coronavirus

冠状病毒
  • 文章类型: Journal Article
    2019年冠状病毒(COVID-19)的全球大流行是由SARS-CoV-2病毒引起的,目前几乎没有高效的抗病毒治疗方法。在感染过程中负责病毒RNA复制和转录的机制由几种重要的蛋白质组成。其中两个是nsp12,病毒聚合酶的催化亚基,和nsp9,nsp12的辅因子,参与病毒RNA的加帽和引发。虽然最近的几项研究已经确定了在RNA加帽的背景下nsp9与nsp12相互作用的结构细节,目前很少有生化或生物物理细节。在这项研究中,我们使用了表面等离子体共振(SPR)实验的组合,尺寸排阻色谱(SEC)实验,和生化分析,以确定对nsp12结合以及RNAylation至关重要的特定nsp9残基,这两者对于RNA加帽过程都是必不可少的。我们的数据表明nsp9二聚化不太可能在病毒中发挥重要的功能作用。我们证实,一组最近发现的抗病毒肽通过特异性结合nsp9抑制nsp9-nsp12相互作用;然而,我们发现这些肽不影响RNA化。总之,我们的研究结果对未来抗击SARS-CoV-2和任何新出现的冠状病毒的药物发现工作具有重要意义.
    The ongoing global pandemic of the coronavirus 2019 (COVID-19) disease is caused by the virus SARS-CoV-2, with very few highly effective antiviral treatments currently available. The machinery responsible for the replication and transcription of viral RNA during infection is made up of several important proteins. Two of these are nsp12, the catalytic subunit of the viral polymerase, and nsp9, a cofactor of nsp12 involved in the capping and priming of viral RNA. While several recent studies have determined the structural details of the interaction of nsp9 with nsp12 in the context of RNA capping, very few biochemical or biophysical details are currently available. In this study, we have used a combination of surface plasmon resonance (SPR) experiments, size exclusion chromatography (SEC) experiments, and biochemical assays to identify specific nsp9 residues that are critical for nsp12 binding as well as RNAylation, both of which are essential for the RNA capping process. Our data indicate that nsp9 dimerization is unlikely to play a significant functional role in the virus. We confirm that a set of recently discovered antiviral peptides inhibit nsp9-nsp12 interaction by specifically binding to nsp9; however, we find that these peptides do not impact RNAylation. In summary, our results have important implications for future drug discovery efforts to combat SARS-CoV-2 and any newly emerging coronaviruses.
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  • 文章类型: Journal Article
    目的:本研究的目的是评估冠状病毒大流行对妇科手术培训的影响。
    方法:向爱尔兰妇产科高级专科培训计划的所有受训者和培训者分发了一项全国横断面在线调查。调查包括关于以下主题的问题:大流行之前和之后进行的外科手术的数量,在大流行之前和之后进行各种妇科手术的信心,以及有关大流行对健康和工作习惯的影响的问题。
    结果:对于大多数手术类型,培训师和受训者的手术量显著减少。分析表明,受训者执行的次要程序数量显着减少(z=-2.7,P=0.007),培训者执行的所有程序类型数量显着减少(次要程序z=-3.78,P=<0.001;中间程序z=-4.48,P=<0.001;主要程序z=-3.69,P=<0.001)。受访者表示,他们进行研究和审计的时间较少,参加课程或会议的能力较弱,并担心工作对家庭的影响。
    结论:结论:这项研究强调了目前由于COVID-19大流行,妇科手术受训者面临的困难.这些挑战为妇科学员增加了已经具有挑战性的培训环境。必须努力继续提供高质量的定制培训,以确保下一代妇科外科医生的发展。
    OBJECTIVE: The objective of this study was to assess the impact of the coronavirus pandemic on gynecology surgical training.
    METHODS: A national cross-sectional online survey was distributed to all trainees and trainers in the higher specialist training program for obstetrics and gynecology in Ireland. The survey consisted of questions on topics which included: the volume of surgical procedures performed before and since the pandemic, confidence in performing various gynecologic procedures before and since the pandemic and questions regarding the impact of the pandemic on wellbeing and work practices.
