The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

A Single-Centre Experience of Telephone Assessment of Patients Referred to Two Week-Wait Colorectal Surgery Clinics in England

Aim: Despite Covid-19, hospitalsin the England, United Kingdom continued to assess and manage patients referred on two week-wait (2WW) suspected cancer referral pathways. Most index clinic assessments of such patients were conducted viatelephone. We retrospectively evaluated adistrict general hospital experience of managing patients on a 2WW suspected lower gastrointestinal tract (LGIT)cancer referral pathway, initially assessed via telephone Method: Data were obtained using a prospectively maintained database and electronic patient records. LGIT 2WW referrals between 01/06/2020to 31/10/2020 were included. Data were retrospectively collated and analysed using Excel (Microsoft Corporation, USA) Results: A total 757 patients (median age = 70, interquartile range = [59-79], female = 47.2%) were identified. The majority (n = 629,83.1%) were white Caucasian. All patients were initially assessed virtually and only 3 (0.4%) were re-assessed face-to- face for their index appointment. Sixteen (2.1%) missed at least one prior appointment. The most common presenting complaints included change in bowel habit, rectal bleeding, weight loss, anaemia and abdominal pain, and 415 (54.8%), 269 (35.5%) underwent endoscopy and imaging respectively as the first investigation. Forty four (5.8%) patients had malignant pathology with the majority (n = 37,84.1%) being colorectal in origin. Of those diagnosed with a primary colorectal malignancy 25 (67.6%) underwent surgical or endoscopic treatment, 3 (8.1%) were referred to chemoradiotherapy and 8 (21.6%) were referred for palliation. Conclusion(s): Patients referred on the 2WW LGIT pathway continued to be assessed and managed despite Covid-19. Index telephone clinic assessments are perhaps as effective a tool as face-to- face assessments, for patients referred on this pathway. This warrants further investigation.

The Use of Telephone Versus Face to Face Appointments in Two Week-Wait Colorectal Surgery Clinics -a Single Centre Experience

Aim: Telephone appointments have replaced face-to- face hospital clinic appointments due to the Covid-19 pandemic. We evaluated the impact of telephone appointments on patients referred on a two week-wait (2WW) suspected lower gastrointestinal tract (LGIT) cancer pathway. Method(s): Two independent patient samples between the 01/06/2019-31/ 10/2019 (face-to- face cohort) and 01/06/2020-31/ 10/2020 (telephone cohort) were identified using a prospectively maintained local database and electronic patient records. Data were retrospectively collated using Excel (Microsoft, USA). Chi-square and Man-Whitney- U statistical tests were performed using SPSS (IBM, USA). Result(s): A total 1531 (median age = 70, interquartile range [IQR] = 60-79, female = 679, 44.4%) were analysed. Of these, 757 (49.4%) were assessed via telephone;the remainder were face-to- face (n = 774,50.6%). The age, gender and ethnicity distributions across the two groups were similar. A total of 92 (6%, telephone = 44, face-to- face = 48) patients had malignant pathology and 64 (4.2%) were colorectal cancer (CRC). Of those with a CRC diagnosis, 46 (3.0%, telephone = 26, face-to- face = 20) underwent surgical or endoscopic treatment with curative intent. There was no significant difference in diagnoses made (P = 0.749) or treatment of CRC (P = 0.785) following telephone versus face-face- appointments. The median waiting times for index appointment, investigation and diagnosis for telephone appointments were significantly lower compared to face-to- face appointments (P < 0.001). There was no significant difference in median time to index treatment for CRC between the two groups (P = 0.156). Conclusion(s): Patients referred to 2WW LGIT clinics were efficiently and safely assessed and manged using telephone clinics during the Covid-19 pandemic. The cost-effectiveness and stakeholder views on permanent use of telephone assessments in these clinics must be evaluated.

