RESUMO
This qualitative study, designed by nursing professional development specialists, explored novice nurses' experiences working during the first COVID-19 surge of 2020. Semistructured focus group interviews were conducted in June-December 2020 with 23 novice nurses who cared for patients with COVID-19 in March-April 2020. Sixteen themes were identified under three broad categories (viz., stimuli, coping, and adaptation). These themes and participant exemplars are shared along with recommendations on how best to support novice nurses working through the ongoing pandemic.
Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Humanos , Aprendizagem , Pesquisa Qualitativa , Estudos LongitudinaisRESUMO
RATIONALE: Mycobacterium avium complex lung disease is an increasingly common and chronically debilitating problem. Several host traits have been suggested or confirmed as risk factors. Potential environmental and behavioral risk factors have also been proposed. Few have been evaluated in comparative studies. OBJECTIVES: To determine if aerosol-generating activities in the home and garden, features of the home water supply, or several pulmonary and immune-compromising conditions are associated with Mycobacterium avium complex lung disease. METHODS: Cases were recruited from academic medical centers and by informal referrals from nonuniversity practices in Washington and Oregon. Control subjects were recruited by random-digit dialing and matched to cases by age, sex, and partial telephone number. Associations were measured as odds ratios (OR) estimated using conditional logistic regression. MEASUREMENTS AND MAIN RESULTS: Known and potential risk factors were measured by in-home interview. Fifty-two matched pairs were studied. Six of 12 examined host traits were associated with disease, including history of chronic obstructive pulmonary disease (OR, 10; 95% confidence interval [CI], 1.2-80), pneumonia hospitalization (OR, 3.4; 95% CI, 1.1-11), and steroid use (OR, 8; 95% CI, 1.6-41). In contrast, 11 of the 14 aerosol-generating activities and all five features of home water supply studied bore little or no association with disease. CONCLUSIONS: Aerosol-generating activities seem not to be risk factors for Mycobacterium avium complex lung disease in HIV-negative adults, but prior lung disease and immune-suppressing drugs seem to be associated with susceptibility.
Assuntos
Pneumopatias/epidemiologia , Pneumopatias/microbiologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Adulto , Aerossóis/efeitos adversos , Idoso , Estudos de Casos e Controles , Suscetibilidade a Doenças , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Fatores de Risco , Microbiologia do Solo , Microbiologia da ÁguaRESUMO
BACKGROUND: Hypobaric hypoxia during commercial air travel has the potential to cause or worsen hypoxemia in individuals with pre-existing cardiopulmonary compromise. Knowledge of cabin altitude pressures aboard contemporary flights is essential to counseling patients accurately about flying safety. The objective of the study was to measure peak cabin altitudes during U.S. domestic commercial flights on a variety of aircraft. METHODS: A handheld mountaineering altimeter was carried by the investigators in the plane cabin during commercial air travel and peak cabin altitude measured. The values were then compared between aircraft models, aircraft classes, and distances flown. RESULTS: The average peak cabin altitude on 207 flights aboard 17 different aircraft was 6341 +/- 1813 ft (1933 m +/- 553 m), significantly higher than when measured in a similar fashion in 1988. Peak cabin altitude was significantly higher for flights longer than 750 mi (7085 +/- 801 ft) compared to shorter flights (5160 +/- 2290 ft/1573 +/- 698 m). Cabin altitude increased linearly with flight distance for flights up to 750 mi in length, but was independent of flight distance for flights exceeding 750 mi. Peak cabin altitude was less than 5000 ft (1524 m) in 70% of flights shorter than 500 mi. Peak cabin altitudes greater than 8000 ft (2438 m) were measured on approximately 10% of the total flights. CONCLUSIONS: Peak cabin altitude on commercial aircraft flights has risen over time. Cabin altitude is lower with flights of shorter distance. Physicians should take these factors into account when determining an individual's need for supplemental oxygen during commercial air travel.
Assuntos
Altitude , Aviação , Medicina Aeroespacial , Aeronaves , Ar Comprimido , Humanos , Hipóxia/fisiopatologia , Hipóxia/prevenção & controle , Fatores de TempoRESUMO
The future of the profession is being forged under challenging circumstances.
Assuntos
COVID-19/enfermagem , Recursos Humanos de Enfermagem Hospitalar/psicologia , Estresse Ocupacional , Pandemias , SARS-CoV-2/isolamento & purificação , Apoio Social , COVID-19/virologia , HumanosRESUMO
The coronavirus 2019 (COVID-19) pandemic has changed the trajectory of health care delivery in the United States and the whole world. Frontline nurses-essential warriors in this fight-complete exhausting shifts and experience the moral distress that comes with making difficult ethical decisions. This deeply human crisis requires a deeply human response. To augment the mental health of their frontline staff, nurse leaders must tap into their staff's psychological capital (PsyCap). PsyCap is characterized by having high levels of HERO (i.e., hope, efficacy, resilience, and optimism). In this article, we describe strategies that nurse leaders can utilize to foster PsyCap in their nurses.
RESUMO
New registered nurses are expected to utilize critical thinking when providing care to their patients, especially in critical situations. Using mini-scenarios on the human patient simulator, faculty members can foster critical thinking and expose students to critical situations in a nonthreatening environment. An example of one such scenario, using an oncology patient with hypercalcemia and ventricular tachycardia, is outlined in the article.
