OBJECTIVE: The aims of this study were to describe the experiences of nurses in the aftermath of the COVID-19 pandemic and to explore nurses\' current desired support needs.
METHODS: This study used a qualitative descriptive design.
METHODS: This study was conducted in the Southeastern United States at an academic health system encompassing acute care hospitals and outpatient speciality clinics. Thirteen nurses were interviewed in August and September of 2023 in five small groups of two or three nurses. Photovoice was used for data collection and each nurse submitted two photographs. Data were analysed utilising conventional content analysis, with transcripts and photograph analysis occurring concurrently.
RESULTS: Three themes were identified: (1) organisational turmoil, (2) personal traumatisation and transitions and (3) striving for revival and renewal. A conceptual model illustrating the three themes and their relationships was developed to depict study findings.
CONCLUSIONS: Nurses were impacted by organisational factors, such as staffing issues and lack of support, and personally through psychological trauma that has remained challenging. Nurses found revival and renewal in their personal lives, but still desire continued improvement in organisational factors to enhance their well-being in ways not currently being addressed to allow for full recovery. Findings from this study are pertinent for healthcare organisations and leaders to develop organisational changes and mental health solutions to support nurse well-being.
UNASSIGNED: The prioritisation of nurse well-being is critical for the nursing profession and healthcare organisations. Organisational improvements and the implementation of support resources are urgently needed to aid in nurse recovery, nurse retention and to ensure patients receive quality care.
CONCLUSIONS: This study identified nurses\' struggles 3 years after the beginning of the COVID-19 pandemic, highlighting the ongoing need to provide resources and interventions that support nurse well-being. Our findings offer nurses\' descriptions of their experiences and support needs for organisations and healthcare leaders to consider in the future.
UNASSIGNED: Standards for Reporting Qualitative Research (SRQR) Checklist.
UNASSIGNED: No patient or public contribution.

I would like to reconsider a recent analysis by Prof. Senn on the statistics of the Pfizer-BioNTech vaccine trial, to express some different opinions and to clarify some theoretical points, especially regarding the clinical applications of Bayesian statistics.

BACKGROUND: While COVID-19 has been controlled and deaths have decreased, the long-term consequences of COVID-19 remain a challenge we face today. This study was conducted to determine the relationship between the apoptosis of lymphocyte cells with DNA damage and oxidative stress and the therapeutic and clinical outcomes of elderly patients with COVID-19.
METHODS: This study was conducted from April 2020 to May 2021 (the period of severe attacks of the epidemic peak of COVID-19) and September 2022 (the post-COVID-19 period). The study groups included elderly patients with COVID-19 hospitalized in the ICU and normal wards of the hospital as well as elderly patients with influenza. A polymerase chain reaction was used to check the validity of the studied diseases. The Annexin V/Propidium Iodide method was used to evaluate the level of apoptosis. Genotoxic effects and DNA damage were assessed by the comet assay method. Total antioxidant status (TAS), total oxidant status (TOS), and myeloperoxidase activity (MPO) were measured by photometric methods.
RESULTS: The highest level of apoptosis in peripheral blood lymphocytes and the highest level of DNA damage were observed at both times in the intubated-ICU and non-intubated-ICU groups. In all groups, there was a significant increase in peripheral blood lymphocyte apoptosis levels and DNA damage levels compared to the healthy control group (p < 0.01). The level of apoptosis and DNA damage decreased significantly in the post-COVID-19 period (p < 0.01). In the investigation of oxidative stress biomarkers, the oxidative stress index, including TOS and MPO levels, increased in patients (p < 0.01), and the TAS level decreased (p < 0.01).
CONCLUSIONS: It shows that the apoptosis of lymphocyte cells, DNA damage, and oxidative stress can be effective in prognostic decisions and is a suitable predictor for diagnosing the condition of patients with viral infections such as COVID-19 and influenza.

Limited research suggests that certain viruses reactivate in severe-acute-respiratory-syndrome-coronavirus 2 infection, contributing to the development of postacute sequelae of COVID-19 (PASC). We examined 1083 infected individuals from a population-based cohort, and assessed differences in plasma immunoglobulin (Ig)G and immunoglobulin A levels against Epstein-Barr virus (EBV), cytomegalovirus, varicella zoster virus (VZV), BK polyomavirus, KI polyomavirus, WU polyomavirus (WUPyV), respiratory syncytial virus, and Adv-36 according to the severity of previous COVID-19 and PASC history. Individuals who had experienced severe COVID-19 had higher antibody responses to latent viruses. Ever PASC, active persistent PASC, and PASC with neuropsychiatric symptoms were associated with higher immnoglobulin G to EBV early antigen-diffuse, VZV, and WUPyV even among individuals without previous severe COVID-19.

