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Background: Exploring lived experiences of recovered COVID-19 patients might have scientific, social, and policy relevance that apply to the healthcare infrastructure. This multi-center phenomenological study was conducted to explore lived experiences of Palestinian patients who recovered from COVID-19. Methods: In this qualitative study, a phenomenological descriptive approach was used. A purposive sampling technique was employed to select the study participants. Semi-structured qualitative interviews were conducted with patients who recovered from COVID-19 (n = 20). The transcripts of the audio recorded interviews were analyzed by using Giorgio’s phenomenological analysis method. Results: Semi-structured interviews were conducted with 14 male and 6 female participants. The age of the participants ranged from 25-50 years. Nine themes and multiple subthemes emerged from the qualitative data. The themes were relevant to patient’s feelings about the experience, mental issues, social discriminations/stigma, symptoms, life in isolation, using supportive treatment, personal preventive measures, social support, and life after recovery.Conclusion: Survivors who were interviewed in this study recounted devastating experiences with regard to their mental health, social stigmatization, feeling guilt, shame, and hesitant to regain contact with others. Mental health issues should be addressed as a part of the care plan for patients with COVID-19. More studies are still needed to investigate if introducing mental healthcare providers to the care team of patients with COVID-19 can improve the experiences of the patients.

Objectives: The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician-led care. Background: Protocol-directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients. Study design: Systematic review with meta-analysis. Search strategy: The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. Inclusion and exclusion criteria: Searches were performed to identify the best available evidence including quantitative studies of nurse-led weaning protocols formechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non-nurses and non-invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. Results: The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse-led weaning protocol for reducing the duration of mechanical ventilation (mean differences=−1.69 days, 95% confidence interval =−3.23 to 0.16), intensive care unit length of stay (mean differences=−2.04 days, 95% confidence interval=−2.57 to −1.52, I2 =18%, and p=0.00001); and hospital length of stay (mean differences=−2.9 days, 95% confidence interval=−4.24 to −1.56, I2 =0%, and p=0.00001). Conclusion: There is evidence that the use of nurse-led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. Relevance to clinical practice: This review provides evidence supporting intensive care unit nurses’ crucial role and abilities to lead weaning from mechanical ventilation. info:eu-repo/semantics/publishedVersion

Background: Unintended intra-operative awareness is a serious complication of general anesthesia. The incidence of such awareness has been reported to be about 0.1-0.6% of patients under general anesthesia. Reminiscence of what occurred during the operation can be felt by patients, which can be stressful and leave lasting mental suffering afterward the operation. Patients that experience unintended intra-operative awareness may have some combination of auditory function, tactual feeling, a sense of weakness, an inability to move, pain, and dread. Bispectral Index (BIS) monitoring has been shown to decrease awareness and boost recovery time from anesthesia. Aims of the study is to evaluate the clinical impact of BIS monitoring to reduce the incidence of awareness and its impact on hemodynamic parameters, drug consumption, the recovery time and the end-tidal concentration of volatile anesthetics in adult patients undergoing various types of surgery under general anesthesia. Methods: The design adopted for this study is a prospective, randomized, doubleblind trial. The study involved fifty-nine adult patients with American Society of Anesthesiologists (ASA) physical status I-III, aged 18 to 72 years. 41 males and 18 females scheduled for different types of operations under general anesthesia participated in the study. Patients were randomized for inclusion in the BIS-handled anesthesia group (n=30), with the BIS value controlled between 40 and 60, which is considered convenient for surgical anesthesia; or the regular care (RC) group without BIS-control (n=29). A BIS sensor was placed on the forehead of patients. Hemodynamic specifications were recorded before induction of anesthesia and every five minutes during surgery until the removal of the endotracheal tube. The patients were interviewed by a blinded observer at 24-36 hours after operation through the use of a structured questionnaire. Two independent endpoint adjudication committees blinded to group identity assessed the interview results and identified the confirmed awareness cases. Findings: There were no significant differences between the two groups in all the general characteristics of the patients. Regarding anesthetic time, the mean ± SD in the RC group was 76.6 ± 84.3 minutes, and 124.2 ± 124.4 minutes in the BIS group; the difference was not significant. Surgical time was 73.8 ± 85.8 minutes in the RC group and 116.4 ± 106.2 minutes in the BIS group; the difference was not significant. Of the total 59 patients 29 patients were assigned to the routine control group and 30 patients to the BIS group. No case of awareness was reported in the BIS-guided group but 4 reports (13.8%) in the control group (P=0.035), BISguided anesthesia decreased awareness by 13.8% (95% CI (1.3%-26.4%). The most common forms of awareness was auditory perceptions, tactile perception and the sense of paralysis. There was a statistically significant difference in the mean dose of inhaled anesthetic agents between the RC group (0.029 ±0.008 %) and the BIS group (0.025 ± 0.009%), P=-0.023, which indicates that BIS monitoring could reduce the needed use of inhalation anesthesia. Regarding the opioid fentanyl there was also a significant difference in the used dose of fentanyl for the BIS group (115.56 ± 94.18 mcg and the RC group (77.76 ± 40.52 mcg), P=0.035.There was found to be a difference in the propofol dosage between the BIS group (474.07 ± 711.3 mg) and the RC group(230 ± 59.938 mg), P=0.235. It is clear that patients in the RC group had a lower dosage of propofol than patients in the BIS group, but the difference was not significant. Low doses of fentanyl and propofol may be one of the causes of awareness in the RC group. We found no significant differences in somatic responses of sweating, tearing, pupil dilation and coughing intra-operatively between BIS-monitored and RC patients. However, a significant reduction in intra-operational jerking was recorded for the favor of BIS group .The percentage of patients who experienced jerking movements intra-operatively was 27.6% in the RC group and 6.9% in the BIS group, P=0.037. There were no statistically significant differences between the two study groups in any of the time measures under study which are: time from cessation of inhalational agents to eye opening; time to respond to commands; time to eye opening (either spontaneously or in response to command, time to first movement response; and time to extubation. The time to phonation for the RC group was 12.82 ± 6.11 minutes and only 10.21 ± 5.127 minutes for the BIS group, P=0.026, this occurs for the favor of BIS group. There is a statistically significant difference between the two groups in the time to discharge from the PACU at 12.38 ± 4.989 minutes for the RC group and 9.23 ± 3.819 minutes for the BIS group, P=0.007. In other words, patients in the BIS-monitored group were discharged earlier from the Post Anesthetic Care Unit (PACU) than the RC patients. Conclusions: BIS-guided anesthesia where the BIS score is kept between 40 and 60, reduced the risk of awareness compared to routine care. The main reason for the occurrence of awareness in the RC group could be due to a light general anesthetic. In addition, BIS monitoring reduces the usage of volatile anesthesia and the time of discharge from the Post Anesthetic Care Unit.

