Complex presentations in people with diabetes: Does HbA1c help or hinder?

HbA1c measurement is widely used for diagnosis/ management/remission of diabetes with international schemes certifying comparability. A) 75 year-old Chinese female with type 2 diabetes was admitted in April 2020 with Covid-19 and diabetic ketoacidosis. Glucose was 35mmol/l and HbA1c 150mmol/mol with previous HbA1c of 45mmol/mol on metformin and alogliptin. She was treated for ketoacidosis and once-daily Lantus introduced along with supportive management of viral illness. B) 68 year-old Afro-Caribbean with type 2 diabetes on metformin before admission, presented with new onset, jerky ballistic movements of high amplitude in right arm, 10-15 movements every 5 min. Admission glucose was >33mmol/l, ketones 1.8mmol/l and HbA1c >217mmol/ mol. Hemichorea-hemiballism, a hyperglycaemia related movement was diagnosed and insulin commenced. Glucose decreased to 8-20mmol/ l, reaching 5-15mmol/ l by time of discharge. Ballistic movements resolved when glycaemic control improved with HbA1c 169mmol/mol, 25 days after discharge. C) Several days before admission, a female with diabetes over 20 years required attention from paramedics on four occasions for hypoglycaemia. Months beforehand metformin was replaced by gliclazide due to chronic kidney disease with HbA1c 50mmol/mol, and she was transfused six weeks before admission for microcytic anaemia. Gliclazide was discontinued and her diet modified which prevented further hypoglycaemic episodes. Variant haemoglobin, beta-thalassaemia which can overestimate glycaemia;undetected by HbA1c HPLC method, invalidated HbA1c as did the blood transfusion. These cases highlight that inadequate understanding of HbA1c can lead to acute presentations of dysglycaemia. As HbA1c accuracy can be affected by multiple factors, clinical assessment and triangulation are key to the management of such patients.

Rheumatology Advice Lines: How to Manage Rising Demand and Limited Capacity?

Background/Aims Advice lines services (ALS) are a key aspect of providing coordinated patient care in rheumatology. Demand for rapid access to specialist advice increased during the pandemic due to the disruption of routine outpatient services but it is not clear whether this demand is sustained. We aimed to investigate the changes in demand for ALS, how this varied pre/during COVID-19 and audit the effect upon response times. We also aimed to assess the impact of introducing an email advice service on demand. Methods We audited the number of advice line contacts of a single rheumatology department, serving a population of 500,000 people. The telephone adviceline is provided as an answer machine with an email advice service set up in April 2020. The outcome of each contact is recorded as a) advice only b) action required (e.g., prescription, blood test, GP letter) or c) required appointment (monitor/nurse/ medical). We audited response times using the RCN guidelines of a two-day response1 as the gold standard. Results Demand for advice had been increasing pre-COVID with an average of 368 calls/month (1/1/19-1/7/19) to 420/month (1/7/19-31/12/19). Sixty percent were advice only calls but 27% required additional action. Response times met the audit standard in 97% of cases pre-COVID. During the first two months of COVID demand for advice services doubled, however demand continued to rise although outcomes were similar (Table 1). As the number of contacts increased the proportion of telephone contacts responded to within the audit standard fell. Numbers of email contacts were variable, but response times exceeded the audit standard. Conclusion This audit demonstrates the demand of adviceline services has continued to increase throughout the pandemic and beyond, impacting the ability of services to respond within a timely manner. Ongoing QI work is assessing mechanisms to manage increased demand (using healthcare support workers to triage calls) and investigating reasons for accessing ALS to ensure appropriate advice is available. (Table Presented).

Mission Vaccine Suraksha - A Massive COVID 19 Vaccination Drive by Reliance Industries Limited

