Organisation and delivery of a dedicated multidisciplinary prone ventilation team in the intensive care unit: Strategies and lessons from COVID-19.

BACKGROUND: COVID-19 placed immense strain on healthcare systems, necessitating innovative responses to the surge of critically ill patients, particularly those requiring mechanical ventilation. In this report, we detail the establishment of a dedicated critical care prone positioning team at University Hospital Southampton in response to escalating demand for prone positioning during the initial wave of the pandemic. METHODS: The formation of a prone positioning team involved meticulous planning and collaboration across disciplines to ensure safe and efficient manoeuvrers. A comprehensive training strategy, aligned with national guidelines, was implemented for approximately 550 staff members from a diverse background. We surveyed team members to gain insight to the lived experience. RESULTS: A total of 78 full-time team members were recruited and successfully executed over 1200 manoeuvres over an eight-week period. Our survey suggests the majority felt valued and expressed pride and willingness to participate again should the need arise. CONCLUSION: The rapid establishment and deployment of a dedicated prone positioning team may have contributed to both patient care and staff well-being. We provide insight and lessons that may be of value for future respiratory pandemics. Future work should explore objective clinical outcomes and long-term sustainability of such services.

The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students.

BACKGROUND: Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS: Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS: One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION: The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

Caring for COVID-19 patients through a pandemic in the intensive care setting: A narrative review.

Since the declaration of the novel SARS-CoV-2 virus pandemic, health systems/ health-care-workers globally have been overwhelmed by a vast number of COVID-19 related hospitalizations and intensive care unit (ICU) admissions. During the early stages of the pandemic, the lack of formalized evidence-based guidelines in all aspects of patient management was a significant challenge. Coupled with a lack of effective pharmacotherapies resulted in unsatisfactory outcomes in ICU patients. The anticipated increment in ICU surge capacity was staggering, with almost every ICU worldwide being advised to increase their capacity to allow adequate care provision in response to multiple waves of the pandemic. This increase in surge capacity required advanced planning and reassessments at every stage, taking advantage of experienced gained in combination with emerging evidence. In University Hospital Southampton General Intensive Care Unit (GICU), despite the initial lack of national and international guidance, we enhanced our ICU capacity and developed local guidance on all aspects of care to address the rapid demand from the increasing COVID-19 admissions. The main element of this success was a multidisciplinary team approach intertwined with equipment and infrastructural reorganization. This narrative review provides an insight into the approach adopted by our center to manage patients with COVID-19 critical illness, exploring the initial planning process, including contingency preparations to accommodate (360% capacity increment) and adaptation of our management pathways as more evidence emerged throughout the pandemic to provide the most appropriate levels of care to our patients. We hope our experience will benefit other intensive care units worldwide. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics.

Assessing the crash risks of evacuation: A matched case-control approach applied over data collected during Hurricane Irma.

Recent hurricane experiences have created concerns for transportation agencies and policymakers to find better evacuation strategies, especially after Hurricane Irma-which forced about 6.5 million Floridians to evacuate and caused a significant amount of delay due to heavy congestion. A major concern for issuing an evacuation order is that it may involve a high number of crashes in highways. In this study, we present a matched case-control based approach to understand the factors contributing to the increase in the number of crashes during evacuation. We use traffic data for a period of 5 to 10 min just before the crash occurred. For each crash observation, traffic data are collected from two upstream and two downstream detectors of the crash location. We estimate models for three different conditions: regular period, evacuation period, and combining both evacuation and regular period data. Model results show that, if there exist a high volume of traffic at an upstream station and a high variation of speed at a downstream station, the likelihood of crash occurrence increases. Using a panel mixed binary logit model, we also estimate the effect of evacuation itself on crash risk and find that, after controlling for traffic characteristics, during evacuation the chance of a crash is higher than in a regular period. Our findings have implications for evacuation declarations and highlight the need for better traffic management strategies during evacuation. Future studies may develop advanced real-time crash prediction models which would allow us to deploy proactive countermeasures to reduce crash occurrences during evacuation.

A framework for identifying and selecting long term adaptation policy directions for deltas.

Deltas are precarious environments experiencing significant biophysical, and socio-economic changes with the ebb and flow of seasons (including with floods and drought), with infrastructural developments (such as dikes and polders), with the movement of people, and as a result of climate and environmental variability and change. Decisions are being taken about the future of deltas and about the provision of adaptation investment to enable people and the environment to respond to the changing climate and related changes. The paper presents a framework to identify options for, and trade-offs between, long term adaptation strategies in deltas. Using a three step process, we: (1) identify current policy-led adaptations actions in deltas by conducting literature searches on current observable adaptations, potential transformational adaptations and government policy; (2) develop narratives of future adaptation policy directions that take into account investment cost of adaptation and the extent to which significant policy change/political effort is required; and (3) explore trade-offs that occur within each policy direction using a subjective weighting process developed during a collaborative expert workshop. We conclude that the process of developing policy directions for adaptation can assist policy makers in scoping the spectrum of options that exist, while enabling them to consider their own willingness to make significant policy changes within the delta and to initiate transformative change.

Identification of microbial faecal sources in the New River in the United States-Mexican border region.

Water samples were analysed to differentiate human and animal faecal contamination of the New River, Mexico/USA, by genotyping bacterial viruses detected in the samples. From 46 water samples collected from the New River, 372 plaques of male-specific coliphages were isolated and genotyped; 44% of the plaques were identified as F-RNA coliphages and further characterized into four groups. Group I was the most prevalent (56%), followed by group IV (25%), group III (10%) and group II (9%). Group III coliphages were only detected at the sampling site in the vicinity of the international boundary, indicating human faecal contamination. As the New River traverses through the US region, groups I and IV coliphages were predominantly identified, but no human-specific genotypes were detected. The study also found that water temperature influenced the prevalence of the relative proportions of F-RNA coliphages in the environmental water samples. The strategy used in this study appears to be a practical and reliable tool for monitoring and distinguishing between human and animal faecal contamination.