Perceived stress and coping capacities among frontline healthcare workers of AIIMS during COVID-19 pandemic:A cross-sectional study

Objective:To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic.Methods:This cross-sectional study conducted from May to July 2021 enrolled 694 participants.An online questionnaire based on Google Forms was developed to collect the data.Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale.Results:The age of participants were 27(23-52)years old.The majority of respondents(73.5%)felt moderately stressed.Of the 694 participants,83.0%of the 576 participants had average stress management skills.Sex,marital status,and profession were significantly associated with perceived stress.In addition,marital status and profession were significantly associated with coping capacity.Conclusions:The majority of participants have moderate stress levels and average coping skills.Frontline healthcare workers have to maintain mental and physical health.Achieving this requires early screening and stress management for healthcare workers.

High-dose Chemotherapy Combined with Autologous Hematopoietic Stem Cell Transplantation as Frontline Therapy for Intermediate/High-risk Diffuse Large B Cell Lymphoma

The role of autologous hematopoietic stem cell transplantation(auto-HSCT)following high-dose chemotherapy has been validated and accepted as a standard treatment for patients with relapsed diffuse large B-cell lymphoma(DLBCL).However,its clinical efficacy as frontline therapy remains to be elucidated.This study aimed to examine the feasibility of frontline auto-HSCT for newly diagnosed intermediate/high-risk DLBCL patients.We retrospectively reviewed the data of 223 patients treated with frontline auto-HSCT or chemotherapy alone(year 2008-2014)from four hospitals.The median follow-up time was 29.4 months.Between the two treatment arms among the intermediate/high-risk DLBCL patients,the 3-year overall survival(OS)and progression-free survival(PFS)rates of patients given frontline auto-HSCT were 87.6%and 81.9%,respectively,and the chemotherapy-alone group showed 3-year OS and PFS rates of 64.9%and 59.59%,respectively.Compared with the chemotherapy-alone group,the frontline auto-HSCT could eliminate the adverse impact of non-germinal center B-cell(GCB)type.In addition,in the frontline auto-HSCT group,patients who achieved complete response(CR)at auto-HSCT had a longer survival time than those who did not achieve CR.Our results suggested that frontline auto-HSCT could improve the prognosis of intennediate/high-risk DLBCL patients.

Review of possible psychological impacts of COVID-19 on frontline medical staff and reduction strategies

Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available.Here,we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic.These include anxiety,insomnia,depression,interpersonal difficulties,and post-traumatic stress disorder syndrome.We further present a summary of countermeasures for alleviating these problems based on our findings.These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff,developing timely and clear guidelines,strengthening social support,and providing clear criteria and additional training,focusing on the choice of frontline medical staff.An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff.Consequently,they will be able to cope better with outbreaks of infectious diseases in the future,to reduce the psychological pressure of the front-line medical staff,and to improve the treatment level.

Cross-sectional study of traumatic stress disorder in frontline nurses 6 mo after the outbreak of the COVID-19 in Wuhan

BACKGROUND Frontline nurses in Wuhan directly fighting severe acute respiratory syndrome coronavirus-2 diseases are at a high risk of infection and are extremely susceptible to psychological stress,especially due to the global coronavirus disease 2019(COVID-19)pandemic.The psychological after-effects of this public health emergency on frontline nurses will last for years.AIM To assess factors influencing post-traumatic stress disorder(PTSD)among frontline nurses in Wuhan 6 mo after the COVID-19 pandemic began.METHODS A total of 757 frontline nurses from five hospitals in Wuhan,China,participated in an online survey from July 27 to August 13,2020.This cross-sectional online study used a demographic information questionnaire,the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders,the Connor-Davidson Resilience Scale,and the Patient Health Questionnaire-4.The chisquare test and logistic regression were used to analyze the association of demographics,COVID-19-related variables,and PTSD.Logistic regression was also conducted to investigate which variables were associated with PTSD outcomes.RESULTS A total of 13.5%,24.3%,and 21.4%of the frontline nurses showed symptoms of PTSD,depression,and anxiety,respectively.The multivariate logistic regression analysis showed that the following factors were strongly associated with PTSD:Having a relative,friend,or colleague who died of COVID-19;experiencing stigma;or having psychological assistance needs,depressive symptoms or anxiety.Showing resilience and receiving praise after the COVID-19 outbreak were protective factors.CONCLUSION Frontline nurses still experienced PTSD(13.5%)six months after the COVID-19 outbreak began.Peer support,social support,official recognition,reward mechanisms,exercise,better sleep,and timely provision of information(such as vaccine research progress)by the government via social media,and adequate protective supplies could mitigate the level of PTSD among nurses responding to COVID-19.Stigmatization,depression,and anxiety might be associated with a greater risk of PTSD among nurses.

