ABSTRACT
The early stages of the COVID-19 pandemic were a time of great job insecurity. Knowledge of how such feelings of insecurity were mitigated during a time of crisis has important implications for the development of future interventions. Drawing from uncertainty management theory (UMT), we explored the impact of informational justice perceptions on the effects of job insecurity in a sample collected during the early stages of the pandemic (March-May 2020). The findings indicated that informational justice buffered the impacts of job insecurity on employee life satisfaction and perceived ability to perform. Furthermore, the source of information regarding COVID-19-related job changes mattered for predicting informational justice perceptions. Our findings bolster UMT and have important practical implications for future times of crisis.
ABSTRACT
The SARS-CoV-2 (COVID-19) pandemic has led to the rapid implementation of virtual clinics across the healthcare sector. Alternatives to the conventional face-to-face patient assessment have been sought and piloted within dermatology departments. Cutaneous patch testing is traditionally assessed on days 2 and 4, and often delayed readings are required. Strategies to minimize physical attendance and the potential risk of COVID-19 transmission were required in order to maintain access to services. Photographic assessment of patch testing was introduced in our department. In addition, we employed photographic phototonics to augment the patch-test result image. Phototonics is the technology of generating, detecting and manipulating physical light, whose quantum unit is the photon. Photonics can be used to assess levels of blood flow in a clinical photograph of skin acting as a surrogate marker for cutaneous inflammation. Our aim was to assess if clinical photography and photonic image analysis can improve the detection of positive reactions in the virtual interpretation of patchtest results. Consecutive patients attending for patch testing were recruited and written consent was obtained. Photographs of patch-test results were taken using a 40-megapixel colour camera, on day 5, contemporaneous to patch-test assessment by the study investigators. The photographs were then analysed using spectral imaging technology software (HyperCube). The analysis employed principal component analysis, a technique used to reduce the dimensionality of datasets. The phototonic images were then examined to determine a combination of variables or colour patterns (red-green-blue) that would indicate a positive result and a surrogate marker for cutaneous inflammation. Thirty patients were recruited from September to November 2020. Two blinded investigators determined whether the results were positive, ?positive, irritant or other. Phototonic, photographic and clinical results were then compared. Photonic evaluation captured 59% of positive patch-test readings, while photographic assessment captured 50%. Interpretation of the results was almost identical between both investigators. This pilot study outlines the potential application of phototonic technology in the interpretation of virtual patch-test results. It is evident that physical attendance for patch-test reading is superior to both photographic phototonic assessment and photographic assessment. However, there may be role for the use of phototonics in order to augment the evaluation of virtual patch-test results. Interpretation of phototonics can be difficult and is generally modelled to validated results. Analysis using a multispectral camera to include specific wavelengths to monitor increased blood flow may have a role.
ABSTRACT
The COVID-19 pandemic precipitated a unique set of circumstances where the provision of care via telemedicine was rapidly adopted. Delivering high-quality care is a primary focus and the consideration of sustainability should be central to this process. Value in healthcare is often defined by outcomes for patients and populations in relation to economic costs;however, a more holistic approach using the 'triple bottom line' factors in environmental and societal impacts. The primary drivers in developing dermatology video consultations were the promotion of equitable and co-produced care, constructing sustainable healthcare and mitigating against environmental impacts, and demonstrating leadership in establishing new methods of outpatient care delivery. Patient video consultation demographics and outcomes were captured from 24 June 2020 to April 11 2020. Data were collected via the hospital software and dictation system with ethical approval. Patient experience was assessed via an online questionnaire. One hundred video consultation episodes were examined. The rate of nonattendance at scheduled video consultation was 10%. Successful video consultations were completed in 90% of patient episodes. Conversion to a telephone consultation was required in 12% and face-to-face presentation in 4%. Further information (e.g. photographs) was required to complete the consultation in 18%. In relation to outcomes, 25% of patients were discharged back to their general practitioner. Day case procedures were arranged in 12% of patients. Follow- up was conducted via telephone in 21% of patients (n = 12/56) and face to face in 79% (n = 44/56). The rate of change in diagnosis following face-to-face follow-up/investigation was 8%. Seventy patients completed an online questionnaire;the response rate was 70%. Mean age was 39 years (range 16-74). Eighty-five per cent were satisfied or very satisfied with their consultation, 83% felt their skin complaint was adequately addressed and 73% rated their overall user experience as very good or excellent. In relation to environmental impacts 12 760 km and 228.6 h of travel time were saved, and carbon emissions were reduced by 2.19 metric tonnes of CO2. In terms of accessibility, 84% of households in the area have fixed broadband and 42% have mobile broadband. When endeavouring to determine the quality of a new service many aspects require attention. Our service demonstrates equity in accessibility with a wide age range and good broadband coverage. The rate of change in diagnosis was low at 8% and patient satisfaction was high. Questionnaire responses provide an opportunity for co-production and positive environmental and societal impacts are also created.
