Emotional, mental health and physical symptom experience of patients hospitalized with COVID-19 up to 3 months post-hospitalization: A longitudinal study.

AIMS AND OBJECTIVES: To explore emotional, mental health and physical symptoms up to 3 months after discharge for adults hospitalized with COVID-19. BACKGROUND: 10%-30% of adults with COVID-19 experience physical and psychological symptoms 3 months or more following infection. Knowing symptoms can help direct early intervention. DESIGN: A longitudinal descriptive design to study COVID-related symptoms 2 weeks, 6 weeks and 3 months after hospitalization. METHODS: Sixty-six patients were recruited from a hospital system in Midwestern US (October 2020-May 2021). Participants self-reported demographics, hospital and post discharge symptoms, PROMIS measures (depression, anxiety, fatigue, cognitive function, satisfaction social roles, sleep disturbance) and Impact of Event Scale-Revised (IES-R). Hospital length of stay, comorbidities, lowest oxygen saturation, respiratory support and resources used were collected. Descriptive and nonparametric statistics described the sample and identified correlations between variables. The STROBE checklist was used. RESULTS: Data from 1 (T1) and 3 months (T2) post discharge were analysed (N = 52). A majority were female, white and married; 96% experienced ≥1 COVID-related symptoms at T1; 85% at T2. Fatigue was most prevalent, followed by shortness of breath, muscle weakness and foggy thinking. More physical symptoms during hospitalization correlated positively with number of symptoms at T1 and T2; a majority stated these impacted their normal routine 'somewhat' or 'a lot'. T1 depression highly correlated with all T2 PROMIS and IES-R scores and number of physical symptoms. More symptoms at T1 were associated with worse fatigue, lower cognitive function and lower satisfaction with social roles at T2. CONCLUSION: This study adds to the growing knowledge of mental, physical and emotional symptoms and relationships between these early after hospitalization with COVID-19. RELEVANCE TO CLINICAL PRACTICE: Findings can help identify holistic nursing interventions to improve health and mitigate symptoms for people with long COVID. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed via study participation.

A Web-based Educational Intervention to Increase Perianesthesia Nurses' Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids.

PURPOSE: The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education. DESIGN: A pre-test, post-test longitudinal design. METHODS: An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. FINDINGS: The participants were invited to complete a pre-test survey (n = 672), the immediate post-test (n = 245), and the 4-week post-test (n = 172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant. CONCLUSIONS: In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed.

Partnership Through Integration: Perianesthesia Policy Standardization.

PURPOSE: To develop system-wide perianesthesia policies, through partnerships, across 11 acute care hospitals and 1 ambulatory surgery center. DESIGN: A partnership culture was created and maintained throughout the development and integration of multiple site-based policies into system policies. METHODS: Policies were built using evidence-based practice and professional organizational standards with an emphasis on quality, safety, and standardization of patient care. Early and ongoing partnerships with key stakeholders were maintained in order to effectively develop the policies. FINDINGS: More than 50 independent policies across 11 acute care hospitals and 1 ambulatory surgery center were integrated and updated into 4 main perianesthesia nursing policies. CONCLUSIONS: Flexibility and partnership with key stakeholders throughout the policy process was instrumental for early detection of barriers and the successful development of perianesthesia nursing policies.

Nosological delineation of congenital ocular motor apraxia type Cogan: an observational study.