The Effect of Customer Verbal Aggression on Burnout in Frontline Employees in Hotels and Travel Agencies: The Moderating Role of Perceived Supervisor Support

This study aimed to assess the effect of customer verbal aggression(CVA)on job burnout(JB)in frontline employee in both hotels and travel agencies,trying to reveal if there is a difference between both sectors in this context.The study additionally tested the moderation role of perceived supervisor support(PSS)in the relation between customer verbal aggression and burnout in hotels and travel agencies.Two versions of the questionnaire were distributed online.The first among hotels employees and the second was addressed to travel agencies employees;613 were retrieved and analyzed using the version of Spss 23.0.The results showed a significant difference among the level of customer verbal aggression,job burnout,and perceived supervisor support in hotels and travel agencies.Although there was a significant relation between customer verbal aggression and job burnout among frontline employees in both settings,this relationship was moderated by PSS in hotels but not in travel agencies.Eventually,the study concludes with recommendations and practical managerial implications in this regard and it can be considered as a first step for helping practitioners to efficiently manage such a phenomenon.

The psychological experience of Chinese nurses in support of COVID-19 frontline:A qualitative study

Objective: The objective of the study is to explore the real psychological experience of the frontline support nurses in fight against COVID-19,so as to provide a reference basis for targeted intervention and ensure the mental health of the frontline support nurses.Methods: The objective sampling method was used to conduct semi‑structured interviews with 9 frontline support nurses fighting COVID‑19,and the interview contents were analyzed using Colaizzi’s 7‑step method.Results: The psychological experience of frontline support nurses in fight against COVID-19 can be summarized into four themes: Thecoexistence of negative psychological experience and positive psychological experience (tension, anxiety, fear, and depression);psychologicalpressure;many factors that affect the negative psychological experience (the stimulation of the external environment, the care of family members,the guidance of network public opinion);and solid support system (good family support and rich social support).Conclusion: Although frontline support nurses have negative emotions and bear great psychological pressure, they all have a high sense ofprofessional responsibility. Therefore, managers should pay attention to their psychological experience and provide targeted assistance to them.

Comparative Efficacy of Frontline Tri-Act^(■) Spot on(Fipronil/Permethrin)versus Seresto^(■) Collar(Imidacloprid/Flumethrin)against Fleas(Ctenocephalides felis)and Ticks(Rhipicephalus sanguineus)on Dogs with Simulation of Bi-Monthly Rain Exposure