UNASSIGNED: COVID-19 patients might be admitted to the hospital based on their clinical manifestations or to the intensive care unit (ICU) due to the severity of their symptoms or critical situation. Our main objective was to investigate clinical and demographic factors influencing COVID-19 patients\' admission to the ICU and length of stay (LOS) using extracted data from the hospital information systems in Iran.
UNASSIGNED: The data of hospitalized patients with confirmed COVID-19 were retrieved from the health information system of Imam Khomeini Hospital Complex, Tehran, Iran between March 2020 and February 2022. The primary outcome was the ICU admission, and the secondary outcome was the LOS. The correlation analysis between laboratory findings and demographic data with ICU admission and LOS was done using SPSS 21.0, and p < 0.05 was considered significant.
UNASSIGNED: Of all the 4156 patients, 2391 (57.5%) were male and the mean age was 58.69 ± 8.19 years. Of these, 9.5% of patients were admitted to ICU at any time point during their hospital stay. Age and laboratory variables such as neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), albumin (g/dL), plasma glucose (mg/dL), ferritin levels (ng/mL), and phosphorous levels (mg/dL) shown the significant relationship with ICU admission. Also, being a smoker and having hypoxemia had a significant relationship with longer stays in the hospital. In this study, we validated a cut-off value of 4.819 for NLR, calculated at hospitalization, as a useful predictor of disease progression and occurrence of serious clinical outcomes, such as ICU admission.
UNASSIGNED: The study examined various clinical factors associated with ICU admission in COVID-19 patients. The findings suggest that certain factors can increase the risk of ICU admission and influence the length of hospital stay which should be focused in future studies.

SARS-CoV-2 infection causes disruptions in inflammatory pathways, which fundamentally contribute to COVID-19 pathophysiology. The present review critically evaluates the gaps in scientific literature and presents the current status regarding the inflammatory signaling pathways in COVID-19. We propose that phytoconstituents can be used to treat COVID-19 associated inflammation, several already formulated in traditional medications. For this purpose, extensive literature analysis was conducted in the PubMed database to collect relevant in vitro, in vivo, and human patient studies where inflammation pathways were shown to be upregulated in COVID-19. Parallelly, scientific literature was screened for phytoconstituents with known cellular mechanisms implicated for inflammation or COVID-19 associated inflammation. Studies with insufficient evidence on cellular pathways for autophagy and mitophagy were considered out of scope and excluded from the study. The final analysis was visualized in figures and evaluated for accuracy. Our findings demonstrate the frequent participation of NF-κB, a transcription factor, in inflammatory signaling pathways linked to COVID-19. Moreover, the MAPK signaling pathway is also implicated in producing inflammatory molecules. Furthermore, it was also analyzed that the phytoconstituents with flavonoid and phenolic backbones could inhibit either the TLR4 receptor or its consecutive signaling molecules, thereby, decreasing NF-κB activity and suppressing cytokine production. Although, allopathy has treated the early phase of COVID-19, anti-inflammatory phytoconstituents and existing ayurvedic formulations may act on the COVID-19 associated inflammatory pathways and provide an additional treatment strategy. Therefore, we recommend the usage of flavonoids and phenolic phytoconstituents for the treatment of inflammation associated with COVID-19 infection and similar viral ailments.

COVID-19, the disease caused by SARS-CoV-2, particularly causes severe inflammatory disease in elderly, obese, and male patients. Since both aging and obesity are associated with decreased testosterone and estradiol expression, we hypothesized that decreased hormone levels contribute to excessive inflammation in the context of COVID-19. Previously, we and others have shown that hyperinflammation in severe COVID-19 patients is induced by the production of pathogenic anti-spike IgG antibodies that activate alveolar macrophages. Therefore, we developed an in vitro assay in which we stimulated human macrophages with viral stimuli, anti-spike IgG immune complexes, and different sex hormones. Treatment with levels of testosterone reflecting young adults led to a significant reduction in TNF and IFN-γ production by human macrophages. In addition, estradiol significantly attenuated the production of a very broad panel of cytokines, including TNF, IL-1β, IL-6, IL-10, and IFN-γ. Both testosterone and estradiol reduced the expression of Fc gamma receptors IIa and III, the two main receptors responsible for anti-spike IgG-induced inflammation. Combined, these findings indicate that sex hormones reduce the inflammatory response of human alveolar macrophages to specific COVID-19-associated stimuli, thereby providing a potential immunological mechanism for the development of severe COVID-19 in both older male and female patients.