ABSTRACT
The incidence of melanoma and nonmelanoma skin cancer continues to rise in Ireland. This study aimed to explore the tanning and sun-protection behaviour and attitudes, as well as awareness of signs of melanoma, of the Irish population. A cross-sectional study was performed in December 2020 via an online questionnaire. Respondents were recruited according to gender, age and geographical region. In total, 1043 respondents (49% female) completed the questionnaire (mean age 41 years;range 20-72). In total, 443 sunbathe when there is sunny weather in Ireland, with 245 wearing suncream less than half of the time. Thirty-eight per cent (n = 399) have used sunbeds in the last 12 months, despite the global COVID-19 pandemic. Almost half (49%) did not believe getting a sunburn was serious. Most (87%) were aware melanoma would have serious consequences for them and 91% believed it was important to protect themselves from getting melanoma. In total, 839 know that wearing sunscreen can prevent sunburn. However, the main reasons they do not apply it include just forgetting (n = 207), to get a tan (n = 177) and they just don't like putting it on (n = 359). The main reason for limiting sunbathing was to avoid wrinkles/ skin pigmentation (n = 356), followed by a fear of getting skin cancer (n = 334). The primary reason people sunbathed was to top up their supply of vitamin D (n = 336), which was closely followed by getting a tan. Eighty-five per cent reported feeling and looking better with a tan. Despite knowledge of the risks of sunburn, 208 respondents felt it was worth getting slightly sunburnt to get a tan. Most respondents were aware of sun-protection measures (n = 729), but 484 people were not confident about what to look for when performing a self-skin examination and only 410 know the signs of a melanoma. This study found that although the majority of people are aware of the risks of sunbathing, many are happy to take these risks in order to get a tan. Tans are still considered to be attractive by the majority of respondents. Although there are high levels of awareness regarding sun protection, knowledge regarding skin self-examination and the signs of melanoma is lacking. Our results indicate that health promotion interventions for skin cancer may need to focus on education regarding the signs of melanoma and consider strategies to alter the perceptions of the beneficial factors of tanning.
ABSTRACT
Objectives: To compare autonomic function and health-related quality of life (HRQoL) in those with post-acute sequelae of Covid-19 (PASC), postural orthostatic tachycardia syndrome (POTS) and healthy controls. Method(s): A total of 60 participants were recruited (PASC = 20, POTS = 20, controls = 20). There were no significant differences in age or other demographics between groups. PASC was defined as >=3 months of persistent unexplained symptomology post SARS-CoV-2 infection. 10-minute active standing test was undertaken using Finapres NOVA to measure beat-to-beat haemodynamic response. Composite Autonomic Symptom Score (COMPASS-31) was used to assess autonomic symptomology and the Euroquol 5-Dimension (EQ-5D) survey to assess HRQoL (scale of 0-1 with '1' representing full health). The 5-point hypermobility questionnaire (5-PHQ) was used to assess generalized joint hypermobility (defined as score >=2). Result(s): 95% of PASC subjects fulfilled the standing test criteria for POTS (DELTA heart rate, bpm: 42 +/- 10 vs. 48 +/- 14 in POTS and 16 +/- 6 in controls;p < 0.001) and significantly increased autonomic symptoms per COMPASS-31 score as compared to controls (39 +/- 11 vs. 51 +/- 15 in POTS and 12 +/- 14 in controls;p < 0.001). Individuals with PASC and POTS had higher rates of joint hypermobility than controls (45% vs. 75% vs. 25% respectively;p = 0.006) and significantly reduced HRQoL utility scores (0.61 +/- 0.04 vs. 0.64 +/- 0.03 vs. 0.94 +/- 0.09 respectively;p < 0.001). Conclusion(s): Autonomic dysfunction and reduced HRQoL is prevalent in sufferers with PASC and bear high similarity to those with POTS. This is in keeping with the often-observed post-viral illness-mediated POTS. Our data calls for routine involvement of autonomic physicians in the care of subjects with PASC.
