TP11. TP011 USE OF HEALTH SERVICES AND MEDICAL EDUCATION RESEARCH TO EVALUATE THE EFFECT OF COVID-19, 2021
Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumat... more Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.
Objectives: The study aimed to assess sleep disturbances in patients subjected to home quarantine... more Objectives: The study aimed to assess sleep disturbances in patients subjected to home quarantine due to suspected SARS-CoV-2 infection. The study used a mixed methods design study as a research methodology. Methods: A semi-structured interview and the scale for Insomnia Severity Index (ISI) were used to achieve the aim of the study. The survey was conducted from 16 to 20 April 2020 and 1 to 2 September 2020 in Poland, at the during of SARS-CoV-2 epidemic in this country. The data were coded and cross-processed. The (COREQ) checklist was followed. Results: Interviews with patients and a thorough analysis of recordings revealed commonly used phrases in the following categories: "anxiety", "Am I going crazy?", "Sleep problems". 10 out of 11 respondents reported sleep disorders of varying severity according to the Insomnia Severity Index scale. Patients presented a fear related to the return to society and normal functioning after quarantine. Additionally, some study participants voiced concerns related to their mental health; some cases of hallucinations were reported. Conclusions: Further global population studies should be conducted to analyse this phenomenon. Acute Stress Disorder should be understood as a threat to life and health of an isolated society in quarantine. Further research in this area should be promoted and the need for global guidelines for the entire population should be developed.
Introduction. The study has an innovative character. In Poland, there are no researches on the qu... more Introduction. The study has an innovative character. In Poland, there are no researches on the quality of dying and the moment of death. Studies described in literature involve mostly the quality of life, care and treatment. Results of public surveys show that people have a lot of expectations of both the process and the moment of death. People pay attention to more and more widely known phenomenon of "good death and quality of dying", especially in patients whose prognosis isn't positive and the causative treatment process was terminated. Aim. The main objective of the work was to research the quality of the process of dying, and the moment of death within patients in terminal state, that were under free, at-home palliative care. Material and methods. The work has research qualities. Work material was gathered with a validated, translated into polish language, anonymous sheet QODD-The Quality of Dying and Death. The group of recipients are families and friends who took care of a dying patient, who was taken care of by a home hospice that employs the author. Research material was being gathered since the beginning of 2016-2018. The original QODD questionnaire consists of 31 questions, although modified versions with 17 questions exist. Questionnaire with 31 questions was used in the research. Results. 150 qestionnaires were collected. Most of the respondents are women between the age of 30 and 50. Higher education dominates. Most of the people perform a non medical profession and live in a city. Within patients in palliative care, men with secondary education and living in the city were dominating. Within the deceased, the diagnosis of cancer prevails. It was shown that there is a statistically significant, weak, negative correlation between age and the results of the Symptoms and Personal Control subscales (R =-0.184; P = 0.024) and Family (R =-0.206; P = 0.012). In addition, there is a statistically significant, weak, positive correlation between age and the results of the Preparation for Death subscale (R = 0.176; P = 0.031). It was shown that men in the study presented significantly higher results for the Family subscale than women (50.67 ± 13.36 vs 43.33 ± 13.45; P <0.001; Cohen's d = 0.73)-this means that the quality of death and dying in men in this respect it was significantly better than in women. It has been shown that people who caregivers practice a non-medical profession present significantly better quality of death and dying in the scope of the Holistic approach subscales.
The surgical and anaesthesiological teams are responsible for the safety of the patient throughou... more The surgical and anaesthesiological teams are responsible for the safety of the patient throughout the entire surgical procedure. The anaesthesiologist and anaesthetic nurse, which are part of the operating room staff, should do their best to provide the best possible anaesthesia and intraoperative care. A vital part of the process is epidemiological safety. Causes of potential infections may be linked to: the patient – inadequate preparation (poor dental hygiene, inefficient prevention of surgical site infections), operating theatre and staff, as well as the equipment used intraoperatively. Cross-infections may occur in the operating room. It is worth noticing that both staff and the anaesthetic equipment may be a source of infection. Appropriate hand hygiene and proper use of available devices is vital. This article will try to specify the key points of infection control dedicated to anaesthetic teams and the rules that apply in this area.
