Exploring the Relationship Between COVID-19 Unit Designation and Nurse Burnout Syndrome

Background: The COVID-19 pandemic impacted healthcare due to surges in infected patient and respiratory failure. Nursing burnout syndrome (NBS) results from occupational factors leading to mental health problems. Nurses working in intensive care units (ICUs) dedicated to caring for COVID-19infected individuals may be even more susceptible to NBS due to increased burdens of futile care delivery and high mortality rates within overstretched healthcare systems. Identifying socio-demographic, work-related, and psychological predictors of NBS may help organizations mitigate, or at least minimize, the negative psychological impact on ICU nurses working during future pandemics. Purpose/Aims: The aim of this study was to compare burnout levels in ICU nurses providing direct care to COVID infected patients with nurses caring for non-COVID infected patients. Methods: An observational descriptive study was conducted using 1) a case-controlled prospective quantitative comparative design to compare neonatal and pediatric ICU to cardiac and medical ICU survey scores measuring nurse burnout, work-related, and psychological predictors of NBS and 2) across-sectional longitudinal quantitative causal and comparative study design comparing NBS scores for nurses working in a cardiac and medical ICU captured in 2019 prior to the COVID-19 pandemic to scores captured in the same units after conversion to dedicated COVID-19 ICUs in 2020. This study will explore the relationship between three subscales(Emotional Exhaustion, Depersonalization, and Personal Accomplishment) of the Maslach Burnout Inventory (MBI) as outcome variables and exposure to COVID-19 infected patients during 12-hour shifts worked as explanatory variables in a subset regression model. The study will also measure four subscales (Vocation, Finances, Health, and Social Relationships) associated with post-traumatic stress disorder using the Well Being Instrument(WBI) as control variables. A convenience sample of direct care registered nurses working in four ICUs in a large tertiary care hospital will be recruited to participate in the study. Female nurses working day shifts were surveyed in February and March 2019in two ICUs. In November 2020, four ICUs were used for sampling of both male and female nurses working either day or night 12-hour shifts based on designation as COVID-19 ICUs. Results: Researchers hypothesize burnout scores among nurses working in neonatal and pediatric ICUs will be less than burnout scores for nurses working in designated COVID ICUs. Additionally, investigators hypothesize nurse burnout measured in cardiac and medical ICUs in 2019 will be less than measurements obtained in 2020 after the same ICUs converted into COVID ICUs. This study will also analyze participant socio-demographic and work-related data for psychological predictors of NBS. Conclusion: NBS has been identified as a global problem facing ICU clinicians. Pinpointing associations betweenCOVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Implications for practice: Further research is required to establish relationships between socio-demographic and work-related psychological predictors of NBS. Understanding relationships between these variables may guide development of strategies to build nurse resilience and decrease NBS in ICU settings impacted during pandemics.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1009/thumbnail.jp

25-Hydroxy Vitamin D Deficiency Following Pediatric Hematopoietic Stem Cell Transplant

Children may be at increased risk for vitamin D deficiency following HSCT because of lack of sun exposure, the recommended use of sunscreen, dietary insufficiency, malabsorption, and the use of certain medications. We prospectively assessed the prevalence of and risk factors for 25-hydroxy (25-OH) vitamin D deficiency in 67 patients transplanted at our institution. 25-OH vitamin D levels were checked during 3 separate 4-week periods in the spring, autumn, and winter. Subjects were <2 years following transplant and/or being treated for chronic graft-versus-host disease (cGVHD). Levels less than 20 ng/mL were considered deficient, and those less than 30 ng/mL were considered insufficient. The mean 25-OH vitamin D level was 22.8 ng/mL (range: 7-46.2). A total of 80.6% (confidence interval [CI] 69.1%-89.3%) of patients had a level less than the lower limit of the institutional normal range. The deficiency rate was 37.3% (CI 25.8%-50%). The mean parathyroid hormone (PTH) level was 77.5 (SD = 80.5). There was no correlation between 25-OH vitamin D and PTH levels. We evaluated potential risk factors for 25-OH vitamin D deficiency including age, season of testing, sun exposure, sunscreen use, use of steroid or calcineurin inhibitor, race, and dairy intake. In multivariate logistic regression, only older age was found to be a risk factor for deficiency (P = .004). Patients with deficient levels were treated with 50,000 IU of ergocalciferol once weekly for 6 weeks. A postrepletion 25-OH level was available for 22 patients. The majority of repleted patients had a normal posttreatment level (63.6%). The postsupplementation level corrected into the insufficient range for 31.8% of patients and 4.6% remained deficient. Vitamin D insufficiency and deficiency are common following HSCT. Further investigation into potential risk factors and the appropriate supplementation for these patients is warranted

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes

Should adding pain, oxygen saturation and physical assessment to vital signs become the new standard of care for detecting blood transfusion reactions?

