'Don't forget the children' - even in a pandemic

Background: BHIVA's 'Don't Forget the Children' and Standards of Care (SoC) documents highlight the importance of routine HIV testing for children of people living with HIV (PLWH). Our HIV service audited child testing in 2008, 2009 and 2010 with 46%, 78% and 82% respectively of children requiring testing having a documented result. Having evolved a child testing pathway and MDT, with dedicated Health Advisor and Paediatric nurse support, we wanted to re-evaluate our child testing performance during the COVID-19 pandemic. Method(s): Newly diagnosed PLWH, 01/08/2020 - 31/12/2021, were identified via our HARS dataset. All 32 identified individuals case notes were reviewed and the relevant auditable outcomes from BHIVA's SoC document used. Result(s): 32/32 (100%) had documented evidence that child testing had been considered within 4 weeks of diagnosis (BHIVA target 95%). 13/32 had a total of 35 children, 29 of whom did not require testing. 20/29 had documented evidence their mother was not living with HIV post childbirth, 9/29 were >18 years and all but 1, not living in the UK, had either tested in sexual health or antenatal settings. 6/35 (17%) children required testing. 6/6 (100%) had a documented test result within 6 months of their parent's diagnosis, 1 of whom tested negative prior to parental diagnosis (BHIVA target 90%). 5/6 tested aged >18 months. 1 child <18 months, whose parent was diagnosed antenatally, awaits final 4th generation testing at 18 months. Conclusion(s): Our service has a robust mechanism in place for asking all newly diagnosed individuals, and those new to our service, about children during their first consultation. Where children without documented evidence of HIV testing are identified our child testing pathway ensures timely investigation and documentation - all child testing was completed within one month of parental diagnosis in this audit sample. Our service surpassed the BHIVA standards for child testing for all new diagnoses during the COVID-19 pandemic. Future planned work includes a re-audit of child testing for those already known to our HIV service. As neither parental status nor child location is static regular enquiry in relation to children needs embedding into routine HIV care. (Table Presented).

Kinesiology Faculty Reflections on COVID-19 and Future Directions in Online Education

The COVID-19 pandemic proved to be an unprecedented disruptor on college and university campuses as stakeholders at all organizational levels were challenged to consider new approaches to teaching and learning using online course modalities with very limited preparation time and faculty support. Using a case study approach, this paper reviews valuable lessons learned through the experience, particularly regarding shifts in course delivery to include online and hybrid modalities on a widespread scale. Specifically, the authors reviewed the processes, outcomes, and student perceptions associated with online and hybrid course delivery in various kinesiology courses at three different higher education institutions. The paper also offers useful perspectives for kinesiology program administrators and faculty who are contemplating the continued application of online and hybrid course formats in greater capacity postpandemic. © 2022 American Kinesiology Association.

COVID-19 management in a UK Tertiary Centre with High Consequence Infectious Diseases Centre: Nutritional status, intervention and outcome

