Vol. 00, No. 0, pp. 00–00 x Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Abstract: The novel coronavirus disease (COVID-19) emerged in December 2019 and, in less than 3 months, evolved to a worldwide pandemic.1–3This virus has spread rapidly, leading to an unprecedented global crisis that’ shows no signs of abating in the near future. As of Wednesday, April 1, 2020, there were more than 911 308 cases and more than 45 000 deaths reported globally.4 Confirmed cases in the United States were at 206 207 with more than 4542 deaths. Statistical models predict that more than 260 000 hospital beds will be used in the United States by the end of April 2020.5 The impact ofCOVID-19 on our daily lives, work, families, and overall operations is unprecedented in modern times, and the situation continues to change on a day-to-day basis. In addition to constantly evolving information, there are misconceptions among the public about the pathology, etiology, transmission, treatment, and risks associated with COVID-19. COVID-19 is an infectious respiratory disease caused by the newly discovered pathogen, SARS-CoV-2, a novel RNA-dependent RNA polymerase beta coronavirus that is thought to derive from bats. The incubation period for COVID-19 is thought to be within 14 days of exposure, and transmission. The article provides information about the disease process and discusses risk groups such as Cardiac and other risk groups.

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NCRID. Interim Additional guidance for infection prevention and control for patients with suspected or confirmed COVID-19 in nursing homes. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. April 15, 2020

Summary: The National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases has updated guidance recommended for Nursing Homes Given their congregate nature and resident population served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness. COVID-19 cases have now been reported in all 50 states and DC, with many areas having widespread community transmission. Given the high risk of spread once COVID-19 enters a nursing home, facilities must take immediate action to protect residents, families, and healthcare personnel (HCP) from severe infections, hospitalizations, and death. Updates were also made to CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings to address source control for everyone in a healthcare facility, including nursing homes. Refer to that guidance for more detailed recommendations, including when facemasks versus cloth face coverings could be used.

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Raifman, M. and Raifman, R. Disparities in the population at risk of severe illness from COVID-19 by race/ethnicity and income. Am J Prev Med, 2020 Apr 27 doi: 10.1016/j.amepre.2020.04.003 [E pub ahead of print]

Abstract: Identifying those at heightened risk of severe illness from novel coronavirus disease 2019 (COVID-19) is essential for modeling disease, designing return-to-work criteria, allocating economic assistance, advancing health equity, and limiting morbidity and mortality. The U.S. Centers for Disease Control and Prevention has identified criteria associated with risk of severe complications from COVID-19 infection. Structural inequities have shaped racial, ethnic, and income disparities for many of these criteria. To date, there has been limited analysis of the proportion of the population at risk in the U.S. based on these criteria, or risk factors by race/ethnicity or income. Preliminary national data on cases by race/ethnicity suggest that disparities in hospitalization are already developing.3 Quantifying disparities in risk is important for allocating resources to prevent, identify, and treat COVID-19-related severe illness and limit diverging outcomes for already vulnerable subgroups. This study estimated the proportion of adults that have at least one of the Centers for Disease Control and Prevention criteria for risk of severe illness from COVID-19.

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Stafford, K., Swanson, E. AP-NORC poll: Pandemic especially tough on people of color May 6, 2020 Kat Stafford is a member of the AP’s Race and Ethnicity team. Follow Stafford on Twitter at Swanson reported from Washington. AP-NORC Center:

Summary: DETROIT (AP) — new article report on a survey exploring the impact of Corvid 19 on racial groups. People of color have not only been hit harder by the deadly coronavirus than have Americans overall, but they’re also bearing the brunt of the pandemic’s financial impact, according to a recent survey from the Associated Press-NORC Center for Public Affairs Research. The poll found that 61% of Hispanic Americans say they have experienced some kind of household income loss because of the outbreak, including job losses, unpaid leave, pay cuts and fewer scheduled hours. That is compared with 46% of Americans overall. Thirty-seven percent of Latinos and 27% of black Americans say they have been unable to pay at least one type of bill because of the coronavirus outbreak. Only 17% of white Americans say the same.

