Nursing management of cognitive dysfunction in adults with brain injury: Summary of best evidence-practiced strategies.

OBJECTIVE: To summarize the best evidence-based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice. DESIGN: Review. METHODS: The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta-analyses. Two researchers trained in evidence-based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion. RESULTS: A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management. CONCLUSIONS: This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence-based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients. REPORTING METHOD: This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis. TRIAL AND PROTOCOL REGISTRATION: This study has been registered with the Fudan University Centre for Evidence-based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Does pre-existing immunity determine the course of SARS-CoV-2 infection in health-care workers? Single-center experience.

OBJECTIVES: To assess the severity of symptoms, duration of infection and viral loads of health-care workers (HCWs) who tested positive for Coronavirus disease 2019 (COVID-19) during Omicron's prevalence, in regard to vaccination and previous infection. METHODS: During 2 weeks of highest rate of COVID-19 cases in Bosnia and Herzegovina, the positive nasopharyngeal swabs were analysed in 141 HCWs by reverse transcription quantitative PCR, targeting four different genes: RdRp, E, N and nsp14. Uniformed questionnaire was used to collect relevant sociodemographic and epidemiological data from HCWs divided into four groups: unvaccinated/not previously infected (group 1); unvaccinated/previously infected (group 2); vaccinated/not previously infected (group 3); and vaccinated/previously infected (group 4). RESULTS: We observed that occurrence of fever and smell or taste loss were more frequent in group 1 (86.4% and 25%) and group 3 (76.9% and 19.2%), in comparison to group 2 (64.4% and 6.7%) and group 4 (69.2% and 3.8%), (p = 0.023 and p = 0.003). Although statistically not significant, group 2 (61.9%), group 3 (65.4%), and group 4 (70.8%) experienced negativization within 7 days of positive RT-qPCR test, whereas 51.2% of HCWs from group 1 tested negative later on. There is no significant difference between all four groups regarding Ct values of analysed genes. CONCLUSION: During Omicron's prevalence, the vaccination had less substantial effect on symptomatic disease among HCWs, while fever and loss of smell or taste were considerably less likely to occur upon reinfection. Since viral loads and negativization periods do not seem to significantly vary, irrespective of pre-existing immunity, systemic vaccination and mask-wearing should still be considered among HCWs.

Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review.

INTRODUCTION: During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics. METHODS: In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols. RESULTS: In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme. DISCUSSION: The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Hepatitis B vaccination coverage and associated factors among medical students: a cross-sectional study in Bosaso, Somalia, 2021.

BACKGROUND: Hepatitis B virus (HBV) is a leading cause of liver cancer and remains a global public health concern. The risk of acquiring HBV is higher in HCWs than in non-HCWs. Medical students are considered a high-risk group because similar to HCWs, they tend to be exposed to body fluids and blood during training in clinical settings. New infections can be effectively prevented and eliminated with an increased coverage of HBV vaccination. The purpose of this study was to evaluate HBV immunization coverage and associated factors among medical students attending universities in Bosaso, Somalia. METHODOLOGY: An institutional-based cross-sectional study was conducted. A stratified sampling method was employed to draw a sample from four universities in Bosaso. From each university, participants were selected using a simple random sampling technique. Self-administered questionnaires were distributed among 247 medical students. The data were analysed with SPSS version 21, and the findings are presented in tables and proportions. The chi-square test was used to measure statistical associations. RESULTS: Although 73.7% of the respondents had an above-average knowledge level of HBV and 95.9% knew that HBV can be prevented by vaccination, only 2.8% were fully immunized, while 5.3% were partially immunized. The students reported six main reasons for not being vaccinated: unavailability of the vaccine (32.8%), high vaccine cost (26.7%), fear of vaccine side effects (12.6%), lack of trust in vaccine quality (8.5%), lack of awareness about where to get vaccinated (5.7%), and lack of time (2.8%). Occupation and the availability of HBV vaccination in the workplace were associated with HBV vaccine uptake (p values of 0.005 and 0.047, respectively). CONCLUSION: HBV immunization coverage among medical students was extremely low (2.8%), indicating the urgent need for increased vaccination coverage in this population. This should start with evidence-based advocacy for the development of a clear national HBV elimination policy, followed by implementing effective, large-scale immunization strategies and interventions. Future studies should expand the sample size to include multiple cities for increased representativeness and conduct HBV titre tests among participants.