ABSTRACT
Introduction: It is widely accepted that the role of a pharmacist is becoming more complex and the scope of practice has broadened over the past decade. With restricted access to hospitals and general practice, the COVID-19 pandemic shone a light on the vital role that pharmacists play in maintaining patient care and disease management. Pharmacists have always been at the forefront delivering safe and effective care across all settings. Recent reforms to the education and training of pharmacists in the United Kingdom, will see that from day one on the register, pharmacists are expected to play an active role in the provision of clinical care and consultations including prescribing medicines. These advances make it more important now to have a better understanding of what moral development through pharmacy education and once in practice. Research has shown that healthcare professionals can make better decisions in the interests of their patients when they have advanced levels of moral decision making. Objective(s): It is hypothesised that as students' progress through pharmacy education they will demonstrate maturation in moral development, and this should continue as they progress through their careers. This research intends to measure and evaluate the pattern of moral reasoning of undergraduate pharmacy students at the University of Hertfordshire (UH) as they progress through formal education and practice. Method(s): A ten-year longitudinal study which employed the Defining Issues Test 2 (DIT2) to quantitatively measure the changes the participants' moral development. The DIT2 was completed by participants of a single cohort of students, who started the Master of Pharmacy (M.Pharm.) programme in 2008 in each year of study at the University of Hertfordshire, once after passing the General Pharmaceutical Council pharmacist registration exam (as Newly Qualified pharmacists) and a final time five years after they qualified (as matured Established Practitioners). Medians and standard deviations were calculated and compared analysed using pairwise comparison with the Wilcoxon signed-rank test. Result(s): The statistically significant changes were in N2 scores between Level 1 (Median = 22.07) and Level 3 (Median = 26.80) (p = 0.025), this is a positive finding which supports the research that shows that moral development can be taught. To further support these results there was an increase in N2 score between Level 1 and Level 4 (p = 0.011). Research has also shown that practice-based experience can give rise to maturation in moral development, this research showed a statistically significant difference between Level 4 (Median = 22.62) and NQ Level (Median = 40.53). Despite this, surprisingly, there was a marked decrease in p and N2 scores at Established Practitioner level. Conclusion(s): Overall, the research showed a general increase in moral development as the participants progressed through the M.Pharm. programme and in the first year after qualifying. However, with the decrease in moral development indices as an Established Practitioner qualitative research to investigate factors that may have caused this then recommend ways to support pharmacists better through education and practice.
ABSTRACT
Introduction: The COVID-19 pandemic presented many challenges to the delivery of healthcare, especially for those with lung disease.Our group recently reported that the rate of new lung cancer diagnoses declined by 35% during the first year of the COVID-19 pandemic (year 2020). The objective of the present study is to evaluate the changes in new lung cancer (LC) diagnoses during the 2 years of the pandemic compared to the pre-pandemic era, and its subsequent effect on survival of lung cancer patients. Methods: This is a retrospective chart review study including patients diagnosed with lung cancer between March 1st 2019 and February 28th 2022 at the Peter Brojde Lung Cancer Centre at the Jewish General Hospital, Montreal. We compared 3 cohorts: Cohort 1 (C1): March 1, 2019 to February 29, 2020 (pre-COVID). Cohort 2 (C2): March 1, 2020 to February 28, 2021 (1st year of COVID). Cohort 3 (C3): March 1, 2021 to February 28, 2022 (2nd year of COVID;reporting for 11 months). Results: A total of 404 patients were diagnosed with lung cancer throughout the three-year study: 130 in C1, 103 in C2 and 171 in C3. Using C1 as a baseline, we found that new diagnoses of LC declined by 21% in C2, and rose by 32% in C3. The incidence of metastatic lung cancer increased by 41% in 2021 compared to 2019 (96 cases vs 68 cases) and by 63% compared to 2020 (96 cases vs 59 cases). Of the 59 metastatic LC patients diagnosed in 2020, 31 (52%) died, whereas 28/68 (41%) died in 2019. The median survival for metastatic LC in the first year of the pandemic decreased compared to pre-COVID year (14.5 vs 8.7 months) (Table 1). Statistical significance has not been reached as follow-up time was not long enough for year 2020 (p=0.58). Conclusions: The present study represents interim data of our ongoing effort to evaluate the effect of the COVID-19 pandemic on our lung cancer patients. The pandemic has led to a significant decline in LC diagnoses in the first year, and a subsequent increase in diagnoses during the 2nd year. Unfortunately, these changes resulted in a trend towards decreased survival for our metastatic LC patients. The final survival analysis will require longer follow-ups and this data will be presented at the meeting. [Formula presented] Keywords: COVID-19, Retrospective, Survival