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension have been shown to have a higher risk of hospitalization, severe disease, and mortality.1 To date, little data has been published on the timely identification and correction of undernutrition in patients hospitalised with COVID-19. We previously reported a retrospective analysis of the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to our centre, within the first wave of the pandemic between 8th January 2020 and 16th April 2020.2 The study was registered as a clinical service evaluation and was exempt from ethical approval. A total of 316 patients (55% male) were identified with a median (IQR) [range] age of 75 (60 – 83) [23 – 101] years. Twenty-seven of 316 (9%) patients were healthcare workers, and 60 (19%) were admitted from a care home. The median (IQR) duration of admission was 8 (4 – 14) days, and 59 (19%) patients were admitted to critical care. In total, 84 (27%) patients died within 28 days of admission (or before discharge where admission duration >28 days). We here present further hitherto unpublished analyses of the nutritional status, intervention and outcomes of this cohort. Gastrointestinal symptoms present at admission were: anorexia (97 [31%]), diarrhoea (64 [20%]), vomiting (43 [14%]) and abdominal pain (33 [10%]). Admission weight was recorded in 151 (48%) patients, with a median [range] 74.5kg [32.4-168.0]. Where measured (62 [20%] patients), there was significant weight loss observed during admission;median (IQR) weight 77.4kg (65.5-96) at admission and 73.7kg (61.4-94.5) last recorded weight on admission (P=0.0001, paired Wilcoxon signed-rank test). Forty-eight (15%) patients were assessed by a dietitian during their admission. Fifty-three (17%) patients received oral nutritional supplements whilst an inpatient and 38 (12%) received enteral feeding. Of those patients receiving enteral feeding, 30 (79%) had tube placement confirmed by chest x-ray. In conclusion, gastrointestinal symptoms that are commonly associated with reduced nutritional intake were common in these patients hospitalised with COVID-19. There was evidence of reduced nutritional screening on admission compared with pre-COVID practice. This may have been associated with barriers associated with initial infection prevention and control requirements as well as focus on respiratory issues, and should be addressed in future waves of infection. Updated safety advice on enteral tube feeding including confirmation of tube placement was followed in the majority of cases.3 Future studies should aim to better establish the particular circumstances in COVID-19 where nutritional support impacts outcome. 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention 2020 Apr 7;323(13):1239-1242. 2. Baker KF, Hanrath AT, Schim van der Loeff I, Tee SA, Capstick R, Marchitelli G, Li A, Barr A, Eid A, Ahmed S, Bajwa D, Mohammed O, Alderson N, Lendrem C, Lendrem DW, COVID-19 Control Group, COVID-19 Clinical Group, Pareja-Cebrian L, Welch A, Field J, Payne BAI, Taha Y, Price DA, Gibbins C, Schmid ML, Hunter E, Duncan CJA. COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis. Med Sci (2021);9(1):6. 3. Nasogastric tube safety Special Interest Group. May 2020. Enteral tube feeding safety in COVID-19 patients. BAPEN. )

Creation and Evaluation of a Mixed Service Intermediate Care Unit with Obligate Critical Care Consultation to Improve ICU Capacity

Rationale: Significant capacity constraints brought on by the COVID-19 pandemic have underscored the need for novel staffing models that offload ICUs while still providing appropriate standard of care for high acuity patients. Intermediate Care Units (IMCs) provide one such outlet that have not been extensively examined, particularly during the COVID-19 era. Here we describe a quality improvement project focused on the creation of a mixed IMC with critical care support at our institution during the COVID-19 pandemic. Methods: With the support of institutional leadership, an interprofessional working group spanning critical care, surgery, hospital medicine, nursing, and respiratory therapy was convened to establish the staffing model, determine inclusion/exclusion criteria, and track IMC progress. The initial model entailed a medical-surgical service unit staffed by intermediate care-trained nurses, primary teams comprised of hospitalists or surgical teams, and an intensivist who rounded daily. All medical patients received an automatic critical care support consult;all surgical patients had the option of this consult. The maximum census was three. A retrospective chart review was conducted at the end of the initial phase to evaluate process, outcome, and balancing measures. Data were reported using simple descriptive statistics. Results: From August 9th to October 15th 2021, 36 patients - 21 medical and 15 surgical - were admitted to the IMC. The average age was 62.4, 17 (47.2%) were female, and 11 (30.5%) were admitted for COVID-19. The most frequent indications were hypoxemia (15, 71.4%) for medical patients and post-operative monitoring (12, 80%) for surgical patients. The average length of stay was 2.5 days. Most patients stepped down from an ICU or PACU rather than stepping up from a general ward or emergency department. A total of 577 ICU bed-hours were made available by admitting patients to the IMC who would have otherwise occupied an ICU bed. Seven medical patients (33.3%) required transfer back to an ICU and one medical patient (4.8%) transitioned to hospice. The remaining 13 (61.1%) medical and 14 (93.3%) surgical patients were discharged to a general ward. One patient was intubated within 48 hours of triage to the IMC, and zero patients expired while admitted to the IMC.Conclusions: Creation of an IMC provided a means to care for high acuity patients while creating ICU capacity. Subsequent phases will expand on inclusion criteria and maximum census while assessing the effect of critical care support consults on patient safety and hospitalist and intensivist workloads.