Contamination of SARS-CoV-2 RNA on personal protective equipment and environmental surfaces in nonpatient entry area of a Fangcang shelter hospital.

OBJECTIVES: To determine the extent of contamination of personal protective equipment (PPE) and surfaces by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nonpatient entry area of a Fangcang shelter hospital, the medical staff accommodation area, and the staff transport bus. METHODS: We collected 816 samples from the nonpatient entry area and floors in a Fangcang shelter hospital, medical staff accommodation area, and scheduled bus, and the five major types of PPE used from April 13 to May 18, 2022. SARS-CoV-2 ribonucleic acid (RNA) was detected by reverse transcription-polymerase chain reaction. RESULTS: Overall, 22.2% of PPE samples were positive for SARS-CoV-2 RNA. Boot covers and gowns were the most contaminated types of PPE. The positive PPE contamination rate of staff collecting respiratory specimens was significantly higher than that of the general-treatment staff group (35.8% vs. 12.2%) and cleaner group (35.8% vs. 26.4%), p < 0.01. In total, 27 of 265 (10.2%) environmental surface samples were positive for SARS-CoV-2 RNA. The contamination-positive rates were 26.8% (22/82), 5.4% (4/74), and 0.9% (1/109) for contaminated, potentially contaminated, and clean zones, respectively. SARS-CoV-2 RNA was frequently detected on objects such as mobile phones, tables, computer keyboards and mice, and door handles. CONCLUSIONS: SARS-CoV-2 RNA was widely distributed on high-touch surfaces and on PPE in the contaminated zone of the Fangcang shelter hospital, implying a potentially high infection risk for healthcare workers. Our findings emphasize the need to ensure adequate environmental cleaning, improve hand hygiene, and reduce the risk of infection. Additionally, prevention of self-contamination during PPE donning and doffing is complex and needs more research.

Impact of COVID-19 pandemic on health care workers (HCWs) in Sindh Province of Pakistan.

BACKGROUND: In Pakistan, the COVID-19 outbreak posed a significant challenge for healthcare workers in the country's public hospitals. The HCWs faced several problems in terms of the COVID-19 pandemic. Therefore this study investigated how the COVID-19 pandemic has affected the medical staff at the public hospital in Sindh Province, Pakistan. METHODS: In this study, a qualitative exploratory design was used. Semi-Structure interviews (SSI) were conducted by using an open-indeed questionnaire (OIQ) for data collection. An inductive approach was used for theoretical data analysis. A total of 320 HCWs participated to complete the criteria of the study from 10 different public hospitals. RESULTS: The study result showed the Sindh public hospital's insufficient infrastructure, lack of health protective equipment, shortages of isolation rooms and beds, and emergencies during the COVID-19 pandemic caused HCWs to experience physical and psychological weariness, sleep disturbance, mental stress, and fear of infection. CONCLUSION: The study concluded that public hospitals' insufficient infrastructure, furniture, emergency wards, and safety equipment during the COVID-19 pandemic significantly damaged HCWs' physical and psychological health, generating fear of infection and sleep disturbance. Additionally, Sindh healthcare workers' fear of illness and isolation may impair family connections.

Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model.

Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.

[Recommendations for action for SARS-CoV-2 testing concepts for asymptomatic healthcare workers]. / Handlungsempfehlungen für SARS-CoV-2-Testkonzepte für asymptomatische Beschäftigte im Gesundheitswesen.