BACKGROUND AND OBJECTIVES: Clinicians sought to ascertain what frequency of vital signs best detects blood transfusion reactions. This review discusses early and delayed blood product transfusion reaction detection through the lens of scientific literature. METHODS: A comprehensive appraisal of published literature was conducted using Integrative Research Review methodology through June 2022 not limited to English or research in Cumulative Index to Nursing and Allied Health Literature, Cochrane Library of Systematic Reviews, Medline and PubMed. RESULTS: Full-text articles in the final sample included four articles discussing vital signs detecting blood transfusion reactions and four articles reporting the importance of adding physical assessments for early reaction detection. None of the studies provided evidence regarding how often vital signs should be monitored to detect transfusion reactions. No studies included identical screening components for detecting blood product transfusion reactions. Main themes emerged including variations in what was included in vital signs, importance of respiratory assessment, inclusion of physical assessment, nurse documentation and reporting compliance, and patient and family inclusion in transfusion reaction recognition. CONCLUSION: Vital sign components varied across reviewed studies. Respiratory rate and pain were not always included in \u27vital signs\u27 to identify transfusion reactions. Only low-level data and no clinical trials loosely informing frequency of vital sign monitoring to transfusion reaction detection were found. Respiratory (to include oxygen saturation, lung sounds and respiratory rate) and pain assessment emerged as crucial to acute and delayed transfusion reaction recognition. The disconnect between \u27vital signs\u27 and the varied vital sign components reported to detect transfusion reactions in scientific literature requires further exploration

Combining Chemistry and Engineering for Hepatocellular Carcinoma: Nano-Scale and Smaller Therapies

Primary liver cancer, or hepatocellular carcinoma (HCC), is a major worldwide cause of death from carcinoma. Most patients are not candidates for surgery and medical therapies, including new immunotherapies, have not shown major improvements since the modest benefit seen with the introduction of sorafenib over a decade ago. Locoregional therapies for intermediate stage disease are not curative but provide some benefit. However, upon close scrutiny, there is still residual disease in most cases. We review the current status for treatment of intermediate stage disease, summarize the literature on correlative histopathology, and discuss emerging methods at micro-, nano-, and pico-scales to improve therapy. These include transarterial hyperthermia methods and thermoembolization, along with microfluidics model systems and new applications of mass spectrometry imaging for label-free analysis of pharmacokinetics and pharmacodynamics

Reenvisioning Postpandemic Youth Sport to Meet Young People’s Mental, Emotional, and Social Needs

Before 2020, young people were experiencing significant psychosocial challenges, with the COVID-19 pandemic and related events (e.g., lockdowns, social isolation, and economic disruption) amplifying concerns about their well-being. Youth sport is a context for promoting mental, emotional, and social health, and yet it is not achieving its full potential in the United States. The purpose of this expert commentary, composed by the 2020–2021 President’s Council on Sports, Fitness & Nutrition Science Board, is to present a vision of youth sport in the United States that prioritizes young people’s mental, emotional, and social health. The extraordinary events of 2020 and 2021 provide an opportunity to reenvision our approach to youth sport as pandemic-related restrictions are lifted. Ten recommendations from this vision are presented in this article, along with 10 innovative, actionable takeaways; each of these offer meaningful benefits to young people’s mental, emotional, and social health

Reimagining the Youth Sport System Across the United States: A Commentary From the 2020–2021 President’s Council on Sports, Fitness & Nutrition Science Board

The youth sport system in the United States is not achieving its full potential. There is a need to reimagine this system in ways that are evidence-based, innovative, and coordinated to best safeguard and promote the well-being of young people. The purpose of this expert commentary, composed by the President’s Council on Sports, Fitness & Nutrition Science Board, is to propose a set of changes across multiple levels of influence (e.g., individual, family, school, organization) that could cultivate a more developmentally sound youth sport system. By advancing the vision of the National Youth Sports Strategy to provide quality youth sport to all young people in the country, these changes have substantial potential to benefit young people

Resistance of canine lymphoma cells to adenoviral infection due to reduced cell surface RGD binding integrins

Recombinant adenovirus vectors (Ad) have been recognized as effective in vivo gene delivery vehicles and utilized as gene therapy agents for a number of cancers. The elucidation of viral entry mechanisms has allowed the development of recombinant vectors that exploit existing cell surface receptors to achieve entry into the cell. B lymphocytes are normally resistant to infection by adenovirus 5, likely due to the lack of the Coxsackie and Adenovirus receptor (CAR). Using reverse-transcriptase PCR and flow cytometry, the CD40 receptor has been shown to be expressed on many lymphoma cells. We exploited this finding to develop a gene therapy strategy for treatment of canine B-cell lymphoma. Ad5 was targeted to cells expressing CD40 via CD40 ligand (CD40L) and was effective in infecting CD40-expressing control cells; however, both primary canine lymphoma cells and cell lines demonstrated limited evidence of transduction. Following receptor binding, adenovirus entry into cells may require interaction with αvβ3/5 integrins; we demonstrate that canine lymphoma cells are deficient in these integrins. Reduced αvβ3 integrin expression may render these cells incapable of internalizing Ad vectors. Thus, any viral targeting approaches for treatment of canine lymphoma must also take into account the potential lack of internalization signals