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To assess the presence of journal policies discouraging inappropriate author’s self-citation (A-SC) in “Respiratory System” journals, we evaluated submission guidelines of “Respiratory System” journals included in Journal-Citation Reports 2020 (Clarivate Analytics®) for presence of policies on A-SC and its impact on journals’ self-citation (J-SC) rate and impact factor (IF). We found that 14.3% of journals (n=8/56) reported policies on inappropriate A-SC. The median IF was not different in “Respiratory System” journals with (3.6; IQR:2.3) vs without A-SC policies (3.1; IQR:3.0; p=0.41). The J-SC rate was not influenced by presence of A-SC policies (p=0.83). Fully open-access (n=14) and traditional (n=42) journals had no differences in IF (3.3; IQR:1.5 vs 3.1; IQR:3.4, respectively; p=0.77) and J-SC rate (4.5%; IQR:5.6 vs 6.2%; IQR:8.4, respectively; p=0.38). The majority of “Respiratory System” journals do not have policies discouraging A-SC. The presence of such policies is not associated with changes in IF or J-SC rate.

Background: Tracheal intubation in patients with coronavirus disease-19 is a high-risk procedure that should be performed with personal protective equipment (PPE). The influence of PPE on operator’s performance during tracheal intubation remains unclear. Methods: We conducted a systematic review and meta-analysis of simulation studies to evaluate the influence of wearing PPE as compared to standard uniform regarding time-to-intubation (TTI) and success rate. Subgroup analyses were conducted according to device used and operator’s experience. Results: The TTI was prolonged when wearing PPE (eight studies): Standard Mean Difference (SMD)-0.54, 95% Confidence Interval [-0.75,-0.34], p < 0.0001. Subgroup analyses according to device used showed similar findings (direct laryngoscopy, SMD-0.63 [-0.88,-0.38], p < 0.0001; videolaryngoscopy, SMD-0.39 [-0.75,-0.02], p = 0.04). Considering the operator’s experience, non-anesthesiologists had prolonged TTI (SMD-0.75 [-0.98,-0.52], p < 0.0001) while the analysis on anesthesiologists did not show significant differences (SMD-0.25 [-0.51, 0.01], p = 0.06). The success rate of tracheal intubation was not influenced by PPE: Risk Ratio (RR) 1.02 [1.00, 1.04]; p = 0.12). Subgroup analyses according to device demonstrated similar results (direct laryngoscopy, RR 1.03 [0.99, 1.07], p = 0.15, videolaryngoscopy, RR 1.01 [0.98, 1.04], p = 0.52). Wearing PPE had a trend towards negative influence on success rate in non-anesthesiologists (RR 1.05 [1.00, 1.10], p = 0.05), but not in anesthesiologists (RR 1.00 [0.98, 1.03], p = 0.84). Trial-sequential analyses for TTI and success rate indicated robustness of both results. Conclusions: Under simulated conditions, wearing PPE delays the TTI as compared to dressing standard uniform, with no influence on the success rate. However, certainty of evidence is very low. Performing tracheal intubation with direct laryngoscopy seems influenced to a greater extent as compared to videolaryngoscopy. Similarly, wearing PPE affects more the non-anesthesiologists subgroup as compared to anesthesiologists.

Background The coronavirus disease 2019 (COVID-19) pandemic has caused over 530 million infections to date (June 2022), with a high percentage of intensive care unit (ICU) admissions. In this context, relatives have been restricted from visiting their loved ones admitted to hospital. This situation has led to an inevitable separation between patients and their families. Video communication could reduce the negative effects of such phenomenon, but the impact of this strategy on levels of anxiety, depression, and PTSD disorder in caregivers is not well-known. Methods We conducted a prospective study (6 October 2020–18 February 2022) at the Policlinico University Hospital in Catania, including caregivers of both COVID-19 and non-COVID-19 ICU patients admitted during the second wave of the pandemic. Video-calls were implemented twice a week. Assessment of anxiety, depression, and PTSD was performed at 1-week distance (before the first, T1, and before the third, video-call, T2) using the following validated questionnaires: Impact of Event Scale (Revised IES-R), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Results Twenty caregivers of 17 patients completed the study (T1 + T2). Eleven patients survived (n = 9/11 in the COVID-19 and n = 2/6 in the “non-COVID” group). The average results of the questionnaires completed by caregivers between T1 and T2 showed no significant difference in terms of CES-D (T1 = 19.6 ± 10, T2 = 22 ± 9.6; p = 0.17), HADS depression (T1 = 9.5 ± 1.6, T2 = 9 ± 3.9; p = 0.59), HADS anxiety (T1 = 8.7 ± 2.4, T2 = 8.4 ± 3.8; p = 0.67), and IES-R (T1 = 20.9 ± 10.8, T2 = 23.1 ± 12; p = 0.19). Similar nonsignificant results were observed in the two subgroups of caregivers (COVID-19 and “non-COVID”). However, at T1 and T2, caregivers of “non-COVID” patients had higher scores of CES-D (p = 0.01 and p = 0.04, respectively) and IES-R (p = 0.049 and p = 0.02, respectively), while HADS depression was higher only at T2 (p = 0.02). At T1, caregivers of non-survivors had higher scores of CES-D (27.6 ± 10.6 vs 15.3 ± 6.7, p = 0.005) and IES-R (27.7 ± 10.0 vs 17.2 ± 9.6, p = 0.03). We also found a significant increase in CES-D at T2 in ICU-survivors (p = 0.04). Conclusions Our preliminary results showed that a video-call implementation strategy between caregivers and patients admitted to the ICU is feasible. However, this strategy did not show an improvement in terms of the risk of depression, anxiety, and PTSD among caregivers. Our pilot study remains exploratory and limited to a small sample.

Background Inappropriate authors’ self-citation (A-SC) is a growing mal-practice possibly boosted by the raising importance given to author’s metrics. Similarly, also excessive journals’ self-citation (J-SC) practice may factitiously influence journal’s metrics (impact factor, IF). Evaluating the appropriateness of each self-citation remains challenging. Main body We evaluated the presence of policies discouraging A-SC in Critical Care Medicine (CCM) journals with IF. We also calculated the J-SC rate of these journals. In order to evaluate if J-SC rates are influenced by the focus of interest of CCM journals, we separated them in three sub-categories (“multidisciplinary”, “broad” or “topic-specific” CCM journals). We analyzed 35 CCM journals and only 5 (14.3%) discouraged excessive and inappropriate A-SC. The median IF was higher in CCM journals with A-SC policies [4.1 (3–12)] as compared to those without [2.5 (2–3.5); p = 0.02]. The J-SC rate was highly variable (0–35.4%), and not influenced by the presence of A-SC policies (p = 0.32). However, J-SC rate was different according to the focus of interest (p = 0.01): in particular, it was higher in “topic-specific” CCM journals [15.3 (8.8–23.3%)], followed by “broad” CCM [11.8 (4.8–17.9%)] and “multidisciplinary” journals [6.1 (3.6–9.1%)]. Conclusions A limited number of CCM journals have policies for limiting A-SC, and these have higher IF. The J-SC rate among CCM journals is highly variable and higher in “topic-specific” interest CCM journals. Excluding self-referencing practice from scientific metrics calculation could be valuable to tackle this scientific malpractice.