After COVID-19 long term respiratory symptoms and reduced lung function including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) have been reported. However, no studies have looked at MIP and MEP in all disease groups and the reference materials collection methods differ substantially. We aimed to determine MIP and MEP in individuals after COVID-19 infection with different disease severity using reference material of healthy control group obtained using the same standardized method. Patients with COVID-19 were included March 2020-March 2021 at Rigshospitalet, Denmark. MIP and MEP were measured using microRPM. Predicted MIP and MEP were calculated using reference material obtained from 298 healthy adults aged 18-97 years using the same method. In SECURe, 145 participants were measured median 5 months after COVID-19 diagnosis and of these 16% had reduced MIP and/or MEP. There was reduced spirometry and total lung capacity, but not reduced diffusion capacity in those with abnormal MIP and/or MEP compared with normal MIP and MEP. Of those with reduced MIP and/or MEP at 5 months, 80% still had reduced MIP and/or MEP at 12 months follow-up. In conclusion, few have reduced MIP and/or MEP 5 months after COVID-19 and little improvement was seen over time.

BACKGROUND: This study aimed to review the activities of the Kobe City Initial-phase Intensive Support Team for Dementia pre- and during the coronavirus disease 2019 (COVID-19) pandemic, to compare the characteristics of the target population and the performance of the team\'s activities, and determine the impact of the pandemic on the team\'s project.
METHODS: The summary data obtained at the time of consultation, team activities, and participants\' characteristics were extracted from 662 participants who started to receive support between April 2018 and March 2022. Statistical analysis was performed by dividing the participants into the following two groups: pre- and during COVID-19 pandemic groups.
RESULTS: There was no significant difference in the number of new cases or cases that led to a dementia diagnosis between the pre- and during COVID-19 pandemic groups. However, there were significant differences in the number of home visits and rate of introduction of medical care between the two groups. In our study population, the number of participants with financial management difficulties and delusions increased and the number of participants who refused visitations slightly decreased.
CONCLUSIONS: The Kobe City Initial-phase Intensive Support Team was able to continue its activities during the pandemic partly because the team is an independent, dedicated team. During the pandemic, there was an increase in the number of participants who were isolated because they were deprived of opportunities to interact with others, and who developed delusions and other psychiatric symptoms. Despite this situation, the professional team responded quickly through individual assessment of the individual needs by continuous outreach, taking into account the infection situation, and thus this outreach team functioned well even under the COVID-19 pandemic.

Assess the changes in post-traumatic stress disorder (PTSD), burnout, anxiety, depression, jobstrain, and isostrain levels over time among healthcare workers in emergency departments (EDs) after successive outbreaks of COVID-19. A prospective, multicenter study was conducted in 3 EDs and an emergency medical service. Healthcare workers who participated in our previous study were invited to participate in a follow-up 16 and 18 months and completed the questionnaires to assess symptoms of PTSD, burnout, anxiety, depression, jobstrain, and isostrain. Among the 485 healthcare workers asked to participate, 211 (43.5%) completed the survey at inclusion (122 were followed up at 3 months) and 59 participate to the follow-up study. At 16 months, 10.9% of healthcare workers had symptoms of PTSD and 17.4% at 18 months. At inclusion, 33.5% and 11.7% of healthcare workers had symptoms of anxiety and depression, respectively. A decrease in anxiety between inclusion and 16 months (p = 0.02) and an increase between 16 and 18 months (p = 0.009) was observed. At inclusion, 40.8% of all healthcare workers had symptoms of burnout. There was an increase in symptoms of burnout between inclusion and 18 months (p = 0.006). At inclusion, 43.2% and 29.5% of healthcare workers were exposed to jobstrain and isostrain, respectively. Jobstrain were higher among paramedics and administrative staff compared to physicians (p = 0.001 and p = 0.026, respectively). Successive outbreaks of COVID-19 led to long-term mental health consequences among ED healthcare workers that differed according to occupation. This must be taken into account to rethink the management of teams.