The objective of the study was to compare the efficacy of one topical insecticide-acaricide (Frontline Tri-Act?) and of one collar (Seresto?) against fleas (Ctenocephalides felis) and ticks (Rhipicephalus sanguineus) on dogs exposed to bi-weekly water showering. Twenty four (24) dogs were enrolled in the study. A first set of 16 dogs were acclimatised to their cages from Day 1 to 7 and a second set of 8 dogs from Day 163 to Day 169. The 24 dogs were randomly allocated to three groups (1 to 3). Dogs assigned to Group 1 were not treated and served as negative controls. Dogs assigned to Group 2 received the Seresto? collar on Day 0 and dogs in Group 3 received Frontline Tri-Act? on Days 170 and 198. The dogs were observed hourly for four hours after treatment administration for possible adverse reactions. Dogs in Groups 1 and 2 underwent water showering on Days 14, 28, 42, 56, 70, 84, 98, 112, 126, 143 and 157. Dogs in all groups underwent water showering on Days 173, 185, 199 and 213. Dogs were infested with approximately 100 (±4) adult, unfed C. felis fleas only on Days 177, 190, 203, and 217, in alternance with infestations with 50 adult unfed R. sanguineus on Days 182, 196, 210, and 224, to assess sustained efficacy. Fleas and ticks were removed and counted on 24 and 48 hours ± 2 hours after each infestation, respectively. Frontline Tri-Act? was >99% effective against C. felis following an initial and a second monthly administration on dogs that were water showered bi-weekly. The Seresto? collar was from 68.3% to 92.9% effective against C. felis Days 178 to 218 after collar administration. Frontline Tri-Act? was effective from 87.8% to 100% against ticks whereas Seresto collar was effective from 82.2% to 94.2% from Day 184 to Day 226.

Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana,2014-2015

Background:Dog bites are common in developing countries including Ghana,with the victims often being children.Although some breeds of dogs have been identified as being more aggressive than others,all dog bites carry a risk of infection.Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites.This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region,Ghana.Methods:We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015.Up to four frontline service providers were randomly selected to participate from each facility.A structured questionnaire was administered to all consenting participants.Continuous variables were presented as means and standard deviations.The frontline service providers’knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions.The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.Results:Regarding the frontline service providers’knowledge about rabies,57.8%(134/232)were correct in that the rabies virus is the causative agent of rabies,39.2%(91/232)attributed it to a dog bite,2.6%(6/232)did not know the cause,and one person(0.4%)attributed it to the herpes virus.Only 15.5%(36/232)knew the incubation period in dogs and the period required to observe for signs of a rabies infection.With respect to the administration of rabies immunoglobulin,42.2%(98/232)of the frontline service providers did not know how to administer it.Of the facilities visited,76%(50/66)did not have the rabies vaccines and 44%(102/232)of frontline service providers did not know where to get the rabies vaccines from.Most of the service providers(87.9%;204/232)had never reported either a dog bite or a suspected case of rabies.Overall,there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.Conclusions:In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers,there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.

Reducing turnover intention: Perceived organizational support for frontline employees

Frontline employees are generally under great pressure,and carry out repetitive and mundane daily tasks,leading to burnout and a high turnover intention among them.To identify ways to reduce this turnover intention,this study examines the effect of perceived organizational support(POS)on burnout and turnover intention in the Chinese context and adds to the literature on frontline employee burnout.Using data from a survey of the frontline employees of a gas station in Beijing,we examine the mediating effects of frontline employee burnout on their POS and turnover intention.This study shows that POS has a significant negative impact on burnout and turnover intention,and that job resources cannot substitute POS.

A FRONTLINE IN THE SAND

Exploring ways to win the battle against desertification in Inner Mongolia Mengke Dalai wanted to escape from the Kubuqi Desert where ecological degradation was making his life increasingly harsh."The grassland became sandy as the grass disappeared.After that we struggled to continue with our way of life,even though generations of herdsmen had lived on this pasture before us,"he recalled.Finally。

Front Line Health Workers’ COVID-19 Lived Experiences: A Case of Levy Mwanawasa Hospital in Lusaka, Zambia