Introduction: Since the beginning of COVID 19 pandemic, more than 641 million cases and 6.63 million confirmed deaths were reported worldwide. A rapid development of COVID 19 Vaccine was the breakthrough in the prevention and control of COVID 19. India has commenced its vaccination drive from January 16, 2021 and has administered more than 219 crores vaccination to date it its people. On war foot, Reliance Industries Limited also launched its free vaccination coverage program - Mission Vaccine Suraksha for employees, family members, and community by collaborating with local authorities and governments. The organization also provided free vaccination to Kerala, Gujarat, Rajasthan, and Maharashtra besides various other national and regional organisations to speed up the vaccination drive. Methodology: A taskforce including stakeholders form the Medical Services, HR, Procurement, Logistics, transportation, digital systems was formed to oversee, implement, monitor, and evaluate a successful vaccine roll-out drive. The drive included Covishield and Covaxin COVID 19 vaccines. As a single point of contact, Reliance Foundation HN Hospital procured, stored, and transported vaccines to all locations. At par with Govt. protocols, Reliance developed its own workplace COVID vaccination centres (CVCs) at its corporate headquarters and 11 other manufacturing sites in Maharashtra and Gujrat. For Cold chain management, Reliance procured Ice Lined Refrigerators (ILRs), refrigerators, vaccine carriers, icepacks, etc. for each CVC. Dedicated medical and paramedical staffs were recruited and trained to carry out vaccination drive with all the COVID 19 protocols in place. Reliance tied up with multiple hospitals to carry out pan-India vaccination drive. The entire operation was digitally enabled by involving mediums such as Reliance's in-house app JioHealthHub (JHH) that included end-to-end vaccination journey, i.e., from slot booking, CoWIN registration, post-vaccination care, uploading of the certificates, etc. Vaccine inventory was monitored by Reliance's digital system named KiviHealth. A vaccination dashboard was created to track real time vaccination update. Result(s): 40 lakh vaccine doses were provided free of cost to support the nationwide vaccination programme. Till date, 31,63,870 beneficiaries were covered under R-Suraksha under which, 15,94,357 people received their 1st dosage, 13,36,613 received the 2nd dose, and 2,32,900 people have received the precautionary dose. Reliance also commenced vaccination for children aged 12 to 17 years covering 7369 children for 1st dose, 5802 children for 2nd dose. Reliance has achieved 100% compliance for 2 doses of COVID 19 vaccination for its employees and contract workers across manufacturing units. Precautionary dose was administered to 75% of employees and contract workers to date. 25 mild and 3 moderate Adverse Event Following Immunization (AEFI) cases were recorded during vaccination at workplace CVCs, which were managed and sent home. Conclusion(s): Reliance's Mission Vaccine Suraksha has reached to all corners of the country, including people with disabilities, the elderly, homeless, and those in far-flung locations. Reliance faced hurdles in procuring and storing of the vaccines at the beginning of the operation. However, this was tackled effectively with strategic approach. The initiative is still ongoing ensuring maximum precautionary dosage coverage for everyone.

Context of SARS-COV- 2 contamination of health care workers in a Tunisian academic hospital

Background: Since the emergence of SARS-CoV- 2 in China, health care workers have been identified as being at risk of contracting Covid-19. Objective(s): To describe the exposure situations of healthcare workers affected by SARS-CoV- 2. Method(s): A questionnaire was established and filled in by healthcare workers practicing at the Sahloul University Hospital of Sousse-Tunisia, who were diagnosed with COVID-19 during the period from September 1, 2020 to December 31, 2020. Data were collected on activity, type of tasks performed, wearing of protective equipment, and existence of possible contacts with cases (professional or extra-professional), in the 2 weeks preceding the date of symptom onset. Result(s): A total of 188/287 infected healthcare workers responded to the questionnaire. The gender and age distribution of the respondents showed a sex ratio of 0.34 and an average age of 41 years. Paramedical staff represented 63% of the participants. Among the infected caregivers, 16 (8.5%) had not worked during the 15 days preceding the symptoms. There were 69 (36.7%) professionals who worked in the Covid sector. The rate of use of a FFP2 mask for the most risky tasks varied greatly according to the sector of practice. Concerning hydro-alcoholic solutions, 58.5% of the workers stated that they had them as often as necessary. Other exposure situations outside of direct patient care were reported by these infected workers: 20.4% reported at least one contact without a mask with one or more caregivers with a confirmed Covid-19 infection, and 32.4% reported contacts with suspected or confirmed cases of Covid-19 infection outside of their professional activity. Conclusion(s): The context of contamination of healthcare workers seems to be essentially professional. The nonuse of protective masks, particularly in non-COVID sectors, as well as the role of contamination between caregivers at their workplace seem to be important determinants of healthcare workers' contamination.

