[Experiences of (care) professionals during a COVID-19 outbreak and results of serological tests in the staff of a heavily affected nursing home.] / Ervaringen van (zorg)medewerkers tijdens een COVID-19 uitbraak en resultaten van serologische testen bij personeel in een zwaar getroffen verpleeghuis.

Despite compliance with national (RIVM) guidelines, nursing home Mariënburght (the Netherlands) was severely affected during the first COVID-19 wave: 68 (68%) of the residents were infected. This resulted in a large emotional impact on the (nursing) staff. This study aims to describe the experiences of (nursing) staff, as well as the results of serological tests on COVID-19 that have been administered to professionals. All professionals (n=281) were invited for group interviews to share their experiences concerning the COVID-19 outbreak and for a serological test for COVID-19. The 29 professionals participating in the group interviews mentioned negative and positive experiences about their fear and anxiety, the changed care for residents, the team spirit, the use of personal protective equipment and the testing policy. Out of 240 professionals who underwent the serological test and completed a questionnaire, 94 professionals (39%) had COVID-19 antibodies. In this group, 18 professionals (19%) indicated not having experienced any (physical) complaints related to COVID. Insight into the experiences of professionals resulted in essential learning points, in particular the importance of clear communication with and emotional support for staff. This study also reveals that many professionals of nursing home Mariënburght were affected by COVID-19. An important finding is the high percentage of asymptomatic employees (19% of 94 infected). Our results contributed to changed national testing policies and adapted recommendations in the use of personal protective equipment in nursing homes.

Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman's perspective.

OBJECTIVE: To explore women's traumatic childbirth experiences in order to make maternity care professionals more aware of women's intrapartum care needs. METHOD: A qualitative exploratory study with a constant comparison/grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting. FINDINGS: Three themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: (i) lack of information and consent - maternity care professionals' unilateral decision making during intrapartum care, lacking informed-consent. (ii) feeling excluded - women's mal-adaptive response to the healthcare professionals's one-sided decision making, leaving women feeling distant and estranged from the childbirth event and the experience. (iii) discrepancies - inconsistency between women's expectations and the reality of labour and birth - on an intrapersonal level. CONCLUSION: Women's intrapartum care needs cohere with the concept of woman-centred care, including personalised care and reflecting humanising values. Care should include informed consent and shared decision-making. Maternity care professionals need to continuously evaluate whether the woman is consistently part of her own childbearing process. Maternity care professionals should maintain an ongoing dialogue with the woman, including women's internalised ideas of birth.

Strategies to enhance fresh produce decontamination using combined treatments of ultraviolet, washing and disinfectants.

This study investigated the effect of a water-assisted ultraviolet system (WUV; samples were treated by UV while being immersed in agitated water) on the inactivation of Salmonella on baby spinach, iceberg lettuce, blueberry, grape tomato, and baby-cut carrot. The Salmonella inactivation effect of the WUV system was tested in two scales, and three disinfectants, chlorine, peroxyacetic acid (PAA) and hydrogen peroxide (H2O2), were tested in combination with the system to see whether the Salmonella inactivation effect could be enhanced. The fresh produce samples were dip-inoculated with a Salmonella cocktail to final concentrations of 4.6-7.6 log CFU/g. To simulate the washing process in the industry, fresh produce extracts and/or silicon dioxide were added in the wash water to adjust chemical oxygen demand to ~2000 mg/L and turbidity to >60 NTU. In general, the decontamination efficacy of WUV treatments followed this order: Tomato > Carrot > Lettuce ≈ Blueberry > Spinach. In the small-scale study, WUV alone was able to achieve 0.9, 2.6, >3.6, 1.7, and 2.0 log CFU/g reductions of Salmonella on fresh produce for spinach, lettuce, tomato, blueberry, and carrot, respectively. For all fresh produce items, WUV combined with PAA could achieve significantly (P < 0.05) higher Salmonella reduction on fresh produce than chlorine wash and PAA wash. The WUV treatments combined with chlorine or PAA were able to keep residual Salmonella in wash water below the detection limit (2 CFU/mL) for almost all the replicates. Similar Salmonella reductions on fresh produce and in wash water were found in the large-scale study. Considering the decontamination efficacy on fresh produce, the ability to disinfect the wash water, and the cost, we recommend chlorine wash for baby spinach, WUV alone for grape tomato and WUV combined with PAA for iceberg lettuce, blueberry and baby-cut carrot.

Glucagon-like peptide 1 receptor agonist or bolus insulin with optimized basal insulin in type 2 diabetes.

OBJECTIVE: Mealtime insulin is commonly added to manage hyperglycemia in type 2 diabetes when basal insulin is insufficient. However, this complex regimen is associated with weight gain and hypoglycemia. This study compared the efficacy and safety of exenatide twice daily or mealtime insulin lispro in patients inadequately controlled by insulin glargine and metformin despite up-titration. RESEARCH DESIGN AND METHODS: In this 30-week, open-label, multicenter, randomized, noninferiority trial with 12 weeks prior insulin optimization, 627 patients with insufficient postoptimization glycated hemoglobin A1c (HbA1c) were randomized to exenatide (10-20 µg/day) or thrice-daily mealtime lispro titrated to premeal glucose of 5.6-6.0 mmol/L, both added to insulin glargine (mean 61 units/day at randomization) and metformin (mean 2,000 mg/day). RESULTS: Randomization HbA1c and fasting glucose (FG) were 8.3% (67 mmol/mol) and 7.1 mmol/L for exenatide and 8.2% (66 mmol/mol) and 7.1 mmol/L for lispro. At 30 weeks postrandomization, mean HbA1c changes were noninferior for exenatide compared with lispro (-1.13 and -1.10%, respectively); treatment differences were -0.04 (95% CI -0.18, 0.11) in per-protocol (n = 510) and -0.03 (95% CI -0.16, 0.11) in intent-to-treat (n = 627) populations. FG was lower with exenatide than lispro (6.5 vs. 7.2 mmol/L; P = 0.002). Weight decreased with exenatide and increased with lispro (-2.5 vs. +2.1 kg; P < 0.001). More patients reported treatment satisfaction and better quality of life with exenatide than lispro, although a larger proportion of patients with exenatide experienced treatment-emergent adverse events. Exenatide resulted in fewer nonnocturnal hypoglycemic episodes but more gastrointestinal adverse events than lispro. CONCLUSIONS: Adding exenatide to titrated glargine with metformin resulted in similar glycemic control as adding lispro and was well tolerated. These findings support exenatide as a noninsulin addition for patients failing basal insulin.