BACKGROUND: The nosological assignment of congenital ocular motor apraxia type Cogan (COMA) is still controversial. While regarded as a distinct entity by some authorities including the Online Mendelian Inheritance in Man catalog of genetic disorders, others consider COMA merely a clinical symptom. METHODS: We performed a retrospective multicenter data collection study with re-evaluation of clinical and neuroimaging data of 21 previously unreported patients (8 female, 13 male, ages ranging from 2 to 24 years) diagnosed as having COMA. RESULTS: Ocular motor apraxia (OMA) was recognized during the first year of life and confined to horizontal pursuit in all patients. OMA attenuated over the years in most cases, regressed completely in two siblings, and persisted unimproved in one individual. Accompanying clinical features included early onset ataxia in most patients and cognitive impairment with learning disability (n = 6) or intellectual disability (n = 4). Re-evaluation of MRI data sets revealed a hitherto unrecognized molar tooth sign diagnostic for Joubert syndrome in 11 patients, neuroimaging features of Poretti-Boltshauser syndrome in one case and cerebral malformation suspicious of a tubulinopathy in another subject. In the remainder, MRI showed vermian hypo-/dysplasia in 4 and no abnormalities in another 4 patients. There was a strong trend to more severe cognitive impairment in patients with Joubert syndrome compared to those with inconclusive MRI, but otherwise no significant difference in clinical phenotypes between these two groups. CONCLUSIONS: Systematical renewed analysis of neuroimaging data resulted in a diagnostic reappraisal in the majority of patients with early-onset OMA in the cohort reported here. This finding poses a further challenge to the notion of COMA constituting a separate entity and underlines the need for an expert assessment of neuroimaging in children with COMA, especially if they show cognitive impairment.

Clinical, neuroradiological and molecular characterization of cerebellar dysplasia with cysts (Poretti-Boltshauser syndrome).

Cerebellar dysplasia with cysts and abnormal shape of the fourth ventricle, in the absence of significant supratentorial anomalies and of muscular involvement, defines recessively inherited Poretti-Boltshauser syndrome (PBS). Clinical features comprise non-progressive cerebellar ataxia, intellectual disability of variable degree, language impairment, ocular motor apraxia and frequent occurrence of myopia or retinopathy. Recently, loss-of-function variants in the LAMA1 gene were identified in six probands with PBS. Here we report the detailed clinical, neuroimaging and genetic characterization of 18 PBS patients from 15 unrelated families. Biallelic LAMA1 variants were identified in 14 families (93%). The only non-mutated proband presented atypical clinical and neuroimaging features, challenging the diagnosis of PBS. Sixteen distinct variants were identified, which were all novel. In particular, the frameshift variant c.[2935delA] recurred in six unrelated families on a shared haplotype, suggesting a founder effect. No LAMA1 variants could be detected in 27 probands with different cerebellar dysplasias or non-progressive cerebellar ataxia, confirming the strong correlate between LAMA1 variants and PBS.

An exploration of context and the use of evidence-based nonpharmacological practices in emergency departments.

BACKGROUND: The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices (EBPs) in healthcare settings may improve patient conditions such as pain and decrease the cost of health care. The relationship between context in the practice environment and uptake of EBP remains an understudied area. AIMS: This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPPs) using an existing data set of RNs and providers, defined as doctors of medicine and osteopathy, nurse practitioners, and physician assistants caring for children in the emergency department. METHODS: A secondary data analysis was conducted using correlation and regression. RESULTS: Initial analysis identified several significant positive correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and magnet status and EBNPP for RNs or providers. RN regression analyses found that knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the RN and provider models. A pooled regression analysis with RNs and providers found that RNs had a significant increased use of EBNPP when compared to providers. CONCLUSIONS: Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

Nonpharmacologic pediatric pain management in emergency departments: a systematic review of the literature.

INTRODUCTION: Children account for numerous ED visits each year, with the majority of children reporting pain or requiring painful procedures. The fast-paced, noisy environment, varying resources, and staff trained in taking care of pediatric patients make the ED a unique place to care for children in pain. Nonpharmacological interventions are an essential part of pain management. The purpose of this review was to examine what nonpharmacological interventions EDs are using for pain management in children ages birth to 18 years. METHODS: A systematic literature search was conducted to examine nonpharmacological interventions used for pain management of children in EDs. RESULTS: Fourteen articles met the inclusion/exclusion criteria. Ten studies used distraction, 2 examined the use of sucrose, 1 explored cold application, and 1 looked at parental holding and positioning. Benefits of using nonpharmacological methods included decreased pain, distress, and anxiety reported by the parent, child, and/or observer. DISCUSSION: Findings suggest nonpharmacological interventions such as distraction, positioning, sucrose, and cold application may be helpful in pediatric pain management in the ED. Nurses can implement these methods independently when caring for children and their families. In addition, nonpharmacological methods are relatively inexpensive to organizations.