Pielegniarstwo XXI wieku / Nursing in the 21st Century, 2020
Introduction. The nursing profession in Poland is subject to continuous transformations, but it s... more Introduction. The nursing profession in Poland is subject to continuous transformations, but it should follow the directions based on the common framework for the development of specialist nursing, drawn up by international specialist nurses associations in Europe. A change in the nursing education system in Poland has provided an opportunity for progress based on consistent framework. Summary. Nurse education organised in a system of first cycle and second cycle university courses was a milestone towards improving the status of the nursing profession. The improved position of Polish nurses paved the way for further advancements in this profession and in the related scientific research, which in the past was rarely conducted by Polish nurses; today more and more research teams are launched and operate both at universities and in nurses’ scientific associations.
Pielegniarstwo XXI wieku / Nursing in the 21st Century, 2019
Introduction. Research demonstrates that nursing documentation is a condition for the continuity ... more Introduction. Research demonstrates that nursing documentation is a condition for the continuity of patient care and for their safety. The objective of the article is to present the existing knowledge on anaesthesiology nursing documentation and to specify its essential elements. Material and methods. A literature review was performed with a systematic literature search. The content of the included studies was analysed in terms of its content and relevance. The materials was gathered through electronic database search. Results. It was found that the key elements of the documentation-related practice of anaesthesiology nurses were as follows: the record-keeping tool should be adjusted to the clinical practice, the documentation for nurses should take into consideration the patient safety aspect and protect nurses from legal consequences; also, the documentation should comply with the current legal regulations and be regularly updated. Conclusions. Anaesthesiology nurses who keep thei...
The Journal of Neurological and Neurosurgical Nursing, 2016
Rapid Sequence Intubation is one of most commonly applied procedures for trauma patient in emerge... more Rapid Sequence Intubation is one of most commonly applied procedures for trauma patient in emergency practice such as Medical Rescue Service as Emergency Hospital Ward, but in the case of patients with maxillofacial trauma it is usually complicated. Firstly the trauma directly involves the airway, but also the commonly associated injuries and conditions, such as craniocelebrar injuries often limit the options in management. The aim of this article is to describe rapid sequence intubation protocol for this group of critical injured patients.
Udar mózgu stanowi drugą po zawałach przyczynę zgonów na świecie. Zmaganie się z licznymi dolegli... more Udar mózgu stanowi drugą po zawałach przyczynę zgonów na świecie. Zmaganie się z licznymi dolegliwościami, często bezpośrednio zagrażającemu życiu chorego, powoduje marginalizację potrzeb stomatologicznych pacjenta po udarze. Tymczasem stanowi to ważny element prewencji wtórnej udaru. Celem pracy jest przybliżenie specyfiki higieny jamy ustnej u pacjentów po udarze mózgu przebywających w warunkach szpitalnych.
Pielęgniarstwo w Anestezjologii i Intensywnej Opiece, 2016
We analyze a stochastic optimal control problem, where the state process follows a McKean-Vlasov ... more We analyze a stochastic optimal control problem, where the state process follows a McKean-Vlasov dynamics and the diffusion coefficient can be degenerate. We prove that its value function V admits a nonlinear Feynman-Kac representation in terms of a class of forward-backward stochastic differential equations, with an autonomous forward process. We exploit this probabilistic representation to rigorously prove the dynamic programming principle (DPP) for V. The Feynman-Kac representation we obtain has an important role beyond its intermediary role in obtaining our main result: in fact it would be useful in developing probabilistic numerical schemes for V. The DPP is important in obtaining a characterization of the value function as a solution of a non-linear partial differential equation (the so-called Hamilton-Jacobi-Belman equation), in this case on the Wasserstein space of measures. We should note that the usual way of solving these equations is through the Pontryagin maximum principle, which requires some convexity assumptions. There were attempts in using the dynamic programming approach before, but these works assumed a priori that the controls were of Markovian feedback type, which helps write the problem only in terms of the distribution of the state process (and the control problem becomes a deterministic problem). In this paper, we will consider open-loop controls and derive the dynamic programming principle in this most general case. In order to obtain the Feynman-Kac representation and the randomized dynamic programming principle, we implement the so-called randomization method, which consists in formulating a new McKean-Vlasov control problem, expressed in weak form taking the supremum over a family of equivalent probability measures. One of the main results of the paper is the proof that this latter control problem has the same value function V of the original control problem.