Management of Pregnant Woman in their Third Trimester with SARS-COV-2 Symptoms in the Rural Setting

Objective: Can a way forward be created to establish baseline criteria to better assist aeromedical transport crews with optimizing care and increasing the probability of survival of acutely distressed women in their third trimester of pregnancy with SARS-COV-2 symptoms? Information has been derived from a mixed methods research approach. Pregnant individuals with SARS-COV-2 are at increased risk of intensive care unit admission, mechanical ventilation, and death compared with both pregnant individuals without SARS-CoV-2 infection and nonpregnant adults with SARS-CoV-2 infection1. Hypertensive disorders of pregnancy affect up to 20% of pregnancies in the United States and are leading causes of serious obstetric morbidity1. The focus of this research included nearly 2,400 pregnant women infected with SARS-CoV-2 and found that those with moderate to severe infection were more likely to have a cesarean delivery, to deliver preterm, to die around the time of birth, or to experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They were also more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks. Method(s): We intend to develop an algorithm based on current guidelines to smooth the transition of care from prehospital to intrahospital. We will use the guidelines set forth by The American College of Obstetrics and Gynecology (ACOG). In addition, we will take an example of the policies and procedures from a prehospital care aeromedical flight service for inclusion in our proposed treatment recommendation(s). Result(s): We will then use the guidelines to make an all-encompassing protocol to guide the whole trip from onset of symptoms to in hospital care. We believe that a protocol that encompasses the whole of both systems, prehospital flight and in hospital, will help to streamline patient care tasks and reduce the probabilities of morbidity and mortality. Conclusion(s): The aeromedical community should seek out partnerships with the appropriate entities to provide invaluable information about a critical time of transitioning the patient from the point of access to the healthcare system to the appropriate definitive care facility. The aeromedical community has specialized paramedics, nurses, and physicians with knowledge and experience that cannot easily be quantified. These efforts could result in treatment modalities addressing acute management intra/inter hospital upon initial publication and equip air medical personnel with additional critical care education and knowledge to take back to their perceptive communities to enhance the probability of survival with pregnant women adversely affected by SARS-COV-2.Copyright © 2022

Work productivity and activity limitation in healthcare workers after COVID-19 infection

Background: The Covid-19 pandemic has had a significant impact on the physical and psychological health of the people affected. However, this impact has been more significant for health care workers who were on the front line of the management of this health crisis. Objective(s): To evaluate the work productivity and the limitation of activities of healthcare workers in post-COVID- 19. Method(s): A Cross-sectional study was conducted among healthcare workers practicing at the Sahloul University Hospital in Sousse-Tunisia, diagnosed with COVID-19 during a 3-month period. Work productivity and activity limitation were assessed 3 months after infection by the French version of the WPAI questionnaire. Result(s): A total of 188 affected healthcare workers completed the questionnaire (sex ratio = 0.34;mean age = 41 years). Paramedical staff represented 63.1% of respondents. 28.6% worked in the emergency and intensive care units. More than half of the affected workers (52, 4%) had retained physical symptoms 3 months after covid 19 infection. The average percentage of absenteeism was 5.48% and presenteeism was 23.04%. Activity limitation was 26.84%. Work productivity was correlated with age (p = 0.015), presence of pathological history (p = 0.043), and presence of post-covid- 19 physical symptoms (p = 0.007). Conclusion(s): Covid-19 appears to have an impact on work productivity in some healthcare workers.

Post-COVID- 19 syndrome in healthcare workers

Background: COVID-19 is a disease with a varied expression, in terms of its clinical expression, its severity, and its duration. The persistence of symptoms during several weeks or months after the first episode has been reported in several studies. The objective of this survey was to identify the occurrence of post-COVID- 19 symptoms and its determinants in healthcare professionals of Sahloul Academic Hospital in Tunisia. Method(s): A cross-sectional survey was carried out among healthcare workers in Sahloul Academic Hospital in Tunisia for which a diagnosis of COVID-19 was made between September 1, 2020 and December 31, 2020. Data included socio-demographic, professional, and clinical features. Post-COVID symptoms were evaluated 6 months after infection. Result(s): A total of 188/279 affected healthcare workers had participated in our study. The mean age was 41 years and the sex ratio was 0.34. Paramedical staff represented 63.2% of the population. 22.8% were working in the emergency and intensive care units. A previous medical history was reported by 45.2% of patients. The initial symptoms were asthenia (65.4%), headaches (52.9%), and fever (39.4%). Five cases required hospitalisation. Persistent symptoms 6 months after the infection were reported by 67.6% of the staff. The most commonly reported symptoms were asthenia (25%), shortness of breath (24.5%), arthromyalgia (16%), and chest pain (13.3%). The occurrence of post COVID19 symptoms was correlated with female gender (p = 0.018) and initial symptomatic form (p = 0.043). Conclusion(s): The post-COVID- 19 syndrome was common in the population studied. The poly-symptomatic and fluctuating nature of its clinical manifestations raises questions and concerns for patients and clinicians.

