ABSTRACT
It is well known that the COVID-19 pandemic caused significant treatment delays for dermatology patients, and recent studies demonstrate poor outcomes for patients with cutaneous T-cell lymphoma (CTCL) during this time. However, not much is known about patient reported delays in management of this condition following the pandemic. This study sought to evaluate patient-reported illness anxiety and delays in management of CTCL. Fifty-two CTCL patients were recruited from clinic from October 2020 to October 2021. Patients were asked to complete a 22-question survey adapted from the United States Census Household Pulse Survey. Control data was extrapolated from published national data from the Household Pulse Survey. Of 52 patients surveyed, 28 were male (59.6%). 25 identified as white (54.3%), 18 as Black (39.1%), 8 as Asian (15.3%) and 1 as Native American (2.2%). Average age was 57 years, age range 24-89 years. Results demonstrate that 32.6% (n=15) of respondents had a household member experience loss of employment since March 2020 compared to 39.6% of the US population. 46.8% of respondents vs. 32.3% US population noted some level of difficulty in paying for household expenses including medical care. Only 4.3% of respondents noted that they delayed receiving medical care due to the coronavirus pandemic. When compared to the US population (59.8%), a lower proportion of respondents (48.9%) noted symptoms of nervousness or anxiety over the past week. 27.7% of respondents vs. 46.1% of US population reported feelings of hopelessness or depression over the past week. These results demonstrate a low number of patients reporting care delays, possible due to the interval when data was collected, several months after COVID-19 onset. It is also possible that telehealth contributed to lessening delays in care. Overall, the results of this study reinforce the significant physical, financial, and emotional impact of CTCL on the daily lives of patients, and the heightened impact of COVID-19 on this population.Copyright © 2023
ABSTRACT
There is an ever-growing need in several industries to disinfect or sanitise products (i.e., to reduce or eliminate pathogenic microorganisms from their surfaces). Gaseous ozone has been widely applied for this purpose, particularly during the era of the COVID-19 pandemic. However, the large-scale deployment of this technology usually involves a manually-operated chamber, into which articles are loaded and subsequently unloaded after treatment—a batch process. Although the development of large-scale, automated and continuous ozonation equipment has hardly been reported in the literature, this has tremendous potential for industries seeking to decontaminate certain articles/products in a rapid and effective manner. In this paper, an overview of the design and implementation considerations for such an undertaking is evaluated. By presenting a case study for a developed automated system for clothing and personal protective equipment (PPE) disinfection, we provide key data regarding the automation procedure/design's considerations, risks, material compatibility, safety, sustainability and process economics. Our analysis shows that the transfer time for garments between successive chambers and the agility of the sliding doors are crucial to achieving the desired throughput. The automated system is capable of effectively treating (20 ppm ozone for 4 min) 20,000 garments within an 8-h shift, based on a transfer time of 2 min and a sliding door speed of 0.4 m/s. The flexibility of the system allows for variation in the concentration or exposure time, depending on the contamination level and the consequent decontamination efficiency desired. This flexibility significantly limits the degradation of the material during treatment. A return on investment of 47% is estimated for this novel system. © 2023 by the authors.
ABSTRACT
Pandemics do not exist in isolation and COVID-19 is no exception. We argue that existing health crises, notably substance use disorder (SUD), developed syndemic relationships with COVID-19 that produced compounding deleterious effects. Combining Merrill Singer's theory of syndemics and assemblage theory, we analyze the combinatory impact of overdose and COVID-19 within a localized context. We focus on Sandusky, Ohio, where we combine police reports, in-depth interviews with area residents, and ethnographic data to compare conditions before and after the emergence of COVID-19. We find dramatic shifts in relevant local contexts due to COVID-19, inhibiting existing systems of law and public policy aimed at overdose prevention and SUD treatment. Further, our findings provide evidence of complications in the COVID-19 response originating from the overdose epidemic.