    RESULTS: Trainers and trainees experienced a significant reduction in operative volumes for most procedure types. Analysis showed a significant reduction in the number of minor procedures performed by trainees (z = -2.7, P = 0.007) and a significant reduction in the number of all procedure types performed by trainers (minor procedures z = -3.78, P = <0.001; intermediate procedures z = -4.48, P = < 0.001; major procedures z = -3.69, P = < 0.001). Respondents reported they had less time for research and audit, were less able to attend courses or conferences and worried about the impact of their work on their families.
    CONCLUSIONS: In conclusion, this study has highlighted the current difficulties facing surgical trainees in gynecology because of the COVID-19 pandemic. These challenges have compounded an already challenging training environment for gynecology trainees. Efforts must be made to continue to provide high-quality tailored training to ensure the development of the next generation of gynecologic surgeons.
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  • 文章类型: Journal Article
    该研究旨在从分子上研究跳蚤传播病毒在有跳蚤感染的小反刍动物中的存在。它是在埃及的西北海岸(NWC)和南西奈省(SSG)进行的。使用三种特异性引物靶向基因,ORF103(用于羊痘病毒和块状皮肤病病毒),NS3(用于蓝舌病毒),和Rdrp(冠状病毒),其次是基因测序和系统发育分析。结果表明,NWC地区有78.94%的绵羊和65.63%的山羊出没,而在SSG地区有49.76%的绵羊和77.8%的山羊被感染。在两个研究区域中,绵羊是跳蚤侵染的首选宿主(58.9%),而不是山羊(41.1%)。动物的性别和年龄对侵染率没有影响(p>0.05)。动物侵染的季节和部位在两个区域之间显著不同(p<0.05)。Ctenocephalidesfelis在NWC中占主导地位,在SSG中Ctenocephalides犬占主导地位,两种跳蚤的雄性比雌性更普遍。跳蚤DNA的分子分析显示所有测试样品中都存在Capropoxvirus,而没有其他病毒感染。基因测序确定了三个分离株为羊痘病毒,还有一种是山羊痘病毒.研究结果表明,Capripoxvirus适用于跳蚤,并可能通过感染传播给动物。这突出表明需要在埃及不同地区持续监测其他病原体。
    The study aimed to investigate molecularly the presence of flea-borne viruses in infested small ruminants with fleas. It was carried out in Egypt\'s Northern West Coast (NWC) and South Sinai Governorate (SSG). Three specific primers were used targeting genes, ORF103 (for Capripoxvirus and Lumpy skin disease virus), NS3 (for Bluetongue virus), and Rdrp (for Coronavirus), followed by gene sequencing and phylogenetic analyses. The results revealed that 78.94% of sheep and 65.63% of goats were infested in the NWC area, whereas 49.76% of sheep and 77.8% of goats were infested in the SSG region. Sheep were preferable hosts for flea infestations (58.9%) to goats (41.1%) in the two studied areas. Sex and age of the animals had no effects on the infestation rate (p > 0.05). The season and site of infestation on animals were significantly different between the two areas (p < 0.05). Ctenocephalides felis predominated in NWC and Ctenocephalides canis in SSG, and males of both flea species were more prevalent than females. Molecular analysis of flea DNA revealed the presence of Capripoxvirus in all tested samples, while other viral infections were absent. Gene sequencing identified three isolates as sheeppox viruses, and one as goatpox virus. The findings suggest that Capripoxvirus is adapted to fleas and may be transmitted to animals through infestation. This underscores the need for ongoing surveillance of other pathogens in different regions of Egypt.
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  • 文章类型: Journal Article
    目的:描述临床实验室概况并分析与COVID-19严重程度相关的因素。
    方法:一项前瞻性队列研究,涉及累西腓一家三级医院收治的COVID-19患者,巴西。所有病例均通过RT-PCR确认,并根据严重程度标准进行分类。对人群特征进行了描述性统计分析。通过使用一般方程估计(GEE)模型计算比值比(OR),根据严重程度分析与病例结果相关的危险因素。
    结果:在纳入的75例中,64%是女性,62.7%年龄在65岁或以上。中位住院时间为9天(6-14天)。高血压(65.3%)和糖尿病(36%)是最常见的合并症。严重形式的COVID-19占样本的41.3%。与严重程度相关的因素是哮喘病史(OR=4.58,95CI:1.13-18.7),厌食症报告(OR=1,12,95CI:1.01-1.24),和实验室变化,包括血小板升高(OR=1.00,95%CI:1.00-1.01),D二聚体升高(OR=1,26,95%CI:1.04-1.52),天冬氨酸转氨酶升高(OR=1.00,95%CI:1.00-1.01),和γ-谷氨酰转移酶(OR=1.22,IC95%:0.98-1.51),高钠血症(OR=1.31,95CI:1.12-1.52),和高钾血症(OR=1.21,95%CI:1.04-1.41)。
    结论:多系统受累有血栓形成倾向,电解质干扰,和肝脏侵犯,反映在实验室的变化,是与COVID-19严重程度相关的因素。
    OBJECTIVE: To describe the clinical-laboratory profile and analyze the factors associated with the severity of COVID-19.