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May 7, 2020

Berkowitz, S. A., Traore, C. Y., Singer, D. E., Atlas, S. J. Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: Results from a primary care. NetworkHealth Serv Res. 2015 Apr; 50(2): 398–417. Published online 2014 Sep 15. doi: 10.1111/1475-6773.12229.

Abstract: To determine which area-based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective. A sample of 142,659 adults seen in a primary care network from January 1, 2009 to December 31, 2011. Cross-sectional, comparing associations between area-based SES indicators and patient outcomes were conducted. Data were geocoded to construct area-based SES indicators at block group (BG), census tract (CT), and ZIP code (ZIP) levels. Data on health outcomes were abstracted from electronic records. Relative indices of inequality (RIIs) were calculated to quantify disparities detected by area-based SES indicators and compared to RIIs from self-reported educational attainment.

Study Findings focused on ZIP indicators had less missing data than BG or CT indicators (p < .0001). Area-based SES indicators were strongly associated with self-report educational attainment (p < .0001). ZIP, BG, and CT indicators all detected expected SES gradients in health outcomes similarly. The conclusions focused on Area-based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP-level median household income or percent poverty, using cut points.

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Edelson et al.: Interim guidance for life support for COVID-19: Emergency cardiovascular care Committee and others. 10.1161/CIRCULATIONAHA.120.047463

Summary: Existing American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines do not address the challenges of providing resuscitation in the setting of the COVID-19 global pandemic, wherein rescuers must continuously balance the immediate needs of the victims with their own safety. To address this gap, the AHA, in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists, and with the support of the American Association of Critical Care Nurses and National EMS Physicians, has compiled interim guidance to help rescuers treat victims of cardiac arrest with suspected or confirmed COVID-19.

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Kolkata, G. How Remdesivir, new hope for Covid-19 patients, was resurrected. New York Times, Op Ed. 5/3/20

Summary: the Author reports on remdesivir, an antiviral drug designed to treat both hepatitis and a common respiratory virus. Recently the Food and Drug Administration issued an emergency approval for remdesivir as a treatment for patients severely ill with Covid-19, the disease caused by the coronavirus. The Editorial suggest promising all be it cautious results from early testing.

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Muoio, D. In-home passive monitoring can help seniors stay independent. Global Edition Connected Health. April 29, 2020’

Summary: Stony Brook University experts describe key design points for a successful in-home senior-health-monitoring system, and their efforts to develop such a tool. The goal is to develop innovative strategies to reduce disease risk by keeping elderly safely at home.

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Mowinski- Jennings, B., Yeager, K. A. From fear to fortitude: Using the power within the nursing. Nursing Outlook. Received date: 12 April 2020 Accepted date: 26 April 2020 DOI: Reference: YMNO 1560

Summary: Fear is defined as “an unpleasant often strong emotion caused by anticipation or awareness of danger.” (Merriam-Webster Dictionary) Synonyms for fear include dread, fright, and alarm (Merriam-Webster Dictionary). Fortitude, by contrast, is defined as “strength of mind that enables a person to encounter danger or bear pain or adversity with courage.” (Merriam-Webster Dictionary) Synonyms for fortitude include grit, intestinal fortitude, and spunk (Merriam-Webster Dictionary).

As the coronavirus disease, COVID-19, caused by the virus, SARS-CoV-2, spreads across the globe, fear spreads with it—fear for self, family, patients, coworkers; Fear for our profession, country, and world. The authors discuss how Nurses of the USA will stand by their patients, their coworkers, and one another. Nurses? fortitude and courage will bring out the best in everyone”.

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Watson, R.A., Pride, N.B. , Thomas, E.L. , Fitzpatrick, J. G. Durighel, G., J. McCarthy, J., S. X. Morin, S. X. Reduction of total lung capacity in obese men: comparison of total intrathoracic and gas volumes. J Appl Physiol 108: 1605–1612, 2010. First published March 18, 2010; doi:10.1152/japplphysiol.01267.2009