Introduction: Frontline health workers who work in COVID-19 isolation treatment centers are susceptible to developing mental health issues due to the overwhelming workload and stress associated with their job. Thus understanding their lived experiences provides insights that helps alleviate health worker burnout and improving their quality of life thereby leading to an efficient delivery of health care services during a pandemic. Aim: To understand the lived experiences of front line health workers during the COVID-19 pandemics at Levy Mwanawasa Teaching University Hospital. Design and Methods: A qualitative interpretative phenomenological study design was used. Purposive sampling method was adopted to select the 14 participants who took part in the study. The data were collected through face-to-face, audio-taped interviews using an in-depth interview guide, after which the responses were transcribed verbatim before using NVIVO to generate codes. The data were analyzed using thematic method. Results: The lived experiences of the participants were found to be mainly negative with few positive experiences. Their lived experiences were mainly negative emotional and psychological experiences including fear, anger, depression, frustration, anxiety and sadness. The thoughts that were identified included thoughts of surviving through the pandemic, thoughts of getting infected, and dying. The frontline health workers also experienced some personal and professional changes as they offered health services in the COVID-19 wards. The personal changes reported included;social limitations and collapse of extra income business while the professional changes included a change in the way health services were delivered, a gain in knowledge and skills and shaping of a career path. The main challenges experienced were limited resources (man power, resuscitation equipment, drugs, personal protective equipment), limited literature on the disease and limited social interactions. Conclusion and Recommendations: Relevant stakeholders should come on board in order to offer support during a pandemic or a similar situation so as to better the experience of frontline health workers with particular attention directed towards the provision of adequate resources to enable them deliver their services effectively. Frontline health workers perspectives and opinions should be taken into account by the institution’s administrators and policymakers when planning for and managing a pandemic.

A phase Ⅱ study of paclitaxel and nedaplatin as front-line chemotherapy in Chinese patients with metastatic esophageal squamous cell carcinoma

AIM:To evaluate the efficacy and safety of paclitaxelnedaplatin combination as a front-line regimen in Chinese patients with metastatic esophageal squamous cell carcinoma(ESCC).METHODS:A two-center,open-label,single-arm phaseⅡstudy was designed.Thirty-nine patients were enrolled and included in the intention-to-treat analysis of efficacy and adverse events.Patients received 175mg/m2of paclitaxel over a 3 h infusion on 1 d,followed by nedaplatin 80 mg/m2in a 1 h infusion on 2 d every3 wk until the documented disease progression,unac-ceptable toxicity or patient’s refusal.RESULTS:Of the 36 patients assessable for efficacy,there were 2 patients(5.1%)with complete response and 16 patients(41.0%)with partial response,giving an overall response rate of 46.1%.The median progression-free survival and median overall survival for all patients were 7.1 mo(95%CI:4.6-9.7)and 12.4 mo(95%CI:9.5-15.3),respectively.Toxicities were moderate and manageable.Grade 3/4 toxicities included neutropenia(15.4%),nausea(10.3%),anemia(7.7%),thrombocytopenia(5.1%),vomiting(5.1%)and neutropenia fever(2.6%).CONCLUSION:The combination of paclitaxel and nedaplatin is active and well tolerated as a first-line therapy for patients with metastatic ESCC.

Chidamide combined with cyclophosphamide,doxorubicin,vincristine and prednisone in previously untreated patients with peripheral T-cell lymphoma

Objective:Chidamide is an oral histone deacetylase subtype-selective inhibitor approved for relapsed or refractory peripheral T-cell lymphoma(PTCL).This phase 1 b study evaluated the safety,pharmacokinetics,and preliminary efficacy of chidamide in combination with cyclophosphamide,doxorubicin,vincristine and prednisone(CHOP)for treatment-na?ve PTCL patients.Methods:This study was an open-label,multicenter trial composed of dose escalation and dose expansion.Patients received CHOP for six 21-d cycles and chidamide on d 1,4,8 and 11 in each cycle.Four dose levels of chidamide(20,25,30 and 35 mg)were evaluated.The primary objective was to evaluate the safety and tolerability of the combination regimen.Results:A total of 30 patients were evaluated in this study:15 in the dose-escalation part and 15 in the doseexpansion part.In the dose-escalation study,three patients were enrolled in the 35 mg chidamide cohort.One had dose-limiting toxicity with grade 3 vascular access complications,and one had grade 2 neutropenia with a sustained temperature>38°C.Dose escalation was stopped at this chidamide dose level.The most common(≥10%)grade 3 or 4 adverse events(AEs)were leukopenia(90.0%),neutropenia(83.3%),vomiting(13.3%),thrombocytopenia(10.0%)and febrile neutropenia(10.0%).No significant changes in chidamide pharmacokinetic properties were observed before and after combination treatment.The objective response rate for the 28 patients evaluable for preliminary efficacy was 89.3%(25/28),with 16(57.1%)achieving complete response or unconfirmed complete response.The estimated median progression-free survival was 14.0 months.In summary,we chose chidamide 30 mg as the recommended dose for phase 2.Conclusions:The addition of chidamide to standard CHOP chemotherapy was tolerable with promising preliminary efficacy in previously untreated PTCL patients,which supports further clinical studies with this combination regimen for the frontline treatment of PTCL.

