Daylight photodynamic therapy at home

Daylight photodynamic therapy (DPDT) is an established treatment for field-change actinic keratoses (AK) with high rates of satisfaction and success. In recent times there has been a push within the healthcare industry to reduce avoidable clinic time and complement it with community-based healthcare, including self-administration therapies. The importance of 'decentralized' healthcare and at-home therapies has been emphasized by the recent COVID-19 pandemic - access to treatments is restricted and many patients are not receiving the appropriate care in an attempt to minimize hospital-based treatments. In this project, we deconstructed DPDT and by utilizing principles of design and the concept of realistic medicine, transformed it into a user-friendly, environmentally conscious and engaging at-home therapeutic option. Information on protocols and best practice was obtained from clinical colleagues and a map of the patient pathway was outlined. The treatment was broken down and re-formed into simple steps, taking care with the number of instructions to prevent confusion. The physical form of the at-home kit was designed to facilitate the required materials for DPDT, while being simple and methodical to follow. Steps were separated into individual numbered sections, with only the materials needed at each step visible. Simple graphics are displayed alongside relevant instructions, with colouring to highlight importance. The at-home kit was iteratively improved with input from end users. As part of this initiative the DPDT athome kit is designed and prototyped in order to be posted directly to the user. In trialling this kit preclinically, the theoretical patient journey could be visualized, starting with the unboxing of the kit, then followed by the guides and directed procedure. Through feedback, iterations to the design have subsequently been made that efficiently translate the clinical procedure into a successful at-home design. One of the key principles of realistic medicine to consider is the reduction of waste. In this kit we have, where possible, used recycled and recyclable materials, and are in the process of incorporating medically approved biodegradable gloves, which will instantly reduce a high fraction of the nonrecyclable excess. Implementation of the kit in routine clinical practice will provide important feedback allowing further iterations to the design of the kit. Involving patients directly with the development work and continuously responding to the patient experience will significantly improve the final design of the at-home kit. Helping to implement an option to take this important treatment away from a hospitalized environment represents a paradigm shift in the possible delivery of DPDT and can be useful to optimize treatment delivery on a per-patient basis.

Evaluating the Oncology Research Internship (ORIoN) during the COVID-19 Pandemic: A Comparison of Virtual and In-Person Iterations

Purpose/Objective(s) The Oncology Research Internship (ORIoN), a novel resident-supervised initiative for medical students (MS), was first established in 2018 and found to be mutually beneficial to both residents and MS. The COVID-19 pandemic halted many scholarly programs, including ORIoN, which relied heavily on mentorship through in-person interactions. We report results of the first virtual program, adapted to the COVID-19 pandemic, and compare participant feedback to previous in-person iterations. Materials/Methods ORIoN application details were published online and emailed to first- and second-year MS. A panel of 3 physicians reviewed and scored applications independently. Successful MS applicants were paired with volunteer resident supervisors;each pair supervised by a staff oncologist. Compared to previous years, all meetings, correspondences and presentations between MS, residents, and supervising oncologists were conducted exclusively remotely. Only chart reviews were conducted on-site by MS. At the program's conclusion, each MS delivered a live virtual oral presentation of their completed case report, previously done in-person. Resident and MS participants completed questionnaires pre-/post program. Responses were collected on a 5-point Likert scale with open-ended free-text responses. Survey results from this virtual and the previous in-person programs were compared. Results Of 54 applications (previously 32 in 2018), 9 MS (three first-year, six second-year) were accepted and assigned to 9 volunteer residents (6 radiation oncology, 2 medical oncology, 1 pathology). To date, 9 manuscripts have been completed with 2 submitted for publication (1 published, 1 under review). Survey response rates were 100% (9/9) for residents and 89% (8/9) for MS. In the post-program surveys comparing the virtual and prior in-person programs, 87.5% (7/8) MS felt comfortable completing a clinical research project (22% strongly agree (SA), 62.5% agree (A), previously 25% and 75% respectively) and 100% (8/8) felt comfortable writing a case report (50% SA, 50% A, previously 75%, 25% respectively). All MS felt comfortable giving an oral research presentation (37.5% SA, 62.5% A) and teaching another MS to complete a case report (37.5% SA, 50% A). Similar to the in-person program, MS unanimously agreed that ORIoN was a beneficial experience (100%) and felt the program contributed to their career goals (100%, previously 88%). Post-program, all residents felt comfortable as a supervisor (67% SA, 22% A, previously 33%, 67% respectively), reviewing manuscripts (56% SA, 33% A, previously 33%, 50% respectively) and providing constructive feedback to trainees (67% SA, 33% A, previously 17%, 67% respectively). Conclusion Compared to the previous in-person program, the virtual ORIoN retained strongly favorable ratings from MS and residents alike. These findings support adapting similar scholarly and mentorship programs to a virtual setting when in-person interactions are not feasible.