Abstract: Restriction of total lung capacity (TLC) is found in some obese subjects, but the mechanism is unclear. Two hypotheses are as follows: 1) increased abdominal volume prevents full descent of the diaphragm; and 2) increased intrathoracic fat reduces space for full lung expansion. The authors measured total intrathoracic volume at full inflation using magnetic resonance imaging (MRI) in 14 asymptomatic obese men [mean age 52 yr., body mass index (BMI) 35–45 kg/m2] and 7 control men (mean age 50 yr., BMI 22–27 kg/m2). MRI volumes were compared with gas volumes at TLC. All measurements were made with subjects supine. Obese men had smaller functional residual capacity (FRC) and FRC-to-TLC ratio than control men. There was a 12% predicted difference in mean TLC between obese (84% predicted). As a consequence of increased mediastinal volume, intrathoracic volume at FRC in obese men was considerably larger than indicated by the gas volume at FRC. The authors concluded that the major factor restricting TLC in some obese men was reduced thoracic expansion at full inflation using magnetic resonance imaging (MRI).

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April 29, 2020

Aghjayan, R. Combating COVID-19: Best Practices That Clinicians Need to Know. Clinical Guidelines, March 13, 2020

Summary: Some recommended sanitary practices include staying at home when sick, handwashing practices, and disinfecting common surfaces. As the number of global cases of coronavirus disease 2019 (COVID-19) rises, it is imperative that healthcare providers stay informed and prepared with the best clinical practices to combat the SARS-CoV-2 virus. Following appropriate guidelines and practicing proper technique will benefit both patients and clinicians and better prevent the further spread of the virus.

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Edmonds, J., Knelop, S. Campbell, L. A call to action for public health nurses during the COVID-19 pandemic. Editorial, Public Health Nurs. 2020; 00:1–2. DOI: 10.1111/phn.12733

Introduction: The authors focus on public health nurses (PHNs) as being on the frontline of the public health crisis the world now knows as the COVID-19 pandemic. They serve on mobile strike teams investigating case-contacts, deliver education on self-isolation and quarantine through hotlines and home visits, and interpret the rapidly shifting guidance from the Centers for Disease Control and Prevention (CDC). They are reliable and proven responders during infectious disease emergencies, providing safe, effective, and nondiscriminatory care to the communities in which they serve. Yet, despite their critical role, PHN positions have been underfunded, left vacant, eliminated, or replaced over the past three decades. Combined with outsourcing services to agencies that lack the public health mandate and institutional experience necessary to provide public health services to communities, the erosion of the PHN workforce has made us all more vulnerable to both chronic disease and emerging infectious disease threats.

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Huttunen, R., and Syrja¨nen, J. Obesity and the risk and outcome of infection. International Journal of Obesity (2013), 37, 333–340; doi:10.1038/ijo.2012.62; published online 1 May 2012

Abstract: The interactions between obesity and infectious diseases have recently received increasing recognition as emerging data have indicated an association between obesity and poor outcome in pandemic H1N1 influenza infection. Obesity is an established risk factor for surgical-site infections, nosocomial infections, periodontitis and skin infections. Several studies indicate that acute pancreatitis is more severe in the obese. Data are controversial and limited as regards the association between obesity and the risk and outcome of community-acquired infections such as pneumonia, bacteremia and sepsis and obesity and the course of HIV infection. As the cause–effect relationship between obesity and infection remains obscure in many infectious diseases, further studies are warranted. The consequences of obesity may have substantial effects on the global burden of infectious diseases.

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Hillier, M., D. Using Effective Hand Hygiene Practice to Prevent and Control Infection. Nurs Stand, 2020 Apr 23. PMID: 32337862, doi: 10.7748/ns.2020.e11552. Online ahead of print.10.7748/ns.2020.e11552

Abstract: Decontamination using hand hygiene remains one of the most important and effective methods for reducing healthcare-associated infections and cross-infection between patients. In 1860, Florence Nightingale wrote that nurses should wash their hands frequently throughout the day, demonstrating an early awareness of the effectiveness of this simple procedure. The COVID-19 pandemic has demonstrated that effectively applied hand hygiene is a vital intervention that can be used to prevent the spread of disease. This article details the correct procedure required for effective hand hygiene and emphasizes the need for nurses to keep up to date with evidence-based guidelines. The article also outlines the differences between hand decontamination using alcohol-based hand gels and soap and water, and the complex factors that can interfere with effective hand hygiene compliance.