Knowledge, attitudes and perceptions of radiology healthcare workers during the COVID-19 pandemic

Background: Medical imaging is vital in the diagnostic workup and evaluation of patients suspected or confirmed to have COVID-19;hence, radiology healthcare workers (HCWs) were an essential part of the early containment response to the pandemic. Radiology services are facing rising demands to introduce stricter infection control measures, and staff are expected to adhere to the new protocols while coping with a surge in patients. Objective(s): This study aims to identify the knowledge, attitudes and perceptions (KAPs) of radiology HCWs at a single site with regard to workplace preparedness during the COVID-19 pandemic. Method(s): A 26-item questionnaire was conducted with radiographers, radiology nurses, and support staff who had direct patient contact. Questions were concerned with involvement in managing suspected or positive COVID-19 patients, knowledge of infection control measures, and attitudes and perceptions in relation to working during the pandemic. Results were analysed using t-tests, chi-square tests, and Spearman's rank-order correlation, with statistical difference set at p<0.05. Result(s): Radiology HCWs self-reported significantly better knowledge of infection control measures and positive work attitudes. Those who had received the flu vaccine had significantly better perceptions of working during the pandemic. Suggested improvements included better organisational structure and more resources, better staff compliance and vigilance, better education, and a clearer focus on staff wellbeing. Conclusion(s): The findings indicate favourable KAPs among radiology HCWs in Singapore with regard to workplace preparedness during the pandemic, but efforts towards sustainability must be considered. Formulating policies to nurture motivated and resilient HCWs during a pandemic is advocated to foster a resilient workforce that is prepared for the next pandemic.Copyright © The Author(s) 2021.

Sleep disorders in healthcare workers

Introduction: COVID-19 has killed more than 5 millions people worldwide. The effects on mental health are also significant, especially among healthcare personnel. Our aim is to determine the prevalence and the factors of sleep disorders on healthcare workers. Method Descriptive and analytical cross-sectional study including 87 healthcare workers during February 2022, using an anonymous online questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Result(s): The average age was 31.71 +/- 5.93 years. Sex ratio was 1.04. The participants were doctors (69.6%) and paramedical staff (30.4%), 23.2% of them had comorbidities: cardiovascular pathologies (27.2%), respiratory pathologies (24.7%) psychiatric pathologies (18.1%), neurological pathologies (13.9%) and immunodeppression (11.2%). 86.3% were working in the public sector. 62.3% had worked in a COVID-19 unit. Severe clinical insomnia was found in 9.7% and moderate severity clinical insomnia in 13.1%. For the PSQI, 41.5% had an overall score>5, which is an indicator of sleep disorders. A sleep latency>30 minutes was observed (22%), nocturnal awakenings (15.9%), a feeling of fatigue at work (61%) and difficulty concentrating was reported in 38%. For behavioral disorders during sleep, participants had nightmares (35.2%), sleep paralysis (17.7%), sleep talking (10.9%), bruxism (1%) and somnombulism (1.2%). Sleep disorders were correlated with the presence of newborns or infants at home (p=0.001), the number of shifts and working hours per week (p=0.034) and the presence of psychiatric comorbidities (p<0.05). Conclusion(s): Sleep disorders among caregivers are quite common, long-term follow-up for better prevention and management is necessary.

Assessment of Psychiatric Morbidity In Healthcare Professionals Working In A Covid Hospital In West Bengal During Covid-19 Pandemic

Introduction: Pandemic, being unprecedented, leads to several mental health problems, especially among the front-line healthcare professionals (HCP). Front-line HCPs often suffer from anxiety, depression, burnout, insomnia and stress-related disorders. This is mediated by different biopsychological vulnerabilities of the individuals;socio-environmental factors such as the risk of exposure to infection, availability of personal protective equipment, psychological impact of the isolation/quarantine and interpersonal distancing also play the major roles. Aim(s): This study aimed to investigate the Psychiatric Morbidity in different Healthcare professionals (HCPs) and to observe any changes that occurred in this COVID pandemic situation. Material(s) and Method(s): The present study was a Hospital based Cross-sectional observational study, conducted over 1.5 years at College of Medicine and Sagore Dutta Hospital, Kamarhati. 126 HCPs (Consultants, Senior Resident, junior residents, Interns, Nurses, Paramedical Staffs, Non-Clinical staffs) were included in this study. Bengali version of Self Rated Questionnaire (SRQ-24) was used to assess the psychiatric morbidity. Result(s): In our study 61.9% HCPs were having Psychiatric Morbidity and 38.1% were not having Psychiatric morbidity. Among Consultants 30.2% had psychiatric morbidity, among Senior Residents 40%, in Junior Residents 52.9%, among Interns 50%, among Nurse 77.8% and in Non-Clinical Stuffs 69.6% and in Paramedical Stuffs 75% had psychiatric morbidity. Conclusion(s): Healthcare professionals had to do their duty in many adverse situations in COVID pandemic. They had to face tremendous mental and physical pressure and frequently they became exhausted. In spite this they did duty properly and saved millions of lives. So, their mental health should be assessed and proper intervention should be taken.