Assuntos
Competência Clínica , Instrução por Computador/métodos , Educação Técnica em Enfermagem/métodos , Manequins , Ressuscitação/educação , Pensamento , Atitude do Pessoal de Saúde , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Emergências/enfermagem , Docentes de Enfermagem , Feminino , Humanos , Hipercalcemia/etiologia , Julgamento , Pessoa de Meia-Idade , Pesquisa em Educação em Enfermagem , Ressuscitação/enfermagem , Desempenho de Papéis , Estudantes de Enfermagem/psicologia , Inquéritos e Questionários , Taquicardia Ventricular/etiologiaRESUMO
Genotypic analysis of Mycobacterium tuberculosis isolates is increasingly applied in direct support of tuberculosis outbreak control activities. This is facilitated by PCR-based strain typing methods that enable the genotypic characterization of samples containing small numbers of M. tuberculosis cells. By using DNA extracted directly from primary diagnostic cultures, PCR-based methods were applied to a tuberculosis outbreak investigation and to surveillance in King County, Washington. In the outbreak investigation, five epidemiologically linked M. tuberculosis isolates had a unique pattern at mycobacterial interspersed repeating unit (MIRU) loci 10 and 23 when the pattern was compared to the patterns in a local MIRU locus database. In order to quickly identify new cases involving this strain (termed SBRI10), targeted genotyping at these two loci was performed with cultures from epidemiologically associated tuberculosis cases. Isolates with the characteristic genotypes at loci 10 and 23 were further analyzed by use of a 12-locus MIRU panel and by repetitive-unit-sequence-based PCR (rep-PCR). Between May 2004 and January 2005, 82 cases were screened, of which 14 were identified for further analysis and 13 were confirmed to be infected with SBRI10. Between September 2005 and August 2006, surveillance universal genotyping was performed by using the 12-locus MIRU panel with DNA from primary diagnostic enrichment cultures. A total of 161 samples were submitted for analysis, and 156 were successfully typed. Fifty-one cases formed 18 presumptive clusters by MIRU locus typing. Of these, 30 cases were confirmed to be members of 11 clusters by rep-PCR. Presumptive genotypic data were available rapidly, sometimes within 2 weeks of diagnosis. In this fashion, PCR-based genotyping provided data that can be used to prioritize disease control activities.
Assuntos
Técnicas de Tipagem Bacteriana , Surtos de Doenças/prevenção & controle , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/métodos , Tuberculose/prevenção & controle , Meios de Cultura , DNA Bacteriano/análise , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Genótipo , Humanos , Controle de Infecções/métodos , Sequências Repetitivas Dispersas/genética , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/microbiologia , Washington/epidemiologiaRESUMO
Nontuberculous mycobacteria are increasingly recognized as causes of chronic pulmonary disease. Treatment decisions are guided by the clinical presentation, microbial isolate, and condition of the patient. Management may include antibiotic therapy, surgical resection, or observation. Definitive trials are lacking, and optimum management remains uncertain.
RESUMO
The genome sequence strain 104 of the opportunistic pathogen Mycobacterium avium was isolated from an adult AIDS patient in Southern California in 1983. Isolates of non-paratuberculosis M. avium from 207 other patients in Southern California and elsewhere were examined for genotypic identity to strain 104. This process was facilitated by the use of a novel two-step approach. In the first step, all 208 strains in the sample were subjected to a high-throughput, large sequence polymorphism (LSP)-based genotyping test, in which DNA from each strain was tested by PCR for the presence or absence of 4 hypervariable genomic regions. Nineteen isolates exhibited an LSP type that resembled that of strain 104. This subset of 19 isolates was then subjected to high-resolution repetitive sequence-based PCR typing, which identified 10 isolates within the subset that were genotypically identical to strain 104. These isolates came from 10 different patients at 5 clinical sites in the western United States, and they were isolated over a 17-year time span. Therefore, the sequenced genome of M. avium strain 104 has been associated with disease in multiple patients in the western United States. Although M. avium is known for its genetic plasticity, these observations also show that strains of the pathogen can be genotypically stable over extended time periods.
Assuntos
Genoma Bacteriano , Complexo Mycobacterium avium/genética , Complexo Mycobacterium avium/isolamento & purificação , Técnicas de Tipagem Bacteriana , Sequência de Bases , DNA Bacteriano/genética , Ligação Genética , Humanos , Epidemiologia Molecular , Complexo Mycobacterium avium/classificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções Oportunistas/microbiologia , Reação em Cadeia da Polimerase , Polimorfismo Genético , Fatores de TempoRESUMO
Beginning in mid-2002, a large tuberculosis outbreak occurred among homeless persons in King County, Washington. In order to further monitor the outbreak following its peak in 2003, Mycobacterium tuberculosis isolates from all new King County tuberculosis (TB) patients in 2004 and the first half of 2005 (n = 220) were genotyped by using a rapid comparative genomics-based (genomic deletion-typing) approach, with confirmation by mycobacterial interspersed repetitive units and repetitive-sequence-based PCR (rep-PCR). Results were compared to retrospective genotypic data from 1995 to 2003. The outbreak strain SBRI9, which was not seen among King County homeless persons prior to 2002, accounted for 16 out of 30 TB cases (53%) within this population in 2002. This trend continued with 27 out of 35 cases (77%) caused by the outbreak strain in 2003, 11 out of 13 cases (85%) caused by the outbreak strain in 2004, and 4 out of 10 cases (40%) caused by the outbreak strain in the first 5 months of 2005. Thus, the outbreak strain remained well established within this homeless population throughout the study period. At least four SBRI9 cases were in people who had previously been infected by other strains. The novel PCR-based strain-typing approach used in this investigation proved to be cost-effective and very rapid. In most cases, it was possible to analyze DNA extracted directly from primary isolation (Mycobacterium growth indicator tube) cultures submitted by clinical laboratories, a feature that markedly reduced the delay between diagnosis and strain typing results. This rapid turnaround facilitated public health efforts to prevent new outbreaks involving this strain.