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Lee, B. How Can Obesity Affect Your COVID-19 Coronavirus Risk? Here Are Some Possibilities. Healthcare, Apr, 2020

Conclusion: Journalist offers perspective on existing health risks are impacting patient’s responses to the COVID 19 Pandemic. According to Lee “experts have been warning our society about not doing enough to prepare for an infectious disease pandemic. This year with the COVID-19 coronavirus pandemic, you’ve seen how that went. At the same time, for years, experts have been warning our society about not doing enough to address the continuing obesity epidemic”.

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Nazareth, R., Chasqueira, M.J., Rodrigues, M. L., Paulino, C., Conceição, C., Lêdo, L., Úrsula Segura, U., Santos4, M., Messias1, A., Póvoa, P., and Paixão, P. BMC Respiratory viruses in mechanically ventilated patients: a pilot study. Pulmonary Medicine (2020) 20:3

Abstract: The aim of this study was to evaluate the presence of respiratory viruses in the lower airways of individuals undergoing invasive mechanical ventilation, with and without acute lower respiratory infection (respectively WRI and WORI groups).The authors studied 44 mini-bronchoalveolar lavage samples from patients with mean age in the seventh decade, 20 from WORI group and 24 from WRI group, who were hospitalized for acute respiratory failure in Intensive Care Units of two hospitals in the Lisbon area. Real-time PCR was applied to verify analyse the presence of 15 common respiratory viruses (adenovirus, human bocavirus, Influenza virus A and B, respiratory syncytial virus, human parainfluenza virus types 1, 2, 3 and 4, human enterovirus, human rhinovirus, human metapneumovirus, human coronavirus group 1 (229E, NL63) and 2 (OC43, HKU1).

Results: Respiratory viruses were detected in six of the 20 patients in the WORI group: influenza AH3 (n = 2), parainfluenza virus 1/3 (n = 2), human rhinovirus (n = 2), respiratory syncytial virus (n = 1) and human metapneumovirus (n = 1).in the WRI group, respiratory viruses were detected in 12 of the 24 patients: influenza AH3 (n = 3), human rhinovirus (n = 3), respiratory syncytial virus (n = 3), human metapneumovirus (n = 3), human bocavirus (n = 2) and human enterovirus (n = 1). Simultaneous detection of two viruses was recorded in two samples in both groups. The results of this study suggest the presence of common respiratory viruses in the lower respiratory tract without causing symptomatic infection, even in carefully collected lower samples. This may have important implications on the interpretation of the results on the diagnostic setting.

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Oval, N.P. IDSA. Issues Guidelines for the Treatment and Management of Patients with COVID-19. MPR, April 14, 2020

Summary: The IDSA highlighted that the guideline for COVID-19 management is a living document that will be frequently updated pending new data. The coronavirus disease 2019 (COVID-19) pandemic caused by a novel strain of the viral family (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has highlighted the need for novel treatment options. However, novel treatments are often offered using non centralized data from small or anecdotal studies, with regimens for these treatments varying on an institutional basis. Therefore, the Infectious Disease Society of America (IDSA) has issued guidelines to aid in the treatment and management of patients with COVID-19.

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April 22, 2020

Newby, Jamison C.; Mabry, Madison C. ; Carlisle, Byron A. ; Olson, DaiWai, M. PhD, ; Lane, Blair E. Reflections on nursing ingenuity during the COVID-19 pandemic.

Journal of Neuroscience Nursing: March 27, 2020 - Volume Published Ahead of Print - Issue - doi: 10.1097/JNN.0000000000000525bbbb

Abstract: This reflections article provides insight toward nursing innovations to reduce the overuse of personal protective equipment while maintaining a safe environment for staff taking care of COVID-19 patients. The secondary aim of this paper to capitalize on recent advances in mass electronic communication through social media to encourage nurses across the globe to share their knowledge and expertise during this pandemic and innovations that can save lives during the COVID-19 pandemic.

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Schreiber, M., Cates, J. D.S., Formanski, S., King, M. Maximizing the resilience of healthcare workers in multi-hazard events: Lessons from the 2014–2015 Ebola response in Africa. §114 Military Medicine, Vol. 184, March/April Supplement 2019.

Abstract: There is increasing knowledge that health care workers (HCWs) can experience a variety of emotional impacts when responding to disasters and terrorism events. The Anticipate, Plan and Deter (APD) Responder Risk and Resilience Model was developed to provide a new, evidence-informed method for understanding and managing psychological impacts among HCWs.

