Background The COVID-19 pandemic has severely impacted Intensive Care Units (ICUs) and Critical Care Healthcare Providers (HCPs) worldwide. Research Question How do regional differences and perceived lack of ICU resources affect critical care resource utilization and the well-being of HCPs? Study Design and Methods Between April 23 rd -May 7 th 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for critically ill COVID-19 patients. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated by World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: 1) Limiting mechanical ventilation (MV), 2) changes in cardiopulmonary resuscitation (CPR) practices, and 3) emotional distress or burnout. Results We included 2700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (10%) and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for COVID-19 patients was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (aRR:2.10, 95% CI:1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America), and associated with female gender (aRR:1.16, 95% CI:1.01-1.33), being a nurse (aRR:1.31, 95% CI:1.13-1.53), reporting a shortage of ICU nurses (aRR:1.18, 95% CI:1.05-1.33) and powered air-purifying respirators (PAPRs) (aRR:1.30 95% CI:1.09-1.55), as well as experiencing poor communication from supervisors (aRR:1.30, 95% CI:1.16-1.46). Interpretation Our findings demonstrate variability in ICU resource availability and utilization worldwide. The high prevalence of provider burnout, and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.

Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.

An overall measure of the recovery of visual neglect in patients with an acute stroke is described: The "Visual Neglect Recovery Index" (VNRI) expresses the amount of visual neglect on a battery of visual neglect tests as a percentage of complete recovery from the maximal visual neglect measurable. The principles underlying the development of the index are similar to those involved in the development of the Motricity Index for hemiplegia. A population of 68 survivors of stroke who presented with visual neglect at two to three days were followed for up to six months. The VNRI showed that neglect was greater in those with right hemisphere stroke than in those with left hemisphere stroke and that recovery was most rapid over the first 10 days and reached a plateau at three months. Most patients, including many with severe initial visual neglect, showed little visual neglect at three months. Stepwise regression analysis showed that the severity of visual neglect at three months and at six months post-stroke could be predicted by the severity of visual neglect and the presence of anosognosia at two to three days. A regression equation was produced which may enable clinicians to select patients for intensive treatment of visual neglect.

Background Assessing the impact of COVID-19 on intensive care unit (ICU) providers’ perceptions of resource availability and evaluating factors associated with emotional distress/burnout can inform interventions to promote provider well-being. Methods Between April 23-May 7, 2020, we electronically administered a survey to physicians, nurses, respiratory therapist (RTs) and advanced practice providers (APPs) caring for COVID-19 patients in the US. We conducted multivariate regression to assess associations between concerns, reported lack of resources and three outcomes: emotional distress/burnout (primary outcome), and two secondary outcomes: 1) fear that hospital is unable to keep providers safe, and 2) concern about transmitting COVID-19 to family/community. Results We included 1,651 respondents from all 50 states; 47% nurses, 25% physicians, 17% RTs, 11% APPS. Shortages of intensivists and ICU nurses were reported by 12% and 28% of providers, respectively. The largest supply restrictions reported were for powered air purifying respirators (PAPRs); (56% reporting restricted availability). Provider concerns included worries about transmitting COVID-19 to family/community (66%), emotional distress/burnout (58%), and insufficient personal protective equipment (PPE) (40%). After adjustment, emotional distress/burnout was significantly associated with insufficient PPE access (aRR: 1.43, 95% CI: 1.32 - 1.55), stigma from community (aRR: 1.32, 95% CI: 1.24 - 1.41), and poor communication with supervisors (aRR:1.13, 95% CI: 1.06 - 1.21). Insufficient PPE access was the strongest predictor of feeling that the hospital is unable to keep providers safe and worries about transmitting infection to families/communities. Conclusion Addressing insufficient PPE access, poor communication from supervisors, and community stigma may improve provider mental well-being during the COVID-19 pandemic.