Background and objective: When implementing SARS-CoV­2 testing concepts in healthcare facilities, different laws and regulations of equal rank apply. In the light of experienced impediments in translating legal requirements appropriately into legally secure concepts on an operational level, the objective of this paper was to develop corresponding specific recommendations for action. Methods: On the basis of guiding questions on previously identified fields of action, a focus group consisting of representatives of administration, different medical disciplines, and special interest groups discussed critical aspects of implementation using a holistic approach. The transcribed contents were analyzed through inductive development and deductive application of categories. Results: All contents of discussion could be matched with the identified categories legal backgrounds, requirements and objectives of testing concepts in healthcare facilities, responsibilities for implementing in operational decision-making chains, and implementing SARS-CoV­2 testing concepts. Implications: The correct implementation of the legal requirements into legally compliant SARS-CoV­2 testing concepts in healthcare facilities previously required the involvement of ministries, representatives of different medical disciplines and professional associations, employer and employee representatives and data privacy experts as well as representatives of possible cost bearers. In addition, an integrative and enforceable composition of laws and regulations is necessary. Defining objectives for testing concepts is significant for the following operational process flows that need to consider aspects of employee data privacy as well as providing additional personnel for fulfilling the tasks. Also, in future one central issue of healthcare facilities concerns the finding of solutions for IT interfaces for information transfer to employees in accordance with data privacy.

Coping strategies and emotional responses adopted by health care workers during COVID-19 pandemic-braving the storm.

Background and Aims: Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic. Material and Methods: This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A P value of <0.05 was considered significant. Results: Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly. Conclusion: Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.

Quality of life among health care workers with and without prior COVID-19 infection in Bangladesh.

BACKGROUND: Health care workers have been facing difficulties in coping with the COVID-19 infection from the beginning. The study aimed to compare Quality of Life (QOL) among health care workers (HCWs) with and without prior COVID-19 disease. METHODS: This study was conducted from July 2020 to January 2021 among 444 HCWs. We randomly interviewed 3244 participants for our earlier nationwide survey from a list of COVID-19 positive cases after their recovery, and we found 222 HCWs among the respondents. We randomly chose 222 HCWs unaffected by COVID as a comparison group from our selected hospitals. We measured QOL using World Health Organization's WHOQOL-BREF tool. Physical, psychological, environmental, and social ties were the four areas assessed on a 5-point Likert scale where a higher score suggests better QOL. Due to pandemic restrictions, we used telephonic interviews for data collection. RESULTS: A higher QOL score was observed in HCWs with prior COVID-19 infection in all four domains than HCWs without previous COVID-19 conditions. Comorbidity was negatively associated with QOL scores of the physical (p = 0.001) and (p < 0.001) and psychological (p = 0.05, and (p < 0.05) domains for non-COVID and COVID-affected groups, respectively. Current smoking was significantly associated with lower psychological (p = 0.019) and environmental (p = 0.007) QOL scores among HCWs with prior COVID-19 infection. Hospitalization history due to COVID infection was a contributing factor for lower physical QOL scores (p = 0.048). Environmental (p = 0.016) QOL scores were significantly associated with the monthly income in the prior COVID-19 infection group, and physical scores were significantly associated (p = 0.05) with a monthly income in the non-COVID group. CONCLUSION: Governmental and non-governmental stakeholders should focus on potentially modifiable factors to improve health care workers' quality of life.

Impact of long duration wearing of N95 masks on cardiorespiratory system and subjective sensations of health-care workers during COVID-19 era.

Background and Aims: N95 mask being an essential element of personal protective equipment to be worn by health-care workers (HCWs) may lead to adverse effects and physiological stress as HCWs have to wear it for prolonged hours. Therefore, we planned to conduct a study in our intensive care unit staff to look for the effects of N95 masks on their health as well as to plan recommendations to ease them. Material and Methods: We conducted this study on our intensive care unit nursing staff and HCWs. We noted their oxygen saturation and heart rate at baseline as well as after 1 h, 2 h, 3 h, and 6 h of duty along with their subjective sensations. Institutional ethical clearance for the same was taken. Collected data were entered in MS Excel database and analyzed using SPSS version 20.0. Fisher's Z test was applied for comparing proportion and analysis of variance for comparing two means. Results: One hundred and nine HCWs participated in this, out of which 93 (85.3%) were females and 16 (14.7%) were males. Eighty-four (77.1%) participants were below 40 years. Twenty-three participants (21.1%) were overweight and 37 (33.9%) were obese. There was no significant drop in saturation and rise in heart rate during these hours. Conclusions: On comparing subjective sensations of HCWs, our study found that feeling of uneasiness was found more in less than 40 years age group as compared to more than 40 years. N95 masks were found to have no impact on cardiovascular system and do not lead to hypoxia while working routinely even for prolonged hours.