    METHODS: A prospective cohort study involving patients with COVID-19 admitted to a tertiary hospital in Recife, Brazil. All cases were confirmed by RT-PCR and classified according to severity criteria. A descriptive statistical analysis of the population\'s characteristics was conducted. Risk factors associated with the outcome of the case according to severity were analyzed by calculating the odds ratio (OR) using the general equation estimation (GEE) model.
    RESULTS: Among the 75 cases included, 64% were female, and 62.7% were aged 65 years or older. The median length of stay was 9 days (6 - 14). Hypertension (65.3%) and Diabetes Mellitus (36%) were the most frequent comorbidities. Severe forms of COVID-19 constituted 41.3% of the sample. The factors associated with severity were a history of asthma (OR=4.58, 95%CI:1.13 - 18.7), report of anorexia (OR=1, 12, 95%CI:1.01-1.24), and laboratory changes that included elevated platelets (OR=1.00, 95% CI:1.00-1.01), elevated D\'Dimer (OR=1, 26, 95% CI:1.04-1.52), elevated aspartate aminotransferase (OR=1.00, 95% CI:1.00-1.01), and gamma-glutamyl transferase (OR=1.22, IC95 %:0.98-1.51), hypernatremia (OR=1.31, 95%CI:1.12-1.52), and hyperkalemia (OR=1.21, 95% CI:1.04-1.41).
    CONCLUSIONS: Multisystemic involvement with a tendency for thrombophilia, electrolyte disturbances, and hepatic aggression, reflected by laboratory changes, were factors associated with the severity of COVID-19.
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  • 文章类型: Journal Article
    在加拿大COVID-19大流行的早期阶段,当食品店关闭时,食品零售企业的销售额显着增加。这项研究调查了安大略省与流行病相关的食品零售企业的修改,加拿大影响了工人的福祉。作为食品零售环境健康与经济弹性研究(FRESHER)的一部分,在2020年6月至2021年5月期间对17名食品零售员工进行了半结构化访谈。成绩单进行了归纳分析,并使用努力奖励失衡模型对主题进行了细化。主题与该模型的主要组成部分相关联:外在努力,内在的努力,钱,尊重,状态控制,和倦怠。结果表明,对于食品零售员工来说,努力和奖励之间的不平衡通过倦怠的症状威胁到幸福。需要进一步的研究来研究如何衡量和解决该人群中的这种不平等和倦怠。
    Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed.
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  • 文章类型: Journal Article
    病毒是专性寄生虫,依赖于细胞机制进行繁殖。几种病毒还掺入促进病毒传播的细胞蛋白。定义这些细胞蛋白对于破译病毒生命周期和描绘新的治疗策略至关重要。虽然许多研究探索了宿主蛋白在冠状病毒传播中的重要性,关于它们在成熟病毒体中存在的信息是有限的。在这项研究中,我们开发了一种方案来高度富集成熟的HCoV-OC43病毒体,并通过蛋白质组学对其进行表征。认识到细胞释放细胞外囊泡,其内容受病毒调节,考虑到我们能够从这些囊泡中分离病毒体,我们还分析了它们在未感染和感染细胞中的蛋白质含量。我们发现了与病毒体相关的69种独特的细胞蛋白,包括31种高置信度命中。这些蛋白质主要调节RNA代谢,酶活性,囊泡运输,细胞粘附,代谢物相互转化,和翻译。我们进一步发现该病毒对外泌体成分有深远的影响,与未感染细胞相比,在病毒相关的细胞外囊泡中掺入了47种新型细胞蛋白(11种高置信度),并排除了92种其他蛋白(61种高置信度)。此外,一个dsiRNA屏幕显示,11的18个目标选择显著影响病毒产量,包括病毒体或细胞外囊泡中的蛋白质。总的来说,这项研究为将许多宿主蛋白掺入HCoV-OC43病毒体提供了新的重要见解,它们的生物学意义,以及病毒调节细胞外囊泡的能力。
    目标:近年来,冠状病毒已经引起了全球的关注,这使得开发控制它们和防止未来大流行的方法变得至关重要。除了病毒蛋白,宿主蛋白在病毒繁殖中起着重要作用,并提供了潜在的治疗靶点。靶向宿主蛋白是有利的,因为与病毒蛋白相比,它们不太可能突变和产生抗性,许多抗病毒治疗的常见问题。在这项研究中,我们检查了毒性较低的生物安全级别2HCoV-OC43病毒的蛋白质含量,以代替毒性较大的SARS-CoV-2。我们的发现表明,整合到病毒体中的几种细胞蛋白调节病毒传播。此外,我们报告说,该病毒广泛调节细胞外囊泡的含量,增强病毒传播。这强调了病毒之间的关键相互作用,宿主蛋白,和细胞外囊泡。
