Background. Dental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic.Methods. The authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (a ¼ .05) and reported odds ratios (ORs) and 95% CIs.Results. The survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health.

Background The incidence of infections in palliative care patients is high due to immunocompromise from underlying disease processes and treatments including chemotherapy and steroids. An earlier audit of hospice notes revealed poor documentation of antibiotic prescribing and poor adherence to hospital antimicrobial guidelines. Aims To promote antibiotic stewardship through the development of local antimicrobial guidelines specific to palliative care and inpatient hospice setting. To provide a simple, pragmatic approach and promote the safe, effective and economic use of antibiotics in palliative care patients. Methods A literature search of Embase, Medline, the Cochrane Library and NHS evidence using the search terms 'palliative care' or 'palliative therapy' and 'antibacterial agents' or 'antibiotic agent' was completed National antibiotic guidance (BNF), published antibiotic guidance specific to palliative care ( palliativedrugs.com) and local antimicrobial guidelines (PCT and Hospital) were also reviewed in development of the hospice antibiotic prescribing guidelines. The guidelines were discussed with the hospice pharmacist and presented to the medical and nursing staff, providing peer review and education. Results The literature search identified 10 articles meeting the search criteria but the focus was on antibiotic use in the last few days of life and was unsuitable. No definitive guidelines for antibiotic prescribing in palliative care were identified. The developed hospice antibiotic prescribing guidelines provide guidance for first and second line treatment of 12 specific infections of the lower respiratory tract, urinary tract, skin and soft tissue and

Objectives The goal of this study was to assess how the mental health of dental trainees has changed during the pandemic and to identify the most stressful aspects of trainees’ programs, stress coping strategies, and suggestions for individual and institution‐driven solutions to improve wellness. Methods The study focused on dental trainees at the University of Washington who completed a wellness survey in fall 2020 (n = 126; response rate = 35.5%) and spring 2021 (n = 105; response rate = 29.6%). The survey included self‐report measures assessing four mental health outcomes: depression, anxiety, isolation from peers, and burnout. Stressful aspects of the training program, coping strategies, and institution‐driven solutions were measured with open‐ended survey items. The chi‐square test was used to compare mental health outcome measures between fall and spring and open‐ended survey responses were inductively coded. Results The prevalence of self‐reported depression and anxiety did not change between fall 2020 and spring 2021 (17.2% vs. 21.1%, p = 0.473; 22.4% vs. 23.7%, p = 0.818). Isolation from peers and burnout each significantly increased by almost 20% from fall 2020 to spring 2021 (46.8% vs. 64.3%; p = 0.009 and 26.6% vs. 43.9%; p = 0.017). Trainees identified workload as the most stressful aspect of their program and described using exercise and social support to cope with stress. Trainees suggested institution‐supported increases in social events and mental health resources. Conclusions One year into the coronavirus disease 2019 pandemic, poor mental health outcomes were common among dental trainees because of high workload and isolation from peers. Dental schools should promote targeted programs and services aimed at improving dental trainees' well‐being.

Introduction Data around end of life care in COVID-19 patients remains lacking. We present a study of 89 COVID-19 hospital patients who received specialist palliative care (SPC) input, which provides a novel understanding of the symptom needs of those dying from COVID-19. Methods Retrospective review of health-records of 89 COVID-19 patients with SPC involvement between 20/3/20-21/4/20. 54 pre-pandemic control patients referred to SPC between 20/ 11/19-20/12/19 were included as comparison. Results and discussion 84% (n=75) of COVID-19 patients had died at follow-up compared to 44% (n=24) of controls. Average time from SPC involvement to death was 3.4 days for COVID-19 patients and 8.3 days for controls. COVID-19 patients were more breathlessness (92%, n=69 vs 75%, n=18) and pyrexial (44%, n=33 vs 4%, n=1) than controls. Control patients were more likely to experience pain (58%, n=14 vs 17%, n=13). Agitation rates were similar in COVID-19 patients (45%, n=34) and controls (58%, n=14). High symptom burden and rapidity of deterioration in COVID-19 patients necessitated an increased use of continuous subcutaneous infusions (CSCI's), (69%, n=52 vs 46%, n=11). Median doses of opioids and benzodiazepines required in CSCI's to control symptoms were similar across both groups. Median 24 hr CSCI morphine equivalent dose of 15 mg (n=51) in COVID-19 patients vs 10 mg (n=10) in controls. Median CSCI midazolam dose of 10 mg in both groups (n=40 vs n=10 in controls). Few COVID-19 patients required glycopyrronium (n=15) and antiemetics (n=5) via a CSCI. Conclusion and recommendations COVID-19 patients have a rapid deterioration and symptomatic dying phase with different symptom profile to control patients. Symptom control in COVID-19 can be achieved with traditional drugs often at low doses, though with earlier use of CSCI's. Education and reassurance for generalists in the early use of opioids and benzodiazepines is essential to managing symptoms of dying COVID-19 patients.

Improve symptom management. 2. Reduce medicine administration errors. 3. Release RN time to care. Method . Literature review and pre-training questionnaire. . SNAD group formed. . Networking with other hospices. . Create teaching package, provide study day including competency assessment. . Devised competency tool and Standard Operating Procedure (SOP).