The Post-COVID-19 Impact on Distance Learning for New Zealand Teachers

This article reports on a survey of New Zealand teachers designed to assess their experiences of distance learning during the COVID-19 lockdowns. The survey gathered detailed quantitative and qualitative data from 31 schoolteachers who had previously experienced professional development in digital learning. The questions addressed many areas of practice, including the issues faced by teachers in the move to online distance learning;the impacts on relationships with students, families, and other staff;the impacts on workload and practice;and the experience of working intensively with digital technologies. The results suggested that this group of relatively well-prepared teachers were able to effectively move their practice online in a short period of time and, in most cases, to maintain the relationships with, and the learning of, their students. However, there were some indications in the data that learners from the Maori community faced resource challenges in successfully transitioning to online distance learning.

Understanding and addressing vaccine hesitancy in the context of COVID-19: development of a digital intervention.

OBJECTIVES: Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. STUDY DESIGN: & Method: We report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines in the United Kingdom. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine-hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. DISCUSSION: The digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.

Community health worker knowledge, attitudes and practices towards COVID-19: learnings from an online cross-sectional survey using a digital health platform, UpSCALE, in Mozambique

Healthcare workers (HCWs) are at the frontline of the Coronavirus Disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as agentes polivalentes elementares (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n = (25%), n = (16%) and n = (39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020. Adapting the existing upSCALE platform enabled a better understanding, in real time, of the KAP of APEs around COVID-19 management. Subsequently, supporting delivery of tailored messages and education, vital for ensuring a successful COVID-19 response.

Internet of Medical Things: Enabling Key Technologies

Across the World the Covid-19 pandemic has created a huge burden on the medical field. Technologies including Internet of Things (IoT) have been playing a vital role to create digital remote health services during a time of social distancing and isolation. IoT has rapidly expanded into the Healthcare field in recent years. The joining of Healthcare with IoT is named Internet of Medical Things (IoMT) and has significantly advanced many technologies with it. This paper is going to examine emerging technologies associated with IoMT as a whole and the embodiment of this technology including: Big-Data, Artificial Intelligence (AI), 5G, and Blockchain and how they are being utilized currently in the field. We will also present how these technologies can help combat the current pandemic.

Assessment of Risk Factors for Corona Virus Disease 2019 (COVID-19) in Health Workers

Background: COVID-19 is a pandemic caused by novel Corona virus;it has infected millions of people and caused mortality of more than half million people around globe. Objective: The study aimed to assess risk factors of infection with COVID-19 among health care workers (HCW) from different aspects. Methods: A cross sectional study was applied based upon a WHO assessment protocol to explore the real facts and situation leading to Health Care Workers infections. Results: The current study has shown that health care workers were often affected by the disease exploring that males and young age employees had predominantly higher percentage of infection. Regarding the occupation, it was clear that doctors were the most often symptomatic (45%) of the total studied samples;46% contracted the infection through contact with patients at work. Finally the study illustrated that only 46% tried their best to protect themselves from infection and 4 out of 44 cases denied the existence of the pandemic. Conclusion: It was concluded that males were predominantly infected, patients with longer exposure had higher rate of infection and those properly using PPE had less chance to acquire the disease. © 2020 Ubiquity Press. All rights reserved.

Blood and marrow transplantation during the emerging COVID-19 pandemic: the Seattle approach.

On January 20, 2020, the first patient with coronavirus disease 2019 (COVID-19) in the United States of America was diagnosed in Washington state, which subsequently experienced rapidly increasing numbers of COVID-19 cases, hospitalizations, and deaths. This placed the Seattle Blood and Marrow Transplant Program at Fred Hutchinson Cancer Research Center (Fred Hutch) in the national epicenter of this pandemic. Here, we summarize the experience gained during our rapid response to the COVID-19 pandemic. Our efforts were aimed at safely performing urgent and potentially life-saving stem cell transplants in the setting of pandemic-related stresses on healthcare resources and shelter-in-place public health measures. We describe the unique circumstances and challenges encountered, the current state of the program amidst evolving COVID-19 cases in our community, and the guiding principles for recovery. We also estimate the collateral impact of directing clinical resources toward COVID-19-related care on cancer patients in need of stem cell transplantation. Although our experience was influenced by specific regional and institutional factors, it may help inform how transplant programs respond to COVID-19 and future pandemics.