    Viruses are obligate parasites that depend on the cellular machinery for their propagation. Several viruses also incorporate cellular proteins that facilitate viral spread. Defining these cellular proteins is critical to decipher viral life cycles and delineate novel therapeutic strategies. While numerous studies have explored the importance of host proteins in coronavirus spread, information about their presence in mature virions is limited. In this study, we developed a protocol to highly enrich mature HCoV-OC43 virions and characterize them by proteomics. Recognizing that cells release extracellular vesicles whose content is modulated by viruses, and given our ability to separate virions from these vesicles, we also analyzed their protein content in both uninfected and infected cells. We uncovered 69 unique cellular proteins associated with virions including 31 high-confidence hits. These proteins primarily regulate RNA metabolism, enzymatic activities, vesicular transport, cell adhesion, metabolite interconversion, and translation. We further discovered that the virus had a profound impact on exosome composition, incorporating 47 novel cellular proteins (11 high confidence) and excluding 92 others (61 high confidence) in virus-associated extracellular vesicles compared to uninfected cells. Moreover, a dsiRNA screen revealed that 11 of 18 select targets significantly impacted viral yields, including proteins found in virions or extracellular vesicles. Overall, this study provides new and important insights into the incorporation of numerous host proteins into HCoV-OC43 virions, their biological significance, and the ability of the virus to modulate extracellular vesicles.
    OBJECTIVE: In recent years, coronaviruses have dominated global attention, making it crucial to develop methods to control them and prevent future pandemics. Besides viral proteins, host proteins play a significant role in viral propagation and offer potential therapeutic targets. Targeting host proteins is advantageous because they are less likely to mutate and develop resistance compared to viral proteins, a common issue with many antiviral treatments. In this study, we examined the protein content of the less virulent biosafety level 2 HCoV-OC43 virus as a stand-in for the more virulent SARS-CoV-2. Our findings reveal that several cellular proteins incorporated into the virion regulate viral spread. In addition, we report that the virus extensively modulates the content of extracellular vesicles, enhancing viral dissemination. This underscores the critical interplay between the virus, host proteins, and extracellular vesicles.
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  • 文章类型: Journal Article
    纳米孔直接RNA测序(DRS)能够捕获和全长测序天然RNA,没有重新编码或放大偏差。可以查询所得数据集以定义化学修饰的核糖核苷酸的身份和位置,以及聚(A)尾巴的长度,在单个RNA分子上。这些分析的成功在很大程度上取决于高分辨率转录组注释的提供,以及最小化未对齐和其他分析工件的工作流程。用于生成高分辨率转录组注释的现有软件解决方案不太适合于病毒的小基因密集基因组,这是由于鉴定其中可变剪接和重叠RNA普遍存在的不同转录同种型的挑战。为了解决这个问题,我们确定了DRS数据集的关键特征,这些特征可为结果的读数比对提供信息,并开发了转录组体系结构的纳米孔指导注释(NAGATA)软件包(https://github.com/DepledgeLab/NAGATA).我们证明,使用来自腺病毒的合成和原始DRS数据集的组合,疱疹病毒,冠状病毒,和人类细胞,NAGATA优于现有的转录组注释软件,并在重建基因稀疏和基因密集转录组时产生一致的高水平的精确度和召回率。最后,我们应用NAGATA产生被忽视的病原体人类腺病毒F41型(HAdV-41)的第一个高分辨率转录组注释,为此我们鉴定出77种不同的转录本,编码至少23种不同的蛋白质.