Immediate psychological outcomes associated with COVID-19 pandemic in frontline physicians: a cross-sectional study in Egypt.

BACKGROUND: The mental health of frontline healthcare workers is influenced by the crisis of the COVID-19 pandemic. This adversely affects their clinical performance and productivity. Therefore, it is important to recognize levels of anxiety, depression and identify the contributing factors. METHODS: A cross-sectional study recruited physicians working at frontline positions in university teaching and isolation hospitals in the Mid Delta Region of Egypt from April to May 2020. Data was collected through an electronic online survey. Anxiety and depression levels were assessed using General Anxiety Disorder-7 and Patient Health Questionnaire - 9 respectively. RESULTS: The study included 237 physicians, their mean age was 38.2 ± 6.2 years and 58% of them were males. Overall, 78.9% and 43.8% of all participated physicians reported symptoms of anxiety and depression. 85% of respondents had children with a significant increase in the risk of anxiety (OR = 20.2). This study revealed that poor sleep quality, being a resident physician, disrupted social life, and stigma exposure due to COVID-19, were significant mediating factors for the observed anxiety (OR = 0.53,3.28,0.18,1.56 respectively) and depressive symptoms (OR = 0.51,1.39,0.56,1.9 respectively). However, working in isolation hospitals wasn't a significant contributing factor. CONCLUSION: The frontline physicians experienced a high rate of mental symptoms during the COVID-19 pandemic. That requires prompt intervention, taking into consideration the underlying determinants.

Assessment of training and mentoring for DR-TB care decentralization in Tanzania.

INTRODUCTION: Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers' (HCWs) DR-TB care performance. METHODS: This mixed study assessed HCWs' DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor's interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared. RESULTS: HCW's knowledge increased for 15-20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care. CONCLUSIONS: Training and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs' knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.

SARS-CoV-2 specific serological pattern in healthcare workers of an Italian COVID-19 forefront hospital.

BACKGROUND: COVID-19 is an infectious disease caused by a novel coronavirus (SARS-CoV-2). The immunopathogenesis of the infection is currently unknown. Healthcare workers (HCWs) are at highest risk of infection and disease. Aim of the study was to assess the sero-prevalence of SARS-CoV-2 in an Italian cohort of HCWs exposed to COVID-19 patients. METHODS: A point-of-care lateral flow immunoassay (BioMedomics IgM-IgG Combined Antibody Rapid Test) was adopted to assess the prevalence of IgG and IgM against SARS-CoV-2. It was ethically approved ("Milano Area 1" Ethical Committee prot. n. 2020/ST/057). RESULTS: A total of 202 individuals (median age 45 years; 34.7% males) were retrospectively recruited in an Italian hospital (Milan, Italy). The percentage (95% CI) of recruited individuals with IgM and IgG were 14.4% (9.6-19.2%) and 7.4% (3.8-11.0%), respectively. IgM were more frequently found in males (24.3%), and in individuals aged 20-29 (25.9%) and 60-69 (30.4%) years. No relationship was found between exposure to COVID-19 patients and IgM and IgG positivity. CONCLUSIONS: The present study did show a low prevalence of SARS-CoV-2 IgM in Italian HCWs. New studies are needed to assess the prevalence of SARS-CoV-2 antibodies in HCWs exposed to COVID-19 patients, as well the role of neutralizing antibodies.

User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa.