Challenges Faced by Hilly Hospitals during Covid-19 Second Wave Disaster: Quantitative Study in Garhwal Region, Uttarakhand

Covid -19 second wave was considered a disaster in India as it was more havoc than the first one. Shortness of breath in patients leads to more demand for oxygen and hospitalization. So, there was a challenge for the hospitals to combat this disease. In the covid second wave, moderate to severe cases were treated at three hospital levels (CHC, Sub-district, and District hospital). This disease was not limited to bigger cities but spread to rural and hilly areas. We conducted quantitative research among government hospitals in five hilly districts of Uttarakhand at three levels of hospitals. Data were collected from a close-ended questionnaire using a judgmental sampling technique and analysed with the help of tables and bar charts. Questions were set based on the pilot study. The challenges explored through this study were divided into five main headings and eleven sub-headings. The main headings were Manpower, Surge capacity, logistics, coordination, and management of non-covid patients. Sub-headings were a shortage of medical staff, shortage of paramedical staff, shortage of sweepers, shortage of ambulance drivers, shortage of ICU beds, shortage of oxygen beds, shortage of covid drugs (Remdesivir and Steroids), oxygen cylinders, PPE kits, difficulty in coordination with staff and difficulty in managing non- covid patients.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Telenephrology: Managing Chronic Kidney Disease during Covid-19 Pandemic

Introduction: The management of kidney diseases is challenging in areas where discrepancy exist between number of nephrologist and patient with kidney disease. COVID-19 pandemic added to these challenges. We initiated a tele-nephrology service in 2020 with primary aim of education, targeted screening and treatment of kidney diseases focusing where there was no nephrologist. Method(s): In this study locally available paramedics were mobilized for information dissemination and follow up of index patient population. The consultation was performed by internists and nephrologist. After initial registration in telemedicine service, social media apps were used for communication. The mode of communication used was audio, text, photography, and video call when needed. Follow-up consultation was done as required and in 3 months which involved review of reports and medical advised as needed including medication. We analyzed the data from the records of tele-nephrology service provided from April 2020 to April 2021 and who has completed at least 6 months of follow up. Result(s): A total of 266 participants who were known to have chronic kidney disease and hypertension were enrolled and followed up. The mean age of the participant was 54.21 + 17 years. Females constitute 53% (n=141). The most common mode of communication was WhatsApp (86.5%), followed by Viber (5.6%). Patients were advised to undergoes investigations in nearby health care facilities as needed. Most of the participants (88.0%, n=232) were managed without need for physical hospital visit. Physical visit to hospital was needed in 84 patients (17%) and 4.1% (n=11) needed hospital admission. During follow up, half of the participants (n=134) had performed tests as advised and 44.4% (n=118) followed the treatment advised, in initial consultation and needed further advice to do so. Five persons died during follow-up (1.9%). Few participants 1.1%(n=3) said that they don't want to use the telemedicine service again. Conclusion(s): Tele-nephrology services can bridge the gap in care in nephrology where access to nephrologists is limited. No conflict of interestCopyright © 2023

Results of a pilot optional e-triage teledermatology advice and guidance pathway for equivocal lesions as an alternative to 2-week wait referrals in two large general practitioner networks in a city

