Videolaryngoscopy: a seismic shift in culture

Evidence shows videolaryngoscopy (VL) creates a safe atmosphere for tracheal intubations by reducing failed intubations and increasing first-pass success [1]. In 2017, University College London Hospital was one of the first hospitals in the UK to roll out VL to all anaesthetic areas to promote patient safety at a time of increased airway complexity cases. We aim to compare staff attitudes about VL at the time of introduction and 3-years later. Methods We sent online surveys to anaesthetists of all grades before and after the introduction of VL. We had over 90 responses to both surveys. Results Our survey results show that anaesthetists are becoming more in favour of VL with > 93% supporting their use. They show 78% gave VL a maximum +5 on the Likert scale;this is an increase from 59% in the initial survey. It indicates that > 88% perceive VL to promote patient safety, improve quality of care, help in training and improve team dynamics of the intubation process. We see overwhelming support for their use in COVID-19 patients with only 1% of survey respondents having negative views. Subjective responses show that clinicians perceived VL to add 'patient and operator safety'. This is due to 'increased distance of operator from the airway';'reducing anticipated infection risk' and 'improving ease of intubation in the hypoxic patient'. They also feel that VL helps 'share a mental model with the team when other aspects of communication are impaired by PPE'. Our surveys demonstrate fewer concerns with VL over the 3-year period. The results show that concerns amongst anaesthetists with regard to training and familiarity had dropped from 33% to 25%. Concerns over the use of single-use equipment had decreased from 81% to 66%, and concerns regarding documentation of VL intubation grades dropped from 59% to 38%;however, there remains a small but noticeable increase in concern over the loss of direct laryngoscopy skills amongst junior anaesthetists from 55% to 64%. Discussion Our surveys demonstrate a department-wide change in attitude that favours the use of VL. Crucially, clinicians feel that VL provides a strong positive patient safety effect and promotes shared decision-making at a time when rare catastrophic events such as unrecognised oesophageal intubation still occur. The pandemic has proven to be a major catalyst for their increased use and familiarity, which is likely to propel the widespread use of VL in the future.

Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality

Background: The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic. Methods: Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID). Results: There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p<0.001). Conclusion: There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality. Funding Acknowledgement: Type of funding sources: None.Figure 1

Insights into patient voices on digital access to health care

The Covid-19 pandemic prompted changes in the ways that individuals access healthcare services and accelerated the transition to digital methods of care. For some, this opened doors for easier and more convenient access. For people already experiencing exclusion and marginalisation however, digital access can create additional barriers for accessing health care. NHS Digital (2019) identified several groups as more likely to be digitally excluded: © 2022. Journal of Community Nursing. All Rights Reserved.

Federal Library Utilization of LibGuides to Disseminate COVID-19 Information

Objective - In winter 2019-2020, the world saw the emergence of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than a year later, the pandemic continues with the U.S. death toll surpassing 550,000. Over the last decade, librarians have increased their roles in infectious disease outbreak response. However, no existing literature exists on use of the widely-used library content management platform, LibGuides, to respond to infectious disease outbreaks. This research explores how Federal Libraries use LibGuides to distribute COVID-19 information throughout the ongoing COVID-19 pandemic. Methods - Survey questions were created and peer-reviewed by colleagues. Survey questions first screened for participant eligibility and collected broad demographic information to assist in identifying duplicate responses from individual libraries, then examined the creation, curation, and maintenance of COVID-19 LibGuides. The survey was hosted in Max.gov, a Federal Government data collection and analysis tool. Invitations to participate in the survey were sent via email to colleagues and listservs and posted to personal social media accounts. The survey was made publicly available for three weeks. Collected data were exported into Excel to clean, quantify, and visualize results. Long form answers were manually reviewed and tagged thematically. Results - Of the 78 eligible respondents, 42% (n = 33) reported that their library uses LibGuides to disseminate COVID-19 information;45% of these respondents said they spent 10+ hours creating their COVID-19 LibGuide, and 60% of respondents spent <1 hour a week on maintenance and updates. Most LibGuides were created in early spring 2020 as the U.S. first saw an uptick in COVID-19 cases. For marketing purposes, respondents reported using web/internal announcements (75%) and email (50%) most frequently. All respondents reported inclusion of U.S. Government resources in their COVID-19 LibGuides, and a majority also included guidelines, international websites, and databases to inform their user communities. Conclusion - Some Federal Libraries use LibGuides as a tool to share critical information, including as a tool for emergency response. Results show libraries tend to start from scratch and share the same resources, duplicating efforts. To improve efficiency in LibGuide curation and use of library staff time, one solution to consider is the creation of a LibGuides template that any Federal Library can use to quickly set up and adapt an emergency response LibGuide specifically for their users. Additionally, findings show that libraries are uncertain of archiving and preservation plans for their guides post-pandemic, suggesting a need for recommended best practices.