    目的:生物体的转录组表示可以表达的编码RNA的全部库。这对于理解生物体的生物学以及准确的转录组和基于表观转录组的分析至关重要。注释转录组仍然是一项复杂的任务,特别是在小的基因密集的生物体,如病毒,通过重叠的RNA最大化其编码能力。为了解决这个问题,我们开发了一种新的软件纳米孔引导的转录组结构注释(NAGATA),它利用纳米孔直接RNA测序(DRS)数据集来快速产生高分辨率的转录组注释不同的病毒和其他生物体。
    Nanopore direct RNA sequencing (DRS) enables the capture and full-length sequencing of native RNAs, without recoding or amplification bias. Resulting data sets may be interrogated to define the identity and location of chemically modified ribonucleotides, as well as the length of poly(A) tails, on individual RNA molecules. The success of these analyses is highly dependent on the provision of high-resolution transcriptome annotations in combination with workflows that minimize misalignments and other analysis artifacts. Existing software solutions for generating high-resolution transcriptome annotations are poorly suited to small gene-dense genomes of viruses due to the challenge of identifying distinct transcript isoforms where alternative splicing and overlapping RNAs are prevalent. To resolve this, we identified key characteristics of DRS data sets that inform resulting read alignments and developed the nanopore guided annotation of transcriptome architectures (NAGATA) software package (https://github.com/DepledgeLab/NAGATA). We demonstrate, using a combination of synthetic and original DRS data sets derived from adenoviruses, herpesviruses, coronaviruses, and human cells, that NAGATA outperforms existing transcriptome annotation software and yields a consistently high level of precision and recall when reconstructing both gene sparse and gene-dense transcriptomes. Finally, we apply NAGATA to generate the first high-resolution transcriptome annotation of the neglected pathogen human adenovirus type F41 (HAdV-41) for which we identify 77 distinct transcripts encoding at least 23 different proteins.
    OBJECTIVE: The transcriptome of an organism denotes the full repertoire of encoded RNAs that may be expressed. This is critical to understanding the biology of an organism and for accurate transcriptomic and epitranscriptomic-based analyses. Annotating transcriptomes remains a complex task, particularly in small gene-dense organisms such as viruses which maximize their coding capacity through overlapping RNAs. To resolve this, we have developed a new software nanopore guided annotation of transcriptome architectures (NAGATA) which utilizes nanopore direct RNA sequencing (DRS) datasets to rapidly produce high-resolution transcriptome annotations for diverse viruses and other organisms.
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  • 文章类型: Case Reports
    由严重呼吸道综合症冠状病毒2(SARS-Cov-2)引起的大流行是世界上见过的最具破坏性的医疗紧急情况之一。COVID-19阳性患者与登革热病毒共感染是一个额外的挑战,特别是在登革热流行地区。登革热和COVID-19感染均导致孕妇的发病率和不良结局增加,同时感染这两种疾病对孕妇可能进一步有害,有时甚至致命。这里,我们介绍了一例妊娠中期早期合并登革热和中度COVID-19疾病的孕妇,治疗成功,结局良好.
    The pandemic due to severe respiratory syndrome coronavirus 2 (SARS-Cov-2) was one of the most damaging healthcare emergencies the world has ever seen. Co-infection with dengue virus in COVID-19-positive patients is an additional challenge especially in dengue-endemic areas. Both dengue and COVID-19 infection cause increased morbidity and adverse outcomes in pregnant women, and simultaneous infection of these two illnesses can be further detrimental and sometimes fatal in pregnant women. Here, we present a case of a pregnant woman in her early second trimester with co-infection of dengue and moderate COVID-19 disease who was managed successfully and had a favorable outcome.