In our hospital we receive about 200 skin 2-week wait (2WW) referrals weekly. This is a huge burden on local services. Many of these patients are discharged at the first appointment, and, for a significant proportion of referrals, the 'level of cancer concern' on the general practitioner (GP)-provided 'suspected skin cancer referral form' is rated: 'I'm unsure, it might well be cancer but there are other equally plausible explanations'. In collaboration with secondary care and community stakeholders, an innovative pilot using an optional teledermatology advice and guidance process (A&G) was implemented as a complementary pathway for patients in two large GP practice networks. Conventional 2WW faceto- face referrals could be initiated as normal;however, at the GP's discretion an alternative teledermatology e-triage A&G pathway was introduced for lesions equivocal for malignancy. A model where healthcare assistants (HCAs) maintained a weekly clinic in each of the practices was designed and implemented. The HCA received training and undertook a lesion history via proforma and macroscopic and dermatoscopic photographs, which were subsequently uploaded to the National Health Service e-referral service. A consultant dermatologist reviewed the A&G e-triage request within 72 h and either provided advice or recommended 2WW referral, which was then actioned via the outpatient appointment centre, without further need for GP action. The pilot commenced in November 2021. Over 2 months (November-December 2021 inclusive) 101 e-triage A&G requests were made and 212 conventional 2WW face-to-face referrals. Of the A&G e-triage requests 70 (69.3%) were returned with advice and the patient did not require onward referral. In total 70/313 (22.4%) of the skin lesion episodes were retained in primary care with advice. Since the initiation of the pilot, there are signs that A&G requests and 2WW referrals are changing, with increased uptake in A&G e-triage. Comparing the referral behaviours of the two practice networks before and after the pilot is a challenge given the short period of the pilot and the event of COVID-19 on referral patterns. However, in November- December 2019 (pre-community COVID-19 in the UK), the two practices sent 201 2WW referrals juxtaposed with 212 intrapilot (November-December 2021). This demonstrates a more sustainable number of 2WW referrals and in keeping with previous levels at a period when locally skin 2WW referrals are increasing. Fiscally, given that many of the A&G e-triage requests would have resulted in a face-to-face 2WW referral a cost saving has been made. Our interim data demonstrate the development and implementation of an optional A&G e-triage pathway as an alternative approach for equivocal lesions and it has resulted in retention of 22.4% of would-be 2WW referrals in primary care. Community stakeholders and engagement has been crucial for the project. Our 6-month pilot data will be presented.

Psychological impact of the covid-19 pandemic on the operating room paramedical staff

Introduction: the recent covid19 pandemic is not devoid of psychological risks on paramedical staff. Among them, those who work in the operating theaters are exposed to such risks. Objective(s): to determine the perceived stress level and the psychological impact of COVID-19 on paramedics in the operating room. Method(s): This is an observational, descriptive and analytical study carried out in the operating rooms of Sahloul University Hospital during a 3 month period. The data collection tool was a selfadministered questionnaire composed of 5 main parts (sociodemographic characteristics, occupational characteristics, exposure to COVID-19, the Perceived Stress Scale (PSS) and the Hospital Anxiety and depression scale (HADS)). Result(s): 96 paramedical staff participated in our study. The average perceived stress score was significantly higher among anesthetists. 48% of participants had anxiety. Anesthetists had significantly higher anxiety scores (p = 0.001). 26.1% of participants had definite depression. Of those with definite depression, 35.3% were anesthetists (p = 0.028). Factors significantly associated with the occurrence of anxiety were: psychiatric history, increased workload, contact with a positive coronavirus patient in the operating room, and severe perceived stress. However, the factors significantly associated with the occurrence of depression were: initial training in the management of covid-19 patients, personal infection with SARS-COV2 and severe perceived stress. Conclusion(s): Covid-19 pandemic is causing significant symptoms of anxiety and depression among operation room staff. Primary and secondary prevention strategies must then be undertaken.

Exploring the reasons behind Ocrelizumab infusions delay during the first wave of COVID-19 pandemic in Italy: results of a survey among MS centers

Introduction: MS centers (MSc) activities related to OCR management were strongly and diffusely hit during the first wave of COVID-19 pandemic. Concerns were mainly related to its immunosuppressive effects and the need for in-hospital administration. Objective(s): To investigate changes in OCR schedule among Italian MS centers participating to the Italian MS Register during the first wave of COVID-19 pandemic and to identify factors determining such changes. Material(s) and Method(s): A quick online survey was sent to 65 Italian MSc in order to collect from them the following data: macro-region (North, Center, South) location, number of OCRtreated patients, modifications of OCR schedule and a list of factors potentially influencing the postponement of OCR infusions (i.e. age, co-morbidity, MS phenotype, number of previous OCR cycles, disease severity/activity, CD-20 lymphocytes count, distance to MS center, fear of infection, inclusion in a research trial, infections trend, shortage of medical/paramedical staff for reallocation/ infection). Result(s): Among 55 MSc who answered the survey, 50 (91%) declared to have suspended or extended OCR interval dosing for at least one patient. The MSc that didn't modify OCR schedule were all from the South of Italy (33% of all South MSc). Main factors influencing OCR schedule delay were advanced age/comorbidity (70%) and pandemic trend in the area (72%), while recent MS-disease activity hindered OCR schedule modifications (65%). Conclusion(s): This study shows that most Italian MSc decided either to delay or suspend OCR treatment during the first wave of COVID-19 pandemic. Advanced age and co-morbidity and no evidence of recent MS-disease activity were the most relevant patient-dependent predictors of OCR postponement. Among patient-independent factors the most relevant factor was the local trend of infections. Contrary to what expected, the shortage of medical and/or paramedical staff in MSc did not come out as relevant. The disruption of OCR schedule during the first COVID-19 pandemic wave in Italy mostly reflected the geographical distribution and the impact on the National Health System of COVID- 19 pandemic.

