Objective The rapid spread of COVID-19 has overwhelmed healthcare systems across the world. During the early stage of the pandemic, frontline healthcare workers (FHWs) caring for patients at intensive care units (ICUs) faced extreme pressure and challenges. This qualitative study aimed to describe the different phases of psychological distress of FHWs during the early stage of the COVID-19 pandemic. Design Qualitative study. Setting The First Affiliated Hospital of Zhengzhou University, a designated hospital for patients with COVID-19 in central China. Participants Eight physicians and six nurses working in the ICU who provided direct patient care for COVID-19 patients. Methods A descriptive phenomenological study using thematic analysis was applied. Semi-structured one-on-one interviews over telephone or Wechat (a social platform in China) rather than face-to-face interviews were conducted due to quarantine. Interviews were audio-recorded and transcribed verbatim and then were analysed thematically. Findings A total of 14 interviews were conducted, and each interview lasted 20–60 min. Five thematic categories were identified, and the participants’ psychological experiences were classified into five stages (1) the mobilisation period: a sense of responsibility with worries; (2) the preparation period: worries, fears and doubts about the epidemic; (3) the transitional period: complex and diverse psychological feelings; (4) the adaptation period: self-adjustment and help from external support and (5) the reflection period: a reflection on life and nature. Conclusion The study showed that the COVID-19 pandemic had significant psychological impacts on FHWs. Self-regulation and external support help FHWs to overcome challenges to a certain extent. More attention should be paid to the psychological wellbeing of ICU FHWs in COVID-19-designated hospitals.

Background: No clinical study on the use of polymyxin B in Chinese children has been reported, thus making it difficult for pediatric clinicians to rationally select these drugs.Methods: A retrospective analysis of children treated with polymyxin B during hospitalization in a hospital from June 2019 to June 2021 was conducted to analyze its effectiveness and the incidence of acute kidney injury (AKI) during treatment with polymyxin B.Results: A total of 55 children were included in this study, and the results showed that the intravenous polymyxin B-based regimen had an effective rate of 52.7% in the treatment of Carbapenem-resistant Gram-negative bacterial (CR-GNB) infection in children. The results of the subgroup analysis showed that the course of treatment was longer in the favorable clinical response group than in the unfavorable outcome group (p = 0.027) and that electrolyte disturbances in children during the course of treatment could lead to unfavorable clinical outcomes (p = 0.042). The risk of incidence of AKI during treatment was 27.3%, and the all-cause mortality rate in the children on their discharge from the hospital was 7.3%.Conclusion: Polymyxin B can be used as a salvage therapy for CR-GNB infection in children when no other susceptible antibiotics are available, and the monitoring of kidney function should be strengthened.

Purpose: To analyze the risk factors for acute kidney injury (AKI) induced by intravenous polymyxin B in Chinese patients with severe infection and to provide a reference for clinicians and pharmacists. Methods: We retrospectively analyzed patients treated with intravenous polymyxin B from August 2018 to August 2020 in a Chinese teaching hospital. Renal function was evaluated during therapy with polymyxin B and at the end of the treatment. Univariate and multivariate analyses were conducted to determine risk factors for the nephrotoxicity of polymyxin B. Results: A total of 321 patients were included, and the incidence of AKI was 26.2% and 25.1% during polymyxin B therapy and at the end of treatment, respectively. Independent risk factors for AKI during therapy with polymyxin B were septic shock, coadministration of vancomycin or loop diuretics, and advanced age (≥ 60 years), while the incidence of AKI during treatment with polymyxin B was considered to be an independent risk factor for AKI at the end of the treatment. Conclusion: Septic shock, coadministration of vancomycin or loop diuretics, and advanced age (age ≥ 60 years) were found to be risk factors for AKI induced by intravenous polymyxin B. Clinicians and pharmacists should consider these factors when designing and recommending treatment with polymyxin B.

Objective: This study incorporates the results of subgroup analyses of currently published randomized controlled trials (RCTs) and real-world cohort studies to compare the effectiveness and safety of new direct oral anticoagulants (NOACs) and warfarin among nonvalvular atrial fibrillation patients with diabetes. Methods: The PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov databases were searched. Five retrospective cohort studies and four subgroup analyses of RCTs were included in this meta-analysis. Results: A meta-analysis of the data of 26,7272 patients showed that for patients with nonvalvular atrial fibrillation and diabetes, NOACs can significantly reduce the incidence of stroke/systemic embolism (SSE), ischaemic stroke, and haemorrhagic stroke compared with warfarin, with no significant difference in major bleeding and all-cause mortality. Additionally, NOACs were superior to warfarin in the incidence of intracranial bleeding, gastrointestinal bleeding, myocardial infarction, and vascular death. Conclusions: Among nonvalvular atrial fibrillation patients with diabetes, NOACs were associated with a lower risk of SSE versus warfarin, with no significant difference in major bleeding. Therefore, NOACs may be a better clinical choice.

Objective To provide an initial understanding of problems and potential solution strategies for part-time clinical pharmacist work in China, and provide references for the training of part-time clinical pharmacists. Methods The study was conducted in a tertiary teaching hospital in China, and the project lasted 6 months. Phenomenological methods were used to guide the research design. Research data were obtained by conducting one-to-one semistructured interviews with part-time clinical pharmacists, and interview data were coded and analysed through thematic analysis. Results A total of 21 pharmacists were interviewed in a semistructured manner, and the results showed that following problems exist in the work of part-time clinical pharmacists: the existing professional knowledge is not adequate to meet the demands of clinical service; the career orientation of part-time clinical pharmacists is not clear; lack of professional self-confidence in clinical pharmacy practice; there is no suitable entry point to carry out pharmacy service work; it is difficult to communicate effectively, and for in addition, 17 potential solution strategies are proposed for the current problems, which can provide reference for the development of part-time clinical pharmacists’ work. Conclusions The work performed by part-time clinical pharmacists is currently immature and the strategies derived from this study may serve as potential solutions to resolve the part-time clinical pharmacy practice challenges.

Background: Polymyxin B (PMB) is a remedial treatment for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection; however, there is a paucity of reports on the treatment of high-level CRKP infections with polymyxin B. Studies are needed to explore its treatment efficacy and associated influencing factors. Methods: Patients with high-level CRKP infections treated with PMB during hospitalization from June 2019 to June 2021 in a hospital were retrospectively studied, and risk factors affecting the efficacy were explored by subgroup analysis. Results: A total of 92 patients were enrolled, and the results showed that the PMB-based regimen had a bacterial clearance rate of 45.7%, an all-cause discharge mortality rate of 22.8%, and an incidence of acute kidney injury (AKI) of 27.2% for high-level CRKP treatment. The combination of β-lactams other than carbapenems facilitated bacterial clearance, and the combination of electrolyte disturbances and higher APACHE II scores was detrimental to microbial clearance. Risk factors for all-cause discharge mortality were advanced age, concomitant antifungal drugs, concomitant tigecycline and incidence of AKI. Conclusion: PMB-based regimens are an effective option for the treatment of high-level CRKP infections. However, the optimal dose of treatment and the choice of combination regimens need to be explored in further studies.