ABSTRACT
Introduction: Bronchiolitis is the most common cause for paediatric respiratory hospital admissions in young children in the UK.1 Following the relaxation of international SARS-Cov-2 lockdown measures a potential national surge in cases was predicted, highlighting a need for more collaborative working across core specialities.2 This prompted the use of the principles of Inter-Professional Education (IPE) to prepare and deliver an intervention to improve outcomes for these patients.3 Objectives: * To plan, deliver and evaluate an educational intervention focussed on improving the knowledge, skills and attitudes needed to care for a sick child with bronchiolitis * To utilise the principles of IPE to improve competence and confidence across core specialities involved in the care of a sick child with bronchiolitis Methods: A team from the Adult Intensive Care Unit (AICU) and the Paediatric High Dependency Unit (PHDU) from the Royal Berkshire Hospital in Reading delivered an inter-professional teaching session focussed on caring for the sick child with bronchiolitis. The patient journey was utilised as a framework to teach the core knowledge, skills and attitudes needed to clinically manage a child from the Emergency Department (ED) to the Intensive Care Unit (ICU). Each session included a lecture about bronchiolitis - describing pathophysiology and how to recognise the deteriorating child;a skills and drills tutorial - highlighting the need for weight-based calculations for high flow nasal oxygen, intravenous fluids and drugs;and a practical simulation scenario - focussing on the stabilisation and management of a sick child awaiting retrieval to the Paediatric Intensive Care Unit (PICU). Result(s): 135 healthcare professionals from a range of adult and paediatric disciplines involved in the care of children across the patient journey attended one of fourteen teaching sessions delivered between September to December 2021. Attendees completed a feedback questionnaire. One hundred and twenty-two (90%) reported an extremely high degree of satisfaction overall, with many saying they would recommend the teaching sessions to others. Areas of personal and professional development were highlighted across the following main themes: gaining theoretical knowledge;understanding key equipment;performing drug calculations;preparing for intubation and ventilation;assessing the need for chest physiotherapy techniques;and more collaborative team-working. Free text comments demonstrated that the attendees felt the teaching sessions: built confidence through the sharing of new or improved knowledge and skills;facilitated a safe space to practice using simulation;and provided the opportunity to learn about and from each other. Many of the attendees also commented on areas they wanted to reinforce and further develop in daily clinical practice as a direct result of the sessions. Conclusion(s): On-going evaluation is taking place as the teaching sessions continue throughout the year, facilitating the inclusion of additional inter-professional groups from across core specialities. These sessions have been used as a template for the development of further planned IPE with a more varied range of paediatric clinical cases and presentations. These will continue to build on the transferable knowledge and skills that increase competence and confidence in caring for the sick child whilst developing a more collaborative practice-ready workforce.
ABSTRACT
Background: The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Method(s): The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Result(s): The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Conclusion(s): Role strain may be a significant driver of burden when the caretaker's educational and professional potential collide with traditional South Asian family obligations. The burden reported by our respondents suggests that role strain may elevate stress among young, educated caregivers. Our results, therefore, provide indirect evidence concerning the changing economic and socio-cultural context of caregiving in South Asian households. Copyright © 2022 the Alzheimer's Association.
ABSTRACT
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
ABSTRACT
Rationale: Burnout and distress amongst ICU staff are prevalent and have been exacerbated during the COVID-19 pandemic. In this context, recent data have revealed an increased incidence of adverse mental health events (AMHE) amongst healthcare workers (HCW). However, identifying HCWs at risk for AMHE and offering timely support services remains a challenge. Our aim is to develop a telehealth-based platform to provide mental health screening and tailored interventions to ICU HCW at an academic medical center. Methods: A multidisciplinary team comprised of clinical and behavioral psychologists, resiliency coordinators, pulmonary critical care fellows, and faculty iteratively developed a screening questionnaire using validated tools directed at various domains of mental health including sleep disturbance, depression, anxiety, PTSD, resiliency, alcohol misuse, and burnout. Using Research Electronic Data Capture (REDCap) with an integrated Twilio platform, we developed a text-based, interactive tool designed to 1) screen HCWs for AMHE, 2) communicate results to respondents in real-time, and 3) provide risk-stratified referrals to support services such as a mental health practitioner or self-help mobile applications. We performed cognitive pretesting on the amalgamated survey instrument with 6 ICU HCW stakeholders including three ICU RNs, one RT, and two physicians. We sought feedback on survey length, concerns about confidentiality, likelihood to accept mental health referrals, and pertinence of the questions to ICU HCWs. Feedback was obtained via a 4-question survey and through qualitative field notes. Results: The mean duration required to complete the survey during beta-testing was 6.97 mins +/-2.46 mins (SD). 100% of participants reported that the questionnaire was ”not overly burdensome” (5/6) or “minimally burdensome” (1/6). Participants were also “very confident” (4/6) or “confident” (2/6) their confidentiality would be maintained with this intervention. 83% (5/6) of participants stated that they were either “extremely likely” (3/6) or “likely” (2/6) to accept real-time feedback including a mental health referral if their responses suggest possible mental health distress. Only 17% (1/6) reported that they are unlikely to accept a mental health referral. All participants rated the pertinence of the questions to the healthcare workers to be high with 33% (2/6) characterizing the pertinence as excellent and 67% (4/6) as very good. Illustrative comments from the qualitative assessment are included in the Table. Conclusion: A telehealth-based platform for a mental health screening with real-time feedback and support service referral is feasible and was well-received by ICU HCW during cognitive pretesting.