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) has significantly impacted clinical activities across many medical specialties. The care of lung cancer (LC) patients is no exception. Our group recently reported that the rate of new lung cancer diagnoses declined by 35% during the first year of COVID-19 pandemic (year 2020). The objective of the present study is to continue to evaluate changes in lung cancer diagnosis and management during 3rd and 4th waves of the pandemic (2021). Methods: This is a retrospective chart review study including patients diagnosed with lung cancer between March 1st 2019 and February 1st 2022 at the Jewish General Hospital, Montreal, QC, Canada. We compared 3 cohorts: Cohort 1: 2019 (pre-COVID). Cohort 2: 2020 (1st year of COVID). Cohort 3: 2021 (2nd year of COVID;reporting for 10 months of 2021). Results: A total of 388 patients were diagnosed with lung cancer throughout the three-year study: 130 in cohort 1, 103 in cohort 2 and 155 in cohort 3. Although there was a 35% decline of new lung cancer (LC) diagnoses observed in the 1st year of COVID, there was a 50% increase in diagnoses during the 2nd year comparing to the first year and a 19.2% increase compared to the pre-COVID year. Stage 4 LC diagnoses increased by 29% in 2021 compared to 2019 (88 cases vs 68 cases) and by 54% compared to 2020 (88 cases vs 57 cases). Early stage curative treatments (which had significantly changed in 2020, as the use of radiation therapy [RT] increased by 125% and surgery decreased by 38%), approached pre-pandemic levels in 2021. In 2021 we observed a decrease in RT and a significant increase in surgical resections. Analyses of wait time for initiation of treatment is still ongoing. Conclusions: The present study represents interim data in our ongoing effort to evaluate the dynamic impacts of the COVID-19 pandemic on diagnosis and delivery of LC care. The pattern of lung cancer treatment modalities for early stage disease appears to be recovering to pre-COVID rates. However, the significant decrease in lung cancer diagnoses during the first year of the pandemic has resulted in an increase in new diagnoses during the 2nd year at unfortunately more advanced stage of disease.
ABSTRACT
This paper explores the nature of newspaper coverage of 'cocooning' as a public health measure at the height of the Covid-19 pandemic in Ireland in 2020. The study, which focuses on coverage in The Irish Times, shows that the number of human-interest-framed articles on cocooning was approximately four times greater than the number of informative ones. This suggests that the proportion of human-interest and emotive stories diluted the volume of informative articles. The findings also point to an absence of significant official voices in the coverage of cocooning, such as key ministerial figures, which may have contributed to knowledge gaps. There was also a discernible gender bias, not just in experts quoted but also in the journalists who wrote news and feature articles. The study offers important lessons for government communication strategies in how important public information is provided to target groups.
ABSTRACT
Objectives: Due to restricted access to cutaneous patch testing (PT) during the SARS-CoV-2 pandemic innovative strategies were necessary to promote equitable healthcare. Photonics generates, detects and manipulates physical light (photons) which can assess blood-flow in a clinical photograph and potentially act as a surrogate marker for cutaneous inflammation. We wished to assess if clinical photography and photonic image analysis could improve the virtual interpretation of PT results. Methods: PT photographs of 30 consecutive patients were taken using a 40- megapixel colour camera contemporaneous to PT assessment by study investigators. Photographs were then analysed using HyperCube using Principal Component Analysis (PCA), a technique used to reduce the dimensionality of datasets. Photonic images were then examined to determine a combination of variables or colour patterns indicating a positive result. Results: Thirty patients were recruited from September-November 2020. Two blinded investigators determined whether the results were positive, ?positive, irritant or other. Photonic, photographic and clinical results were compared. Initial blinded photonic evaluation captured 40% of positive PT while photographic assessment captured 51%. Unblinded evaluation captured 90% of both PCA and clinically positive results. Conclusions: The SARS-CoV-2 pandemic catalysed many changes in healthcare delivery and introduced opportunities to produce patient centred care. This pilot study employs innovative technology to improve rural accessibility to PT, promote inclusivity and reduce carbon emissions by reducing patient travel. Further development is necessary as while PCAanalysis of digital images improves pick-up of positive PTvirtually it remains inferior to face-to-face assessment. Multispectral imaging has the potential to expand the range of wavelengths further.