APD includes pre-deployment development of an individualized resilience plan and an in-theater, real-time self-triage system, which together allow HCWs to assess and manage the full range of psychological risk and resilience for themselves and their families. The inclusion of objective mental health risk factors to prompt activation of a coping plan, in connection with unit leadership real-time situational awareness, enables the first known evidence-driven “targeted action” plan to address responder risk early before Post Traumatic Stress Disorder and impairment become established.

This paper describes pilot work using the self-triage system component in Alameda County’s Urban Shield and the Philippines’ Typhoon Haiyan, and then reports a case example of the full APD model implementation in West Africa’s Ebola epidemic.© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: Downloaded from https://academic

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British Psychological Society Covid19 Staff Wellbeing Group, The psychological needs of healthcare staff as a result of the Coronavirus pandemic.

Abstract: This is a guide for leaders and managers of healthcare services who will need to consider the wellbeing needs of all healthcare staff (clinical and non-clinical) as a result of the Coronavirus outbreak. It offers practical recommendations for how to respond at individual, management and organizational level involving the appropriate utilization of expertise within their practitioner psychologist and mental health professionals and anticipates the psychological reactions over time, and what people may need to recovery psychologically from this.

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Meehan, T.C. Timmins, F. Burke, J. Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model. Journal of Clinical Nursing. 2018;00:1–14.

Abstract: There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses’ awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model© (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. Method: A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. Authors data support Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses’ ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness.

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Costa, J. (2020). Can inhaling nitric oxide treat OR prevent COVID-19? MGH wants to find out. Massachusetts General Hospital. (Jesse Costa/WBUR)

Overview: Researchers at Massachusetts General Hospital (MGH) are engaged in an investigation to study whether inhaling nitric oxide can help treat patients with COVID-19, or even prevent people from getting the disease. Nitric oxide is widely used to treat patients with respiratory failure. MGH is the only hospital in the United States, and one of the few in the world, studying it for the treatment of COVID-19, according to the CDC.

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Gray, S. (2020). Carol Bova emphasizes next of kin or proxy needed to enroll patients in clinical trials for potential COVID-19 treatments. UMass Medical School Communications. UMASS, April 15, 2020

Overview: In the face of the COVID-19 pandemic, Bova addresses how critical it is for adults of all ages to have a health care proxy. It is essential to” have someone to make health care decisions on their behalf if they are too sick to make them on their own” Bova describes an experience where she witnessed a person with COVID-19 “who could not speak for himself was unable to enter a clinical trial because there was no next of kin and no available health care proxy.”

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Spenser, S.E.W. (2020). Graduate School of Nursing develops guide to help care for caregivers going home led development of best practices for individuals caring for patients with COVID-19. UMass Medical School Communications. April 15, 2020.

Introduction: The article offers a list of best practices developed by a graduate student Kelly Sudnick, RN, MSN, a registered nurse with the U.S. Navy, for use by health care providers and support staff to help to safely transition home after caring for patients who might have been infected with the novel coronavirus.

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April 15, 2020

Newby JC; Mabry MC; Carlisle BA; Olson DM; Lane BE, Reflections on nursing ingenuity during the COVID-19 pandemic. (English) By: The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses [J Neurosci Nurs], ISSN: 1945-2810, 2020 Mar 27; Publisher: American Association of Neuroscience Nurses; PMID: 32221059;

Abstract This article provides insight toward nursing innovations to reduce the overuse of personal protective equipment while maintaining a safe environment for staff taking care of COVID-19 patients. The secondary aim of this paper to capitalize on recent advances in mass electronic communication through social media to encourage nurses across the globe to share their knowledge and expertise during this pandemic. Innovations that have been implemented fall into 3 categories of: reducing unnecessary use of personal protective equipment (PPE), promoting staff safety and readiness, and reducing foot traffic. Strategies are being shared to promote dissemination of innovative nursing interventions during the COVID-19 pandemic.

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Minton, M.E., Isaacson, M. & Bank, D. (2016) Prayer and the registered nurse (PRN): nurses’ reports of ease and dis-ease with patient-initiated prayer request. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12990.