ABSTRACT
The first years of the worldwide Covid-19 pandemic have brought unanticipated and far-reaching change to the ways language teachers have had to conceptualise and implement their practices. Many teachers have been compelled to move rapidly from classroom to online teaching which has had a substantial impact not only on their sense of identity, but also their sense of confidence in their usual practices. In this chapter, I draw on the reflections of Australian teachers working with international students in the English Language Intensive Courses for Overseas Students (ELICOS) sector, several of whom I have worked with in these early pandemic years as a facilitator of action research, as part of their professional development. Together with their colleagues, they needed to rapidly adjust their professional expectations, roles and practices. The chapter draws on short narrative comments from these teachers and illustrates how they and their colleagues drew on new concepts and mindsets to negotiate their teacher identities and to discover how they could best work with their students in the change to online environments. The data show that social, cognitive and emotional factors were major influences on these negotiations of identity. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Background Gentamicin is one of the most commonly reported medications associated with drug errors amongst paediatric inpatients.1 Such errors include inappropriate dosing, insufficient monitoring and lack of awareness of its role in acute kidney injury (AKI). As with other aminoglycosides, gentamicin side-effects are dose-related, highlighting the significance of dose calculation and therapeutic monitoring. Collaborative services is one of the key recommendations from the RCPCH standards for paediatric care.2 Within Northern Ireland there is a well-established regional neonatal gentamicin prescription chart, however, it has previously lacked a paediatric equivalent. Lack of standardisation of practice across units is a common source of frustration for paediatric trainees and trainers. It also contributes to variations in care across Northern Ireland. Objectives To improve gentamicin prescription, drug monitoring and avoidance of nephrotoxicity, through the design, implementation and evaluation of a standardised gentamicin prescription chart for children (one month to sixteen years old). Particular emphasis was placed on dose adjustment and close monitoring in renal impairment, and ideal-body-weight (IBW) for height prescribing in grossly oedematous or overweight children. Additionally, a stronger focus was placed on antibiotic stewardship. For instance, following two gentamicin doses the prescriber is prompted to review diagnosis, culture results and on-going antimicrobial indication. A further prompt for Paediatric Infectious Diseases discussion is highlighted in treatment courses exceeding five doses. Methods A rapid-fire PDSA QI approach was employed, with contribution from Paediatric Infectious Diseases, Paediatric Nephrology and Pharmacy departments. The team pursued this project during the COVID-19 pandemic, despite some initial colleague hesitancies. Throughout implementation, the chart design, content and accessibility were regularly scrutinised. An initial three month pilot was conducted in RBHSC PICU & surgical ward (August- November 2020), prior to hospital-wide adoption. Pre- and post- implementation multidisciplinary education sessions helped to embed its clinical use and facilitate user feedback. Following pilot, the chart was amended to include specific instructions to review both anaesthetic and emergency department records, to ensure gentamicin doses weren't missed. An audit of toxic gentamicin levels (≥1), renal function monitoring and associated AKI was conducted, comparing serum gentamicin levels sent in the 6 months prior to and following chart introduction. Quantitative and qualitative staff feedback was also obtained. Results Audit data showed improvement in renal function monitoring (84.6% to 100%) and associated reduction in AKI (33.4% to 22.2%), following chart introduction. However, similar levels of gentamicin toxicity were encountered before and after chart implementation (9.8% and 10.7% of all gentamicin results respectively). Staff feedback was overwhelmingly positive, with 100% of prescribers agreeing the chart enhanced their knowledge of therapeutic drug monitoring, and prescription and monitoring in renal impairment. Furthermore, regional implementation was supported by all survey respondents. New relationships with laboratory colleagues has facilitated the development of an auto-analysis function to process creatinine results when serum gentamicin levels are requested;this will help to limit clinician variability and may prompt enhanced AKI recognition. Conclusions A collaborative, multi-professional approach to a standardised gentamicin prescription chart will help to harmonise paediatric clinical care throughout Northern Ireland and may contribute to improved antimicrobial prescribing, monitoring and stewardship.
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Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged >=18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission.
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Purpose The aim of this research is to examine the impact of video-based learning on the cooking skills development of students. More specifically, exploring the first stages in the learning process through embedding declarative knowledge utilising both video content and learner profiles, with the purpose to make teaching practice more effectively and efficiently targeted. Design/methodology/approach A quantitative social experimental approach was employed. The sample consisted of 414 students from three post primary schools in Northern Ireland. Students were randomly allocated into both control and experimental video content groups. All participants were made aware of ethical procedures and the nature of the study. Findings Through the application of latent class analysis (LCA), three distinct types of students were classified. Class one (n = 250) students were termed independent learners, class two (n = 88) students were motivated and benefited from video-based learning and class three (n = 52) students demonstrated an inability to apply information because video did not assist in embedding declarative knowledge. Research limitations/implications Implications from this research inform content generation for video-based cooking skills. Practical implications Given the unprecedented move towards online teaching in 2020 due to coronavirus disease 2019 (COVID-19) restrictions, there is increasing interest in targeting resources effectively to meet the requirements of all learning groups. This paper fulfils an identified need to study how video impacts on skills development and learning within specific learning typologies. Originality/value This research will be of interest to educationalists in promoting a cost-effective resource in line with constructivist values to streamline and meet the needs of individual learners.
ABSTRACT
Illness perception describes patient’s internal beliefs about their illness and their resulting psychosocial impact. This concept is important because it can give healthcare providers a tool to identify issues that may need to be addressed with their patients. However, very few studies have looked into illness perception in cutaneous T-cell lymphomas (CTCLs). CTCL is a chronic, and at times debilitating group of malignancies that can have an indolent but remitting course. Treatment options can also be burdensome to the patient. It is therefore important to gain an understanding of not only what CTCL patients believe about their disease but also how those beliefs impact their quality of life (QOL). Moreover, the current COVID-19 pandemic offers a unique opportunity to investigate how significant disruptions in access to healthcare have impacted illness perception and QOL. The objectives of this study are to identify disease understanding in patients with CTCL, to investigate the impact additional education modalities has on disease understanding, and whether disparities exist between specific groups of patients. We also hope to determine how the COVID-19 pandemic impacted healthcare-related QOL. CTCL patients, above the age of 18, are recruited for this study. Patients are given an electronic survey containing the Illness Perception Questionnaire-Revised (IPQ-R), Skindex-29, FACT-G7, and selected questions based on the Household Pulse survey to assess COVID impact on QOL. Patients are then randomly selected to view an educational CTCL PowerPoint, in addition to verbal education routinely given during their visit. Follow-up responses to these questions will be collected at 2 and 6 months after the initial survey. In this ongoing study, we anticipate a sample size of 100 patients. The outcome of this study will provide insight into the use of additional educational modalities to better patient understanding of CTCL, with the goal of clearing common patient misconceptions about the disease, improve educational resources, and identify actionable paths to diminish obstacles to their access to care.