Purpose In a previous study we noticed that P6 acupressure ecreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acupressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.

To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting (PONV) after gynecological surgery in the everyday clinical setting (effectiveness study).Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospective, consecutive, randomized, multicentre, placebo-controlled, double-blind clinical trial with a reference group. One group was given bilateral P6 acupressure (n = 135), a second group similar pressure on bilateral non-acupressure points (n = 139), and a third group (n = 136) served as reference group. Nausea (scale 0-6), vomiting, pain, and satisfaction with the treatment were recorded. Primary outcome was complete response, i.e., no nausea, vomiting or rescue medication for 24 hr. Results were analyzed by applying logistic regression with indicators of treatments, type of operation and risk score for PONV as explanatory variables.Complete response was more frequent in the P6 acupressure group than in the reference group (P = 0.0194) Conversely, the incidence of PONV was 46% in the reference group, 38% after pressure on a non-acupoint and 33% after P6 acupressure. The decrease from 46% to 33% was statistically significant. When considering vaginal cases separately, the decrease in PONV was from 36% to 20% (P = 0.0168). The corresponding decrease from 59% to 55% in the laparoscopic surgery group was not statistically significant.P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery.

BACKGROUND: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the "true" and placebo effect of acupressure in prevention of postoperat ...

In a previous study we noticed that P6 acupressure decreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acu-pressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.60 women with high and low susceptibilities for motion sickness participated in a randomized and double-blind study with an active P6 acupressure, placebo acupressure, and a control group (n = 20 in each group). The risk score for PONV was over 50%. The motion challenge was by eccentric rotation in a chair, blindfolded and with chin to chest movements of the head. The challenge was stopped when women reported moderate nausea. Symptoms were recorded.Mean time to moderate nausea was longer in the P6 acu-pressure group compared to the control group. P6 acupressure = 352 (259-445), mean (95% confidence interval) in seconds, control = 151 (121-181) and placebo acupressure = 280 (161-340); (P = 0.006). No difference was found between P6 and placebo acupressure or placebo acupressure and control groups. Previous severity of motion sickness did not influence time to nausea (P = 0.107). The cumulative number of symptoms differed between the three groups (P0.05). Fewer symptoms were reported in the P6 acupressure compared to the control group P0.009. Overall, P6 acupressure was only marginally more effective than placebo acupressure on the forearms.In females with a history of motion sickness P6 acu-pressure increased tolerance to experimental nauseogenic stimuli, and reduced the total number of symptoms reported.