Highlights After the global push for the use of Hydroxychloroquine and Chloroquine there is ongoing discussion about the effectivity of these drugs. Findings of this observational study provide crucial data on a potential protective effect of Hydroxychloroquine in non-ICU, hospitalized COVID-19 patients. Early treatment with HCQ on the first day of admission is associated with a reduced risk of 53% in transfer to the ICU for mechanical ventilation. This protective effect was not observed for Chloroquine, therefore these drugs cannot be regarded as interchangeable.

Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens (pneumococcal 23-valent polysaccharide vaccine), B-cell subsets, and the presence of Howell-Jolly bodies (HJB). The data were compared to those obtained from splenectomized patients and healthy controls (HC) who had been included in a previously conducted study. A total of 30 patients were studied: 5 who had proximal SAE, 7 who had distal SAE, 8 who had a splenectomy, and 10 HC. The median vaccine-specific antibody response of the SAE patients (fold increase, 3.97) did not differ significantly from that of the HC (5.29; P ‫؍‬ 0.90); however, the median response of the splenectomized patients (2.30) did differ (P ‫؍‬ 0.003). In 2 of the proximally embolized patients and none of the distally embolized patients, the ratio of the IgG antibody level postvaccination compared to that prevaccination was <2. There were no significant differences in the absolute numbers of lymphocytes or B-cell subsets between the SAE patients and the HC. HJB were not observed in the SAE patients. The splenic immune function of embolized patients was preserved, and therefore routine vaccination appears not to be indicated. Although the median antibody responses did not differ between the patients who underwent proximal SAE and those who underwent distal SAE, 2 of the 5 proximally embolized patients had insufficient responses to vaccination, whereas none of the distally embolized patients exhibited an insufficient response. Further research should be done to confirm this finding.T he spleen is one of the most commonly injured organs after blunt trauma (1, 2). It is involved in the antibody response against infection, most importantly against encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis group C (3, 4). Other functions of the spleen include storing B and T lymphocytes, plasma cells, and iron and filtering the blood, including removing damaged or old erythrocytes.Surgery (splenectomy) has long been the preferred treatment strategy for patients with traumatic injury to the spleen. After a splenectomy, patients have an increased risk of developing an overwhelming postsplenectomy infection (OPSI), which occurs after only 0.5% of all splenectomies in trauma patients but carries a mortality rate of around 50% to 70% (5). The risk of OPSI was one of the driving factors behind the evolution toward the use of more nonoperative treatment (NOM) strategies for splenic injury.Splenic artery embolization (SAE) is a nonoperative treatment strategy that can be used as an adjunct to observation in cases with an arterial bleeding focus. Advantages of NOM over surgical treatment include the avoidance of surgery-associated complic...

Background Novel virus outbreaks, such as the COVID-19 pandemic, may increase psychological distress among frontline workers. Psychological distress may lead to reduced performance, reduced employability or even burnout. In the present study, we assessed experienced psychological distress during the COVID-19 pandemic from a self-determination theory perspective. Methods This mixed-methods study, with repeated measures, used surveys (quantitative data) combined with audio diaries (qualitative data) to assess work-related COVID-19 experiences, psychological need satisfaction and frustration, and psychological distress over time. Forty-six participants (nurses, junior doctors, and consultants) completed 259 surveys and shared 60 audio diaries. Surveys and audio diaries were analysed separately. Results Quantitative results indicated that perceived psychological distress during COVID-19 was higher than pre-COVID-19 and fluctuated over time. Need frustration, specifically autonomy and competence, was positively associated with psychological distress, while need satisfaction, especially relatedness, was negatively associated with psychological distress. In the qualitative, thematic analysis, we observed that especially organisational logistics (rostering, work-life balance, and internal communication) frustrated autonomy, and unfamiliarity with COVID-19 frustrated competence. Despite many need frustrating experiences, a strong connection with colleagues and patients were important sources of relatedness support (i.e. need satisfaction) that seemed to mitigate psychological distress. Conclusion The COVID-19 pandemic resulted in an increase of psychological distress among frontline workers. Both need frustration and need satisfaction explained unique variance of psychological distress, but seemed to originate from different sources. Challenging times require healthcare organisations to better support their professionals by tailored formal and informal support. We propose to address both indirect (e.g. organisation) and direct (e.g. colleagues) elements of the clinical and social environment in order to reduce need frustration and enhance need satisfaction.

After splenectomy, patients are at increased risk of sepsis with considerable mortality. The risk of sepsis can be reduced by immunising these patients and by prescribing antibiotic prophylaxis. The purpose of our study was to determine compliance with the international standards for the management of splenectomised patients in the Netherlands by investigating: (i) vaccination rates, (ii) the prescription of antibiotics and (iii) information in discharge letters. A retrospective review of the medical records and discharge correspondence of 609 splenectomy patients from 1997 to 2008 was performed. Data were collected from 28 hospitals. Adherence to vaccination guidelines and the prescription of antibiotics were assessed. It was found that 85.4% of post-splenectomy patients received pneumococcal vaccination, 39.4% received Haemophilus influenzae type B and 32.3% received meningococcal group C vaccination. Also, 12.4% of patients were discharged on prophylactic antibiotics. In less than 25% of cases were adequate recommendations regarding post-splenectomy management given to the general practitioner (GP). In the Netherlands, compliance with recommendations for the management of patients after splenectomy is insufficient. Fifteen percent of patients do not receive vaccination against pneumococci and the majority of patients do not receive antibiotic prophylaxis. The development and implementation of a national guideline for splenectomised patients is urgently required.

BackgroundCurrent management of asplenic patients is not in compliance with best practice standards, such as defined by the British Committee for Standards in Haematology. To improve quality of care, factors inhibiting best practice care delivery need to be identified first. With this study, we aimed to identify and quantify physicians' barriers to adhere to best practice management of asplenic patients in the Netherlands.Methods and Principal FindingsA cross-sectional survey, preceded by multiple focus group discussions, was performed among Dutch physicians responsible for prevention of infections in asplenic patients, including specialists (of Internal medicine and Surgery) and general practitioners (GPs). Forty seven GPs and seventy three hospital specialists returned the questionnaire, yielding response rates of 47% and 36,5% respectively. Physicians reported several barriers to deliver best practice. For both GPs and specialists, the most frequently listed barriers were: poor patient knowledge (>80% of hospital specialists and GPs) and lack of clarity about which physician is responsible for the management of asplenic patients (50% of Internists, 46% of Surgeons, 55% of GPs). Both GPs and hospital specialists expressed to experience a lack of mutual trust: specialists were uncertain whether the GP would follow their advice given on patient discharge (33–59%), whereas half of GPs was not convinced that specialists' discharge letters contained the correct recommendations. Almost all physicians (>90%) indicated that availability of a national guideline would improve adherence to best practice, especially if accessible online.ConclusionThis study showed that, in accordance with reports on international performance, care delivery for asplenic patients in the Netherlands is suboptimal. We identified and quantified perceived barriers by physicians that prevent adherence to post-splenectomy guidelines for the first time. Better transmural collaboration and better informed patients are likely to improve the quality of care of the asplenic patient population. A national, online-available guideline is urgently required.