Addressing misconceptions about chest drain management is imperative. Providing up to date guidelines in clinical areas will improve chest drain management. Strategic educational initiatives are in place to ensure identified knowledge deficits are addressed and a complete revision of chest drain guidelines has been undertaken.

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Purpose The coronavirus 2019 pandemic has placed all intensive care unit (ICU) staff at increased risk of psychological distress. To date, measurement of this distress has largely been by means of validated assessment tools. We believe that qualitative data may provide a richer view of staff experiences during this pandemic. Methods We conducted a cross-sectional, observational study using online and written questionnaires to all ICU staff which consisted of validated tools to measure psychological distress (quantitative findings) and open-ended questions with free-text boxes (qualitative findings). Here, we report our qualitative findings. We asked four questions to explore causes of stress, need for supports and barriers to accessing supports. A conventional content analysis was undertaken. Results In total, 269 of the 408 respondents (65.9%) gave at least one response to a free-text question. Seven overarching themes were found, which contribute to our proposed model for occupational stress amongst critical care staff. The work environment played an important role in influencing the perceived psychological impact on healthcare workers. Extra-organisational factors, which we termed the "home-work interface" and uncertainty about the future, manifested as anticipatory anxiety, had a proportionally larger influence on worker well-being than would be expected in non-pandemic conditions. Conclusion Our findings have important implications for appropriate allocation of resources and ensuring well-being of the ICU multidisciplinary team for this and future pandemics.

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Effective methods to reduce children preoperative anxiety (such as giving previous information, organising a tour to the operating room before the intervention and the presence of clown-doctors) are time-consuming and expensive as they require hospital staff to be performed. Goal To test the effectiveness of "Clickamico", a new IT method to reduce preoperative anxiety in children. Methods Randomised controlled trial. The experimental intervention was a 6-minute video showing two clown-doctors who visit the operating theatre (OR) and explain each other in a jokingly way what is in it. Subjects were 40 children aged 6 to 11 undergoing a planned surgical intervention and were randomised to 2 groups. In Group A (n = 20), the video was shown to subjects on a tablet the afternoon preceding a planned surgery. In Group B (n = 20) subjects were given usual care (non standardised oral information given by nurses on parents' request). Anxiety was measured before treatment and before entering OR using the Yale Preoperative Anxiety Scale-modified (m-YPAS) Results The groups were homogeneous with regards to age, gender, parents'age and% of children previously undergone surgery. Basal mean m-YPAS scores were not statistically different (Group A 37.3 vs Group B 37.1). Mean m-YPAS observed at entering OR were 33.01 in Group A and 48.6 in Group B (p = 0.009). Basal to pre-OR mean m-YPAS score difference was -2.82 in Group A and +10.7 in Group B (p = 0.003). Conclusion "Clickamico" is effective in reducing preoperative anxiety in children and may substitute staff-provided interventions, allowing possible reductions of Hospital costs.

IntroductionThe gut microbiota develops from birth and matures significantly during the first 24 months of life, playing a major role in infant health and development. The composition of the gut microbiota is influenced by several factors including mode of delivery, gestational age, feed type and treatment with antibiotics. Alterations in the pattern of gut microbiota development and composition can be associated with illness and compromised health outcomes.Infants diagnosed with ‘congenital heart disease’ (CHD) often require surgery involving cardiopulmonary bypass (CPB) early in life. The impact of this type of surgery on the integrity of the gut microbiome is poorly understood. In addition, these infants are at significant risk of developing the potentially devastating intestinal condition necrotising enterocolitis.Methods and analysisThis study will employ a prospective cohort study methodology to investigate the gut microbiota and urine metabolome of infants with CHD undergoing surgery involving CPB. Stool and urine samples, demographic and clinical data will be collected from eligible infants based at the National Centre for Paediatric Cardiac Surgery in Ireland. Shotgun metagenome sequencing will be performed on stool samples and urine metabolomic analysis will identify metabolic biomarkers. The impact of the underlying diagnosis, surgery involving CPB, and the influence of environmental factors will be explored. Data from healthy age-matched infants from the INFANTMET study will serve as a control for this study.Ethics and disseminationThis study has received full ethical approval from the Clinical Research Ethics Committee of Children’s Health Ireland, GEN/826/20.

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