Mental health status of frontline clinical nurses fighting the Omicron variant of COVID-19 - a cross-sectionalsurvey in China

Introduction and Objective. From March 2022, China has been in the rapid progressing stage of the Omicron outbreak. However, the mental status of clinical nurses against infection by the Omicron variant of COVID-19 has been not explored. Therefore, a nationwide online investigation with a larger sample size was conducted to explore the mental status of Chinese frontline clinical nurses, and its influencing factors using sound validated and reliable measurements. Materials and method. A cross-sectional study was conducted, and 1,204 clinical nurses fighting the Omicron outbreak were recruited across various provinces of China. Results. The mean age of the nurses was 30.43 (SD=6.59) years. The majority were female. The rates of these nurses with depression, anxiety, stress, and insomnia symptoms were 29.2%, 37.2%, 19.1%, and 48.8%, respectively. The variables of department, insomnia, fear with COVID-19, turnover intention, job burnout, work coping style, and public recognition of nursing, were significant factors influencing the mental status of clinical nurses. Conclusions. The Chinese clinical nurses fighting the Omicron variant of COVID-19 had a similar level of depression and anxiety, a higher level of insomnia, and a lower level of stress, in comparison with nurses globally who experienced the initial period of the pandemic. Targeted investigation and interventions are urgently needed for Chinese frontline clinical nurses with high levels of anxiety, depression and insomnia, who fought against infection by Omicron. Much more professional advocacy is strongly recommended during control of the pandemic and recovery to consolidate the role and influence of nurses. The contribution and visibility of nursing should be recognized not only by the medical professionals, but by the public in general. Copyright © 2022, Institute of Agricultural Medicine. All rights reserved.

Effect of selected factors related to emotions and general health on the health behaviours of paramedics

Introduction and Objective. Lifestyle and its related health behaviour are significant factors affecting health. The aim of this study was to define a selection of factors influencing the health behaviour of paramedics from the Masovian Province, the biggest in Poland. Materials and method. The study group consisted of paramedics employed in Emergency Response Teams (ERT) on the territory of Masovian Province. The study involved 238 participants: 223 men and 15 women. The mean age of the participants was 39.03±9.27 years for males, and 31.93±7.76 years for females. The research was carried out between May 2019 – September 2019 using the diagnostic survey method, including Jurczyński’s Health Behaviour Inventory (HBI), Courtauld’s Emotional Control Scale (CECS) and the General Health Questionnaire (GHQ-28). Results. The health behaviours of the participants were defined as average. The probability of exhibiting proper health behaviours increases with age (OR=2.178, 95% Cl: 1.030–4.604;p 0,042), the ability to control emotions, especially on the depressive mood scale, (OR=0.901, 95% Cl: 0.827–0.981;p 0.017) and the general health condition, i.e., the less anxiety or insomnia the participating paramedics experience, the higher the chance of them exhibiting proper health behaviours (OR =0.809, 95% Cl: 0.725–0.903;p 0.000) or not experiencing social dysfunction (OR=0.760, 95% Cl: 0.628–0.920;p 0.005). Conclusions. As an occupational group, paramedics require help from their employers and other specialists in the fostering of proper health behaviour in order to experience a good quality of life in the workplace and beyond. Educative measures have to be undertaken in the paramedic population, especially with regard to ameliorating eating habits, handling stress, burnout prophylaxis, and counteracting musculo-skeletal disorders.