Spatial and Temporal Monitoring of SARS-CoV-2 in a Sewershed

In response to the global pandemic, Clean Water Services (Washington County, Oregon) monitored 4 wastewater treatment plants (WWTPs) and 16 manholes over a period of 15 months to determine whether spatial and temporal trends in SARS-CoV-2 concentrations corresponded with reported COVID-19 cases. A total of 738 samples were analyzed for SARS-CoV-2 using reverse transcription droplet digital polymerase chain reaction (RT-ddPCR). SARS-CoV-2 concentrations at WWTPs appeared to be a leading indicator, with increases in wastewater observed two to three weeks before cases rose. Neighborhoods with high LatinX and high poverty populations also had higher SARS-CoV-2 concentrations. Additionally, outbreaks at local food processing plants corresponded with viral peaks in their associated manhole. Surprisingly, SARS-CoV-2 was rarely detected in hospital effluent despite the presence of known cases, and experiments revealed hospital disinfectants can destroy the RNA signal. Collectively, these findings demonstrate the value of wastewater-based epidemiology for monitoring the local burden of COVID-19. Copyright © 2021 Water Environment Federation

The Unheld Child: Social Work, Social Distancing and the Possibilities and Limits to Child Protection during the COVID-19 Pandemic

The recent tragic deaths in England of six-year-old Arthur Labinjo-Hughes and sixteen-month-old Star Hobson during the first phase of COVID-19 have raised questions about why social workers did not protect them. The introduction of social distancing due to the pandemic disrupted the ways social workers used play, talk and touch to understand children's experiences and the research we report on in this article explored how able were social workers to keep children safe and help families from a distance? We followed the work of forty-eight social work staff over the first nine months of the pandemic and found that they were creative in seeing children on video calls and outdoors, and some did get physically close to children. There were, however, significant constraints on their work. High levels of anxiety and fear of infection made it hard for them to think straight and stay focused on children on home visits, to play or even touch toys. Working from home rather than in the office cut them off from vital sources of peer and supervisory support. Better understanding of these limits will be crucial to keeping children safe for the remainder of the pandemic and beyond it. The COVID-19 pandemic changed dramatically the ways social workers engaged with children and families. This article presents findings from our research into the effects of COVID-19 on social work and child protection in England during the first nine months of the pandemic. Our aim is to provide new knowledge to enable realistic expectations of what it was possible for social workers to achieve and particularly the limits to child protection. Such perspective has become more important than ever due to knowledge of children who died tragically from abuse despite social work involvement during the pandemic. Our research findings show how some practitioners got physically close to some children, whilst being distanced from others. We examine the dynamics that shaped closeness and distance and identify seven influences that created limits to child protection and the problem of 'the unheld child'. The article provides new understandings of child protection as embodied, multi-sensorial practices and the ways anxiety and experiences of bodily self-alienation limit practitioners' capacities to think about and get close to children. Whilst social workers creatively improvised to achieve their goals, coronavirus and social distancing imposed limits to child protection that no amount of innovative practice could overcome in all cases.

Index telephone two-week wait lower gastrointestinal clinics as a substitute to face to face outpatient appointments during the COVID-19 pandemic

Purpose/Background: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to- face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods/Interventions: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/ 10/2019 (FtF group) and 01/06/2020-31/ 10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results/Outcomes: In total, 1531 patients were analysed (median age = 70, male = 852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone;the remainder were seen FtF (n = 774, 50.6%). Ninety two (6%, VC = 44, FtF = 48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC);of these, 46 (71.9%, VC = 26, FtF = 20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p < 0.001). The cancer detection rates (p = 0.749), treatments received (p = 0.785) and median time to index treatment for CRC patients (p = 0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p < 0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion/Discussion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders. (Figure Presented).

Child protection social work in covid-19 reflections on home visits and digital intimacy

This article brings together digital anthropology and social work scholarship to create an applied anthropology of everyday digital intimacy. Child protection social work involves home visits in the intimate spaces of others, where modes of sensorial and affective engagement combine with professional awareness and standards to constitute sensitive understandings of children’s well-being and family relationships. In the COVID-19 pandemic, social work practice has shifted, partly, to distance work where social workers engage digitally with service users in their homes while seeking to constitute similarly effective modes of intimacy and understanding. We bring practice examples from our study of social work and child protection during COVID-19 together with anthropologies of digital intimacy to examine implications for new modes of digital social work practice. © The Author(s).