Using video consultation technology between care homes and health and social care professionals: a scoping review and interview study during COVID-19 pandemic

Background: The COVID-19 pandemic disproportionately affected care home residents' and staffs' access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff.

Provision of Palliative and End-Of-Life Care in Care Homes During the COVID-19 Pandemic: A Mixed Methods Study Designed for Policy Impact

Background/aims: COVID-19 has had a devastating impact on care homes, their residents and families, and staff. More than 40,000 UK care home residents have died from COVID-19;many more have experienced symptoms and distress. The aim was to explore experiences of care home staff of providing palliative and end-of-life care (PEoLC) during COVID-19, and make policy recommendations. Methods: Mixed methods study comprising 1) Online survey (in REDCap) of UK care home staff, identified through established networks. The survey was developed from a rapid literature review and included structured and free-text data. 2) Qualitative interviews with care home staff (identified from 1);findings analysed thematically to identify policy recommendations for improving PEoLC. Results: 107 survey responses from across UK;57 (53%) had onsite nursing care. 72 (67%) experienced COVID-19 outbreaks;48 (45%) reported staff shortages;75 (70%) reported staff stress. Challenges included assessing and managing physical symptoms (17, 16%), spiritual needs (26, 24%) and social/family needs (56, 52%). 26 (24%) reported quality of PEoLC fluctuated during the pandemic. 26 qualitative interviews were carried out. Themes: 1/ Workforce. Staff experienced multiple pressures (more deaths, staff sickness/bereavement, new roles), mitigated by adapting working patterns and living arrangements, providing emotional and practical support, and fostering a sense of partnership. 2/ Integration. Integration with GPs, palliative care teams, pharmacists and community nurses varied. Digital communications, shared records, hotlines, regular meetings and strong relationships facilitated good PEoLC. 3/ Legacy. Positive outcomes emerged from the rapid changes made, including a sense of empowerment, pride and confidence among staff. This was undermined by feeling under-recognised and undervalued. Conclusions: Improving PEoLC in care homes is a priority. Recognition of care home expertise, and improved integration with community services, are essential.

Closing the UK care home data gap - methodological challenges and solutions.

UK care home residents are invisible in national datasets. The COVID-19 pandemic has exposed data failings that have hindered service development and research for years. Fundamental gaps, in terms of population and service demographics coupled with difficulties identifying the population in routine data are a significant limitation. These challenges are a key factor underpinning the failure to provide timely and responsive policy decisions to support care homes. In this commentary we propose changes that could address this data gap, priorities include: (1) Reliable identification of care home residents and their tenure; (2) Common identifiers to facilitate linkage between data sources from different sectors; (3) Individual-level, anonymised data inclusive of mortality irrespective of where death occurs; (4) Investment in capacity for large-scale, anonymised linked data analysis within social care working in partnership with academics; (5) Recognition of the need for collaborative working to use novel data sources, working to understand their meaning and ensure correct interpretation; (6) Better integration of information governance, enabling safe access for legitimate analyses from all relevant sectors; (7) A core national dataset for care homes developed in collaboration with key stakeholders to support integrated care delivery, service planning, commissioning, policy and research. Our suggestions are immediately actionable with political will and investment. We should seize this opportunity to capitalise on the spotlight the pandemic has thrown on the vulnerable populations living in care homes to invest in data-informed approaches to support care, evidence-based policy making and research.