The Pandemic COVID-19 and the Auspicious Role of Frontier Pharmacists against This Global Threat

The frontline pharmacists during this pandemic COVID-19 (coronavirus disease 2019) situation are potentially contributing to saving human lives worldwide. The objective of this study was to demonstrate the current contributions of pharmacists among the frontline healthcare professionals in the management of the COVID-19 crisis across the world. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Scopus databases were searched for this study from March 20, 2020 to May 20, 2020. The basic keyword “pharmacist and COVID-19” was used to select studies. Relevant English-language studies, guidelines, articles, relevant published reports in different online news portals and official web pages of different organizations were searched. Pharmacists in the United States and United Kingdom are testing patients for COVID-19 and providing medical advice to patients. Community pharmacists in European countries are focused on the smooth supply of essential medicines, and working to build awareness regarding the community transmission of COVID-19. Hospital and clinical pharmacists are working to facilitate the effective medication therapy management for improving the clinical outcomes of COVID-19 patients. Pharmacists in low-and middle-income countries around the world have focused their efforts mainly on awareness-building activities regarding the community transmission of COVID-19, and the mass production of alcohol-based hand-sanitizer. Several resources are globally available for pharmacists to improve their competency and self-protection from COVID-19. Frontline pharmacists are enthusiastically contributing in the prevention and treatment of COVID-19 from a community-to-clinical level worldwide. Their active participation as a member of the frontline healthcare team is crucial in order to address and overcome the challenges that this pandemic has created, and to tackle this global healthcare crisis efficiently.

Threat recognition and response in an avian brood-parasite host from New Caledonia

Nest predation and avian brood parasitism are the main sources of nest failure in many passerine birds.Large predators threaten both brood and parents,whereas brood parasites pose only a danger to eggs or nestlings.The fan-tailed gerygone Gerygone flavolateralis from New Caledonia is subjected to high rates of nest predation by the New Caledonian crow Corvus moneduloides(responsible for about 20-40%of predation)and moderate rates of brood parasitism by the shining bronze-cuckoo Chalcites lucidus(parasitizing about 18%of nests),which also depredates nests that are too advanced for parasitism(13%of nests).To test if fan-tailed gerygones are able to discriminate predators from brood parasites,we presented 3 bird models at active gerygone nests:a brood parasite/small nest predator(shining bronze-cuckoo),a large nest predator(crow),and a small non-native bird(common chaffinch Fringilla coelebs),which is unknown to the gerygone,as a control.We assessed the response of adult gerygones to the presentation of each model by measuring the minimum approach distance,number of alarm calls,number of attacks,and time to first nest visit after the presentation(latency).Adult gerygones often attacked the cuckoo,approached but never attacked the chaffinch and always avoided the crow.Latency was shorter after an attack response and during brooding,but similar among models.We did not find any link between the cuckoo model presentation and later ejection of cuckoo nestlings.We conclude that adult fan-tailed gerygones discriminate between different models and respond accordingly to the level of threat but do not show awareness of parasitism risk and increase of nestling ejection rates following exposure to the cuckoo model.