BACKGROUND: KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap. METHODS: We conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research. RESULTS: Child-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs' participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children. CONCLUSION: Child-friendly spaces promote HIV positive children's right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children's HIV-related health outcomes.

Posttraumatic stress symptoms of health care workers during the corona virus disease 2019.

Corona virus disease 2019 (COVID-19) outbreak has attracted worldwide attention. The COVID-19 outbreak is unique in its rapid transmission and results in heavy stress for the front-line health care workers (HCWs). The current study aimed to exam posttraumatic stress symptoms (PTSSs) of HCWs fighting for the COVID-19 and to evaluate their sleep quality after 1-month stressful suffering. Three hundred seventy-seven HCWs working in different provinces of China participated in the survey between February 1 and 5. The demographic information was collected first. Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Pittsburgh Sleep Quality Index (PSQI) were selected to measure PTSSs and sleep quality. Results showed that 1 month after the outbreak, the prevalence of PTSSs was 3.8% in HCWs. Female HCWs were more vulnerable to PTSSs with hazard ratio of 2.136 (95% CI = 1.388-3.286). HCWs with higher exposure level also significantly rated more hyperarousal symptoms (hazard ratio = 4.026, 95% CI = 1.233-13.140). There was a significant difference of sleep quality between participants with and without PTSSs (z value = 6.014, p < .001) and among different groups with various contact frequencies (chi-square = 7.307, p = .026). Path analysis showed that there was a significant indirect effect from exposure level to PTSSs through sleep quality (coefficient = 1.750, 95% CI of Boostroop test = 0.543-2.998). In summary, targeted interventions on sleep contribute to the mental recovery during the outbreak of COVID-19. Understanding the mental health response after a public health emergency might help HCWs and communities prepare for a population's response to disaster.

Assessment of knowledge gaps and perceptions about COVID-19 among health care workers and general public-national cross-sectional study.

BACKGROUND AND AIMS: COVID-19 has impacted everyone's life and livelihood in one way or the other. Individual response to measures taken to control the rapid spread of this disease depend on their knowledge and perceptions. Hence, we proposed to evaluate responses about COVID-19 among the health care workers (HCWs) as well as general public participants (GPPs). MATERIAL AND METHODS: This was a cross-sectional, observational survey conducted during the peak of the pandemic. The 35-items questionnaire was prepared using Google forms and distributed through e-mails and social media. RESULTS: The 1,026 responses comprised of 558 HCWs (54.4%) and 468 GPPs (45.6%). The most reliable source of information was TV news for 43% GPPs, whereas it was HCWs/Local health authorities for 36.8% HCWs. HCWs had sufficient knowledge regarding COVID-19, while it was relatively low among GPPs (average correct response 65% and 53%, respectively). Intra-group analysis with respect to age, sex, qualification, and socioeconomic status showed that knowledge about mode of transmission by airborne aerosols was significantly low with respect to qualification among GPPs while younger age group (<40 years) HCWs had significantly more knowledge about mode of transmission and asymptomatic carriers. Paranoia of contracting the infection was significantly higher in GPPs with upper and middle socioeconomic status and younger HCWs. CONCLUSION: HCWs had moderate level of knowledge, whereas GPPs had low to moderate knowledge, with large scope of improvement in both groups. Continued education, both at professional and community level will not only be helpful but also necessary to improve knowledge, avert negative attitudes and control the devastating pandemic.

Synthesis and Application of Silver Nanoparticles (Ag NPs) for the Prevention of Infection in Healthcare Workers.

Silver is easily available and is known to have microbicidal effect; moreover, it does not impose any adverse effects on the human body. The microbicidal effect is mainly due to silver ions, which have a wide antibacterial spectrum. Furthermore, the development of multidrug-resistant bacteria, as in the case of antibiotics, is less likely. Silver ions bind to halide ions, such as chloride, and precipitate; therefore, when used directly, their microbicidal activity is shortened. To overcome this issue, silver nanoparticles (Ag NPs) have been recently synthesized and frequently used as microbicidal agents that release silver ions from particle surface. Depending on the specific surface area of the nanoparticles, silver ions are released with high efficiency. In addition to their bactericidal activity, small Ag NPs (<10 nm in diameter) affect viruses although the microbicidal effect of silver mass is weak. Because of their characteristics, Ag NPs are useful countermeasures against infectious diseases, which constitute a major issue in the medical field. Thus, medical tools coated with Ag NPs are being developed. This review outlines the synthesis and utilization of Ag NPs in the medical field, focusing on environment-friendly synthesis and the suppression of infections in healthcare workers (HCWs).

