The COVID-19 pandemic generated a surge of critically ill patients greater than the capacity of the UK National Health Service (NHS). There have been multiple well-documented impacts associated with ...the national COVID-19 pandemic surge on ICU staff, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. We investigated the prevalence of five mental health outcomes; explored demographic and professional predictors of poor mental health outcomes; and describe the prevalence of functional impairment; and explore demographic and professional predictors of functional impairment in ICU staff over the 2020/2021 winter COVID-19 surge in England.
English ICU staff were surveyed before, during, and after the winter 2020/2021 surge using a survey which comprised validated measures of mental health.
A total of 6080 surveys were completed, by ICU nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (before) to 64% (during), and then decreased to 46% (after). Younger, less experienced nursing staff were most likely to report probable mental health disorders. During and after the winter, >50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety, or depression were more likely to meet threshold criteria for functional impairment.
The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment amongst ICU staff during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.
Over recent years, there has been increasing recognition that effective leadership is critical to establishing positive organisational culture and improving patient outcomes. In maternity, there is a ...unique interplay between different specialties and disciplines in providing high-quality services.
Review of literature pertaining to leadership and maternity.
Good leadership is the key determinant in ensuring that our multi-professional teams function effectively. The relational aspects of teamworking, linked to safer delivery of services, have been explored in great detail in maternity services. However, there has been less focus on the application of leadership theory in this environment and the impact of interventions used in developing leadership skills within maternity teams.
In this paper, we discuss how leadership theory can be used to understand high profile maternity service failures and how effective team culture, clinical team building and individual leadership skill-development are strong contributors to this thinking. Specific examples are used to describe ongoing work in our drive for improvement and to highlight the current lack of evidence in this area.
Frailty is common in the older population and is a predictor of adverse outcomes following emergency and elective surgery. Identification of frailty is key to enable targeted intervention throughout ...the perioperative pathway from contemplation of surgery to recovery. Despite evidence on how to identify and modify frailty, such interventions are not yet routine perioperative care. To address this implementation gap, a guideline was published in 2021 by the Centre for Perioperative Care and the British Geriatrics Society, working with patient representatives and all stakeholders involved in the perioperative care of patients with frailty undergoing surgery. The guideline covers all aspects of perioperative care relevant to adults living with frailty undergoing elective and emergency surgery. It is written for healthcare professionals, as well as for patients and their carers, managers and commissioners. Implementation of the guideline will require collaboration between all stakeholders, underpinned by an implementation strategy, workforce development with supporting education and training resources, and evaluation through national audit and research. The guideline is an important step in improving perioperative outcomes for people living with frailty and quality of healthcare services. This commentary provides a summary and discussion of the evidence informing the standards and recommendations in the published guideline.
Further studies on the fresh rhizomes of Polygonatum kingianum led to the isolation of one new spirostanol saponin (25R)-kingianoside G (1), and two pairs mixture of 25R and 25S stereoisomeric ...spirostanol saponins (25R, S)-pratioside D1 (2a, 2b) and (25R, S)-kingianoside A (3a, 3b), among them 2b and 3b were new spirostanol saponins, together with another two known compounds, disporopsin (4) and daucosterol (5). The structures of the new saponins were determined by detailed analysis of their 1D and 2D NMR spectra, and chemical evidences.
Two new spirostanol saponins, named kingianoside H (1) and kingianoside I (2), were isolated from the processed rhizomes of Polygonatum kingianum, along with a known triterpenoid saponin ...ginsenoside-Rc (3), four known spirostanol saponins Tg (4), (5), polygonatoside C1 (6) and ophiopogonin C′ (7). The structures of the new compounds were elucidated by detailed spectroscopic analyses, including 1D and 2D NMR techniques and chemical methods. Compounds 3 and 5 were first reported from the genus Polygonatum. Compounds 4, 6 and 7 are reported for the first time from the processed Polygonatum kingianum.
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