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  • 文章类型: Journal Article
    症状监测是对基于测试的COVID-19监测的潜在廉价补充。通过加强对COVID-19样疾病(CLI)的监测,可以促进有针对性的快速干预措施,从而预防COVID-19暴发,而无需主要依靠检测。
    本研究旨在评估确认的SARS-CoV-2感染与大学和县环境中自我报告和医疗保健提供者报告的CLI之间的时间关系,分别。
    我们收集了康奈尔大学(2020-2021年)和汤普金斯县卫生局(2020-2022年)的COVID-19检测和症状报告监测数据。我们使用负二项和线性回归模型将确认的COVID-19病例数和阳性测试率与CLI率时间序列相关联,滞后的COVID-19病例或比率,和星期几作为自变量。使用格兰杰因果关系和似然比检验确定了最佳滞后期。
    在模拟本科生案例时,CLI率(P=.003)和CLI暴露率(P<.001)与COVID-19试验阳性率显著相关,线性模型无滞后。在县一级,在线性(P<.001)和负二项模型(P=.005)中,卫生保健提供者报告的CLI率与SARS-CoV-2试验阳性显著相关,且滞后3天.
    大学校园中综合征监测与COVID-19病例之间的实时相关性表明,症状报告是COVID-19监测测试的可行替代或补充。在县一级,综合征监测也是COVID-19病例的领先指标,使快速行动,以减少传输。进一步的研究应该在其他环境中使用综合征监测来调查COVID-19的风险,例如低收入和中等收入国家等低资源环境。
    UNASSIGNED: Syndromic surveillance represents a potentially inexpensive supplement to test-based COVID-19 surveillance. By strengthening surveillance of COVID-19-like illness (CLI), targeted and rapid interventions can be facilitated that prevent COVID-19 outbreaks without primary reliance on testing.
    UNASSIGNED: This study aims to assess the temporal relationship between confirmed SARS-CoV-2 infections and self-reported and health care provider-reported CLI in university and county settings, respectively.
    UNASSIGNED: We collected aggregated COVID-19 testing and symptom reporting surveillance data from Cornell University (2020-2021) and Tompkins County Health Department (2020-2022). We used negative binomial and linear regression models to correlate confirmed COVID-19 case counts and positive test rates with CLI rate time series, lagged COVID-19 cases or rates, and day of the week as independent variables. Optimal lag periods were identified using Granger causality and likelihood ratio tests.
    UNASSIGNED: In modeling undergraduate student cases, the CLI rate (P=.003) and rate of exposure to CLI (P<.001) were significantly correlated with the COVID-19 test positivity rate with no lag in the linear models. At the county level, the health care provider-reported CLI rate was significantly correlated with SARS-CoV-2 test positivity with a 3-day lag in both the linear (P<.001) and negative binomial model (P=.005).
    UNASSIGNED: The real-time correlation between syndromic surveillance and COVID-19 cases on a university campus suggests symptom reporting is a viable alternative or supplement to COVID-19 surveillance testing. At the county level, syndromic surveillance is also a leading indicator of COVID-19 cases, enabling quick action to reduce transmission. Further research should investigate COVID-19 risk using syndromic surveillance in other settings, such as low-resource settings like low- and middle-income countries.
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  • 文章类型: Journal Article
    我们调查了护士在急性护理服务中预防医院获得性压力性损伤(PI)的经验,以更好地了解如何优化PI预防。我们使用理论领域框架来系统地确定国际准则所要求的基于证据的预防措施的障碍和促成因素。这项研究是MonashPartners学术健康科学中心急性健康服务合作伙伴中关于PI监测和预防的复杂能力建设项目的一个要素,位于墨尔本的经认可的学术健康合作伙伴关系,澳大利亚。我们采用了定性的描述性设计。我们采访了32名在重症监护病房提供护理的护士,四个急性护理服务的普通病房和COVID病房。护士是从四个大型急性护理服务中招募的(三个公共,一个私人)位于墨尔本。他们中的大多数人每天都与医院获得PI的高风险患者一起工作。在理论领域框架的指导下,使用主题分析对访谈笔录进行了编码和分析。所有参与者最常提及的领域包括:知识,技能,社会/职业角色和身份,关于能力的信念,环境背景和资源。护士讨论的主要障碍包括与PI识别和分期相关的护士知识和技能的差距,护理工作量大,人员配备不足,与PI识别相关的污名和自责,并加剧了COVID-19大流行的影响。讨论的主要主持人是培训方案,护理审核和反馈,和团队合作。与会者提出了改进建议,包括无障碍和量身定制的培训,视觉提醒,解决护士面临的繁重工作量和情感障碍。迫切需要投资于量身定制的培训计划,以提高护士的知识和组织变革,以解决低水平的人员配备和繁重的工作量,以支持护士提供最佳护理并防止医院获得PI。
    We investigated nurses\' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses\' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses\' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.
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