Challenges in Implementing Patient Safety Culture Ii (Stop the Line Project)

Aims To understand barriers of implementing a near-miss reporting and sharing of lessons as part of patient safety II culture. Staff must be encouraged to report less serious incidents and near misses as well as more serious errors if lessons are to be learned and patient safety enhanced.1 A key task in the enhancement of patient safety involves the ability to learn from error.2 The intention is that any staff member, irrespective of role, grade, seniority, or experience, can call 'Stop the Line' if they see that required safety procedures and checks are not being followed. All members of staff are encouraged to 'Stop the Line' if they notice a series of steps/process that could potentially cause harm to a patient. The event/incident that is stopped is referred to as a 'near miss'. Methods Stop the line piloted in specific clinical area in our trust (Paediatrics unit, surgical ward, neurosurgical theatres). This project was commenced on 1st November 2020. But due to Covid 19 clinical workload pressure it was paused from April 2021, I took over the project last September 2021. -Despite the project being piloted since last year, still considerable number of staff not fully understanding the project and what are near misses and small numbers of near misses reported throughout following months. -A survey formulated and distributed to health staff across the trust to explore their knowledge of near misses and the barriers for lack of reporting. Results The survey designed and published to the staff through global email. Survey structured of four segments including the Department and Job position, Knowledge about the project, definition of a near miss event and how to report a near miss, questions to check situations classifications as near misses or not and questions regarding their perception of barriers for reporting near misses. -Total 60 Respondents from different departments and roles: -Respondents included variant range of roles in the health care system including Consultants, Support workers, Junior doctors, Staff Nurses, Head of Outpatient Services, Healthcare assistants, ward clerks, Pharmacist, Digital Communications Managers, Project officers, members from Patient Safety & Improvement, Resuscitation officers. 90% of respondents reported knowledge of near miss definition, and similar proportion acknowledges that near misses should be reported (87%) (figure 1). -Approximately two thirds of staff respondents were knowledgeable how to report near misses (63%) compared to 37% who did not (figure 1). -Among variable scenarios 73-88% of respondents could identify the near miss events. -Main suggested barriers to reporting near miss events were time constraints, lack of awareness of importance of near misses reporting and fear of reporting on colleagues involved in the event. Conclusion There is a gap between staff intent to record a near miss occurrence and actual event reporting which could be either due to low incidence of near misses in the health organization or simply because of under reporting. (Figure Presented).

Creating Confident Clinicians: Undergraduate Paediatric Simulation

Aims Medical simulation is a well-recognised tool in reducing anxiety and improving clinical confidence and competence in medical students (1). During the coronavirus pandemic a large proportion of medical students studied virtually with >23.5% of students studying online for >15 hours a week (2), reducing clinical exposure. We appreciate that this may affect confidence in clinical assessment. Studies have shown repeated exposure to simulation is important in building and retaining confidence in medical students (3). We developed a robust simulation programme at a children's teaching hospital for 20 fourth year undergraduate medical students from one higher education institution, aiming to establish whether simulation could improve students' confidence in assessing an unwell child. Methods A seven week programme was developed providing students up to four simulation sessions in total. All students acted as both participants and active observers. We surveyed 20 students on their confidence in assessing a child before and after the implementation of the programme, running alongside their paediatric rotation. The students divided their roles as junior doctors, nurses, and healthcare assistants. We discussed these roles in detail so they could appreciate the interprofessional involvement in such scenarios. Each scenario involved an introduction to simulation, introduction to the equipment, a pre-brief of the scenario and proposed methods of management, a ten minute acute paediatric scenario, and a debrief as per the diamond debrief model (figure 1). Scenarios covered included bronchiolitis, sepsis, acute asthma, and anaphylaxis;providing a range of acute paediatrics. APLS guidelines, the BNFC, and local protocols were available;as well as senior support if called. All teachers were trained in simulation teaching and debriefing. We collected qualitative and quantitative feedback through anonymous surveys. Of note, for 89% of students this programme was their first experience of paediatric simulation. Given the limited exposure of the students to simulation, the first session had a dedicated 10 minute talk on the concepts of simulation including the 'suspension of disbelief '. Results Initially, students felt 'scared', 'stressed', 'anxious' and 'inexperienced' about assessing a sick child and 'intimidated', 'terrified' and 'nervous' about simulation. Following the programme (see figure 2): 65% of students felt 'somewhat confident' in examining children. 94.7% of students feel that simulating acute scenarios will benefit their practice. 90% of students felt more confident about future simulation. Students appreciated the opportunity to 'practice making decisions'. One student commented that this is 'hard to come by on wards as you're often just observing rather than assessing'. Conclusion This seven-week paediatric simulation programme improved student confidence in examining and assessing an unwell child, in addition to improving confidence for future simulation. Alanazi et al proposed five best practice measures of simulation in education: study design, debriefing, integration of interprofessional education values, outcome measures, and student satisfaction. All were practised in this programme. Through ensuring a psychologically safe workspace, with appropriate resources and trained teachers, we believe we have created a non-intimidating and encouraging simulation environment. We look to provide virtual alternatives such as online video based interactive simulation should social distancing affect simulation teaching further.