Abstract: The purpose of this study was to explore nurse comfort with patient-initiated prayer request scenarios. Spiritual care is fundamental to patient care evidenced by Joint Commission requirement of a spiritual assessment on a patient’s hospital admission. Prayer is an assessment component. Patients may seek solace and support by requesting prayer from the bedside nurse, the nurse may lack confidence in responding. Absent in the literature are reports specific to nurses’ comfort when patients initiate prayer requests. A Cross-sectional mixed methods study was conducted with data from 134 nurses in the USA via an online survey. The scenario responses revealed patterns of ease and dis-ease in response to patient requests for prayer. The pattern of ease of prayer with patients revealed three themes: open to voice of calm or silence; physical or spiritual; can I call the chaplain. For these nurses, prayer is a natural component of nursing care, as the majority of responses to all scenarios demonstrated an overwhelming ease in response and capacity to pray with patients on request.

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Dannette A. Mitchell, MSN, APRN, ACNS-BC, CCRN, Maureen A. Seckel, MSN, APRN, ACNS-BC, CCRN, CCNS (2020) Acute respiratory distress syndrome and prone positioning AACN Advanced Critical Care, Volume 29, Number 4, and pp. 415-425 © 2018 AACN DOI: Copy write, All rights reserved.

Abstract: Acute respiratory distress syndrome continues to have high morbidity and mortality despite more than 50 years of research. The Berlin definition in 2012 established risk stratification based on degree of hypoxemia and the use of positive end-expiratory pressure.

The use of prone positioning as a treatment modality has been studied for more than 40 years, with recent studies showing an improvement in oxygenation and decreased mortality. The studies also provide evidence to support the methodology and length of treatment time. Recent guidelines include several ventilator strategies for acute respiratory distress syndrome, including prone positioning. Protocols and procedures discussed in this article ensure successful prone repositioning and prevention of complications related to the procedure.

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Susan Mac Leod Dyess, PhD, RN, AHN-BC, NE-BC;Angela S. Prestia, PhD, RN, NE-BC; Marlaine C. Smith, PhD, RN, AHN-BC, FAAN, (2015). Support for caring and resiliency among successful nurse leaders. Nurs Admin, QVol. 39, No. 2, pp. 104–116. Wolters Kluwer Health, Inc. All rights reserved.

Abstract: Health care practice settings are replete with competing priorities for nurse leaders who are responsible to the staff, the organization, and the patients and their families. In the midst of the competing priorities, there is a mandate for successful nursing leadership that is patient centered. To support the continuance of nurse leader success and avoid discouragement and attrition, a caring and resilient model for leadership may be necessary. This article considers the practices of nurse leaders that support caring, resiliency, and, ultimately, their success. Successful navigation toward patient-centered solutions through the intentional and inextricably linked living caring and resiliency was enhanced with practices of self-care, accountability, and reflection. Within each of the 3 intentional practices, a primary process emerged that revealed how nurse leaders actualize their caring and resiliency. The practices and mutually supportive processes are discussed. Useful questions are provided to guide any nurse leader who is contemplating practices of self-care, accountability, and reflection for supporting caring and resiliency.

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Pressure Injury Prevention PIP Tips for Prone Position
Evidence Based Research Guidelines Use a pressure redistribution surface (for those not on a bed specifically designed for proning)

  • Follow manufacturer instructions when using beds and positioning devices specifically designed for proning.
  • Positioning devices/pillows are needed to offload pressure points. Involve enough trained staff to avoid friction-shear.
  • Microshifts and small position changes should be performed while proned, especially in non-rotating beds.
  • Assess all pressure points:
    • Prior to proning (anterior surfaces)
    • Prior to returning to supine position (posterior surfaces)
    • When alternating arm position, assess integrity of skin of arm/head/face.
    • Document all skin assessments and preventive measures.

Acknowledgment of Authors and Contributors: Dr. VIrginia Capasso, Massachusetts General Hospital; Dr. Jill Cox, Rutgers University; Dr. Janet Cuddigan, University of Nebraska Medical Center; Dr. Barbara Delmore, NYU Langone Health; Dr. Ann Tescher, Mayo Clinic; and Susan Solmos, University of Chicago Medicine.

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updated 11-12-2021

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