ABSTRACT
Aims: England and Wales report on average, 700,000 annual pregnancies. From these 5% are complicated with hyperglycaemia with 87.5% of these Gestational diabetes (GDM). Pregnant women living with obesity are at higher risk of developing GDM. There is a linear relationship between glucose and adverse pregnancy outcomes. We noted a marked increase in the number of referrals with GDM to our service in 2021. The aim of this study was to compare the incidence of GDM and the characteristics of women under our service in 2021 to the pre-pandemic data from 2019. Methods: Data were collected retrospectively, analysing the data of women with GDM during the time period of 1st May to 31st July 2019 and compared to the same period from 2021. Results: The number of positive OGTT results increased by 209% in 2021 (n = 107 vs 51). In 2021 there was a 66% increase in the number women with GDM with a Body Mass Index (BMI)≥30kgm2 (36 to 60). The average BMI of this group increased from 34.9kg/m2 in 2019 to 36.5 in 2021 although this failed to reach statistical significance. Conclusion: The local incidence of GDM is higher in 2021 compared to 2019. This is driven by an increase in the number of women diagnosed with GDM with a BMI≥30. We hypothesize that this may be a result of sedentary lifestyle brought on by the lock downs because of the pandemic. Further work may be warranted in this area using a larger sample size derived nationally.
ABSTRACT
This paper explores, through a posthumanist lens, child care as a communal responsibility, taking into account varied partial perspectives produced through human and more-than-human intra-actions. Multiple narratives illustrate embodied and experienced complexities within child care spaces allowing us to reflect on uncomfortable truths to enact affirmative ethics as a way to transform the ways we care for children, their families, each other, and the spaces of child care. Specifically, we think with actual and virtual doors as producers and enablers to create spaces where early childhood educators might collaboratively interrogate how materiality and socially constructed hierarchies are embedded in the inequities that separate us, inequities further exposed and exacerbated by the COVID-19 pandemic.
ABSTRACT
Background: The second wave of COVID 19 resulted in an influx of patients in respiratory distress requiring non-invasive ventilation (NIV) support on the extended respiratory high care ward (RHC). Mortality rates were high, as was symptom burden at the end of life, resulting in an increased need for specialist palliative care support. Aims: To provide early and proactive SPCT (supportive and palliative care team) intervention, in order to optimise symptom control in patients requiring NIV preceding or at the time of death. In particular to reduce the incidence of symptom crises due to respiratory distress. A secondary aim was to support ward staff in managing the clinical and emotional aspects of their work. Methods: From December 2020 to February 2021 the SPCT redesigned their current service provision to allow a nurse specialist and/ or a senior doctor to attend daily board rounds on the 32 bedded RHC ward. Potential patients were identified for referral based on clinical judgement and a prompt question of 'would this patient benefit from early palliative care'. Results: On average the team spent 3 hours/day on the unit. Over an 11 week period a total of 49 patients were identified for review. 73% of patients had a Covid positive or Covid pneumonitis diagnosis. 53% were on a form of respiratory support, either NIV or nasal high flow oxygen (NHFO). 63% of referrals died on the unit during this period, 59% had anticipatory subcutaneous medications prescribed and 49% had a continuous subcutaneous infusion prescribed by the SPCT. During this time period the SPCT were involved in the care of 72% of all patients who died on the unit. Conclusion: Targeted integration of SPCT facilitated early referral. SPCT intervention resulted in appropriate symptom control prescriptions and reduced the numbers of urgent referrals for crisis management. RHC staff reported feeling better supported in the challenge of providing care.
ABSTRACT
Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.