Using Technology to Improve Assessment Facilitation on a Policing Apprenticeship Programme: From COVID-19 Contingency to Best Practice

This article evaluates the introduction of an online assessment protocol to student officers on a Police Constable Degree Apprenticeship (PCDA) programme in the aftermath of the implementation of the COVID-19 global pandemic lockdown. This evaluation comes from conducting two cycles of action research to examine and improve the provision of an online multiple choice/short question exam which came about as a result of the lockdown, and the necessary withdrawal of university staff from face-to-face contact. The study shows that the introduction of the online exam was successful and contributed to a positive student experience, while providing vital feedback to the programme team to make continual improvements and can be progressed after lockdown and into the 'new normal'.

CHALLENGE: A phase III study of the impact of a physical activity program on disease-free survival in patients with high-risk stage II or stage III colon cancer: A randomized controlled trial (NCIC CTG CO.21)

Aims: To determine the efficacy of physical activity (PA) in reducing disease recurrence in patients with localised colon cancer. Our primary hypothesis is that a PA program will improve disease-free survival (DFS) in patients with resected stage II (high risk) and III colon cancer who have completed adjuvant therapy. In addition, we hypothesise that exercise can improve fatigue, quality of life (QOL), physical functioning and body composition. Methods : An international multi-centre phase 3 RCT primarily between Australia and Canada. Subjects are randomised to PA program or standard care. Primary objective compares DFS between patients in PA and control arms. Key secondary objectives are to compare: 1. fatigue, QOL, depression, anxiety, sleep, body composition, exercise behaviour and fitness;2. overall survival (OS);3. association of cytokines, and insulin axis levels with PA, fatigue, and DFS;4. Health economic evaluation of the PA intervention. The study intervention is a 36-month PA programme aiming to achieve > 10 metabolic equivalent rates/week above baseline. Study assessments include: Disease status, fitness, body composition, QOL questionnaires at 0/6/12/18/24/30/36 months. Then annual patient reported outcomes and disease status until study closure. Interim analysis (n = 273 with 12 months follow up) showed good intervention adherence, significant difference in PA with 10.5 MET hours/week difference between groups, and objective fitness improvements in PA group. Adaptations due to COVID: In 2020, rapid amendments were made in response to COVID-19 to provide alternative modes for intervention delivery (via phone or virtual) and assessments conducted virtually where possible, with option of electronic completion of patient-reported outcomes. Current Status: Number of randomisations = 792 (82% of planned sample size);270 from Australia (from 24 sites). Five sites continue recruitment in Australia: Concord, Royal Brisbane and Women's, Tamworth, Newcastle Private, and Northern Cancer Institute.

Minimal clinically important difference for pedometer step count in COPD: A prospective analysis

Background: Infection control precautions arising from the COVID-19 pandemic has led to challenges undertaking face-to-face exercise testing required for pulmonary rehabilitation (PR) exercise prescription and evaluation.1 Self-management programmes, incorporating physical activity, have been advocated as an alternative to PR when face-to-face assessment is not possible.1 Daily step count is the most commonly used physical activity outcome and does not require face-to-face assessment. We aimed to estimate the minimal clinically important difference (MCID) for daily pedometer step count in COPD, using response to PR as a model of improvement and longitudinal decline following PR as a model of deterioration. Methods: This was a secondary analysis of a trial that investigated the effectiveness of pedometer-directed step count targets in COPD as an adjunct to PR, with the study arms combined as the intervention did not result in significant between-group differences.2 We measured spirometry, Medical Research Council score, incremental shuttle walk test, Chronic Respiratory Questionnaire and pedometer step count (Yamax Digiwalker CW700) pre-, post- and six months following PR. Post-PR and six months post-PR, participants completed a Global Rating of Change Questionnaire: 'How do you feel your physical activity levels have changed following rehabilitation?' and rated the response on a five-point Likert scale ( '1: I feel much more active' to '5: I feel much less active'). The MCID for improvement was defined as the median for '2: I feel a little more active' at the post-PR assessment. The MCID for deterioration was the median for '4: I feel a little less active' at the six-month assessment (compared to post-PR). Results: 152 participants enrolled in PR;80% and 70% attended the post-PR and six month assessments respectively. Baseline characteristics and change with PR and over time are (Table presented) in table 1. There were significant improvements in daily pedometer step count following PR and reductions at six months. The median (25th, 75th centile) MCID estimate for improvement and deterioration in daily pedometer step count was 427 (-443, 1286) and -456 (-2271, 650) steps respectively. Conclusion: The MCID estimates for improvement with PR and deterioration over time after PR are 427 and -456 steps respectively.