TP11. TP011 USE OF HEALTH SERVICES AND MEDICAL EDUCATION RESEARCH TO EVALUATE THE EFFECT OF COVID-19, 2021
Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumat... more Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.
Objectives: The study aimed to assess sleep disturbances in patients subjected to home quarantine... more Objectives: The study aimed to assess sleep disturbances in patients subjected to home quarantine due to suspected SARS-CoV-2 infection. The study used a mixed methods design study as a research methodology. Methods: A semi-structured interview and the scale for Insomnia Severity Index (ISI) were used to achieve the aim of the study. The survey was conducted from 16 to 20 April 2020 and 1 to 2 September 2020 in Poland, at the during of SARS-CoV-2 epidemic in this country. The data were coded and cross-processed. The (COREQ) checklist was followed. Results: Interviews with patients and a thorough analysis of recordings revealed commonly used phrases in the following categories: "anxiety", "Am I going crazy?", "Sleep problems". 10 out of 11 respondents reported sleep disorders of varying severity according to the Insomnia Severity Index scale. Patients presented a fear related to the return to society and normal functioning after quarantine. Additionally, some study participants voiced concerns related to their mental health; some cases of hallucinations were reported. Conclusions: Further global population studies should be conducted to analyse this phenomenon. Acute Stress Disorder should be understood as a threat to life and health of an isolated society in quarantine. Further research in this area should be promoted and the need for global guidelines for the entire population should be developed.
Introduction. The study has an innovative character. In Poland, there are no researches on the qu... more Introduction. The study has an innovative character. In Poland, there are no researches on the quality of dying and the moment of death. Studies described in literature involve mostly the quality of life, care and treatment. Results of public surveys show that people have a lot of expectations of both the process and the moment of death. People pay attention to more and more widely known phenomenon of "good death and quality of dying", especially in patients whose prognosis isn't positive and the causative treatment process was terminated. Aim. The main objective of the work was to research the quality of the process of dying, and the moment of death within patients in terminal state, that were under free, at-home palliative care. Material and methods. The work has research qualities. Work material was gathered with a validated, translated into polish language, anonymous sheet QODD-The Quality of Dying and Death. The group of recipients are families and friends who took care of a dying patient, who was taken care of by a home hospice that employs the author. Research material was being gathered since the beginning of 2016-2018. The original QODD questionnaire consists of 31 questions, although modified versions with 17 questions exist. Questionnaire with 31 questions was used in the research. Results. 150 qestionnaires were collected. Most of the respondents are women between the age of 30 and 50. Higher education dominates. Most of the people perform a non medical profession and live in a city. Within patients in palliative care, men with secondary education and living in the city were dominating. Within the deceased, the diagnosis of cancer prevails. It was shown that there is a statistically significant, weak, negative correlation between age and the results of the Symptoms and Personal Control subscales (R =-0.184; P = 0.024) and Family (R =-0.206; P = 0.012). In addition, there is a statistically significant, weak, positive correlation between age and the results of the Preparation for Death subscale (R = 0.176; P = 0.031). It was shown that men in the study presented significantly higher results for the Family subscale than women (50.67 ± 13.36 vs 43.33 ± 13.45; P <0.001; Cohen's d = 0.73)-this means that the quality of death and dying in men in this respect it was significantly better than in women. It has been shown that people who caregivers practice a non-medical profession present significantly better quality of death and dying in the scope of the Holistic approach subscales.
The surgical and anaesthesiological teams are responsible for the safety of the patient throughou... more The surgical and anaesthesiological teams are responsible for the safety of the patient throughout the entire surgical procedure. The anaesthesiologist and anaesthetic nurse, which are part of the operating room staff, should do their best to provide the best possible anaesthesia and intraoperative care. A vital part of the process is epidemiological safety. Causes of potential infections may be linked to: the patient – inadequate preparation (poor dental hygiene, inefficient prevention of surgical site infections), operating theatre and staff, as well as the equipment used intraoperatively. Cross-infections may occur in the operating room. It is worth noticing that both staff and the anaesthetic equipment may be a source of infection. Appropriate hand hygiene and proper use of available devices is vital. This article will try to specify the key points of infection control dedicated to anaesthetic teams and the rules that apply in this area.