Questionnaire-based Evaluation of Factors Leading to Patient-physician Distrust and Violence against Healthcare Workers.

BACKGROUND: Rising incidents of aggression and violence against healthcare workers (HCWs) is widening the rift between the patients and their caregivers. So, aim of the study was to evaluate the perceptions of healthcare workers (HCWs) and patient's attendants about factors responsible for widespread violence and patient-physician distrust. MATERIALS AND METHODS: An anonymous, questionnaire-based, cross-sectional study was conducted over a period of one year in a tertiary care teaching institute. Performas, adapted from WHO published questionnaire and translated to local language, were administered separately to HCWs and attendants. Responses generated were collected and analyzed. RESULTS: Out of 295 HCWs, 11 (3.7%) HCWs faced physical violence, whereas verbal abuse was faced by 147 (50%) HCWs. A higher number of incidents of physical violence (91%) and verbal abuse (64%) were faced by HCWs in the age group of 20-30 years. Verbal abuse was faced by 49.3% of nurses, 53% of junior residents, 61% of senior residents and 36% of consultants. Out of 158 incidents of workplace violence (WPV), maximum occurred in ICUs (62.0%) and emergency (21%). Unexpected death, unexpected complication, extended hospital stay, staff shortage and unexpected bill were some of the factors perceived to be responsible for WPV. CONCLUSION: HCWs commonly face violence from patient's attendants resulting in stressful and fearful environment at the healthcare facility. Dedicated sessions on good communication and counseling for HCWs and better security arrangements at the hospitals are the need of the hour and also in the best interest of HCWs and patients. HOW TO CITE THIS ARTICLE: Sharma S, Gautam PL, Sharma S, Kaur A, Bhatia N, Singh G, et al. Questionnaire-based Evaluation of Factors Leading to Patient-physician Distrust and Violence against Healthcare Workers. Indian J Crit Care Med 2019;23(7):302-309.

Management of two influenza vaccination campaign in health care workers of a university hospital in the south Italy.

BACKGROUND: In Europe, flu remains one of the major public health problems. Healthcare workers (HCWs) are a category at high-risk of contracting the infection and infecting their patients; consequently, for this category, vaccination is highly recommended. Unfortuntely, coverage levels remain insufficient with rates ranging between 4 and 40. STUDY DESIGN: The purpose of our work was to evaluate the adherence of HCWs to the influenza vaccination and to carry out a combination of educational and motivational interventions in order to increase the rate of adherence to the vaccination in this workers' category. METHODS: We conducted two different influenza vaccination campaigns, 2014-2015 and 2015-2016. The study was divided in two steps. In the first, preliminary step, an anonymous questionnaire was administered to HCWs containing a set of questions in order to gain information about the number of subjects willing to undergo the vaccination and the reasons that led others toits rejection. In the second step, vaccination campaigns were carried out preparing an appropriate vaccination calendar that was communicated to all interested Units and vaccination points located in various wards. RESULTS: We found a slightly improved compliance trend, from an average of 2.3% in the previous years to 3.3% in 2014 and 7.4% in 2015. CONCLUSIONS: Despite the observed increase, the adherence remains very low. We found that the main causes of this result are the fear of adverse effects, the negligence and indolence of the same workers and a lack of risk perception of contracting the disease and transmitting it to patients. Our work stressed the importance of offering correct information and of meeting the needs of HCWs, often unable to leave their ward for the excess workload. This could be, in future years, one of the possible solutions to increase vaccination adherence.