Pielegniarstwo XXI wieku / Nursing in the 21st Century, 2020
Introduction. The nursing profession in Poland is subject to continuous transformations, but it s... more Introduction. The nursing profession in Poland is subject to continuous transformations, but it should follow the directions based on the common framework for the development of specialist nursing, drawn up by international specialist nurses associations in Europe. A change in the nursing education system in Poland has provided an opportunity for progress based on consistent framework. Summary. Nurse education organised in a system of first cycle and second cycle university courses was a milestone towards improving the status of the nursing profession. The improved position of Polish nurses paved the way for further advancements in this profession and in the related scientific research, which in the past was rarely conducted by Polish nurses; today more and more research teams are launched and operate both at universities and in nurses’ scientific associations.
Pielegniarstwo XXI wieku / Nursing in the 21st Century, 2019
Introduction. Research demonstrates that nursing documentation is a condition for the continuity ... more Introduction. Research demonstrates that nursing documentation is a condition for the continuity of patient care and for their safety. The objective of the article is to present the existing knowledge on anaesthesiology nursing documentation and to specify its essential elements. Material and methods. A literature review was performed with a systematic literature search. The content of the included studies was analysed in terms of its content and relevance. The materials was gathered through electronic database search. Results. It was found that the key elements of the documentation-related practice of anaesthesiology nurses were as follows: the record-keeping tool should be adjusted to the clinical practice, the documentation for nurses should take into consideration the patient safety aspect and protect nurses from legal consequences; also, the documentation should comply with the current legal regulations and be regularly updated. Conclusions. Anaesthesiology nurses who keep thei...
The Journal of Neurological and Neurosurgical Nursing, 2016
Rapid Sequence Intubation is one of most commonly applied procedures for trauma patient in emerge... more Rapid Sequence Intubation is one of most commonly applied procedures for trauma patient in emergency practice such as Medical Rescue Service as Emergency Hospital Ward, but in the case of patients with maxillofacial trauma it is usually complicated. Firstly the trauma directly involves the airway, but also the commonly associated injuries and conditions, such as craniocelebrar injuries often limit the options in management. The aim of this article is to describe rapid sequence intubation protocol for this group of critical injured patients.
Udar mózgu stanowi drugą po zawałach przyczynę zgonów na świecie. Zmaganie się z licznymi dolegli... more Udar mózgu stanowi drugą po zawałach przyczynę zgonów na świecie. Zmaganie się z licznymi dolegliwościami, często bezpośrednio zagrażającemu życiu chorego, powoduje marginalizację potrzeb stomatologicznych pacjenta po udarze. Tymczasem stanowi to ważny element prewencji wtórnej udaru. Celem pracy jest przybliżenie specyfiki higieny jamy ustnej u pacjentów po udarze mózgu przebywających w warunkach szpitalnych.
Pielęgniarstwo w Anestezjologii i Intensywnej Opiece, 2016
We analyze a stochastic optimal control problem, where the state process follows a McKean-Vlasov ... more We analyze a stochastic optimal control problem, where the state process follows a McKean-Vlasov dynamics and the diffusion coefficient can be degenerate. We prove that its value function V admits a nonlinear Feynman-Kac representation in terms of a class of forward-backward stochastic differential equations, with an autonomous forward process. We exploit this probabilistic representation to rigorously prove the dynamic programming principle (DPP) for V. The Feynman-Kac representation we obtain has an important role beyond its intermediary role in obtaining our main result: in fact it would be useful in developing probabilistic numerical schemes for V. The DPP is important in obtaining a characterization of the value function as a solution of a non-linear partial differential equation (the so-called Hamilton-Jacobi-Belman equation), in this case on the Wasserstein space of measures. We should note that the usual way of solving these equations is through the Pontryagin maximum principle, which requires some convexity assumptions. There were attempts in using the dynamic programming approach before, but these works assumed a priori that the controls were of Markovian feedback type, which helps write the problem only in terms of the distribution of the state process (and the control problem becomes a deterministic problem). In this paper, we will consider open-loop controls and derive the dynamic programming principle in this most general case. In order to obtain the Feynman-Kac representation and the randomized dynamic programming principle, we implement the so-called randomization method, which consists in formulating a new McKean-Vlasov control problem, expressed in weak form taking the supremum over a family of equivalent probability measures. One of the main results of the paper is the proof that this latter control problem has the same value function V of the original control problem.
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Papers by Paweł Witt