Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study.

Background: Literature on telehealth interventions for older adults has been primarily on asynchronous interventions. During the COVID-19 pandemic, older adult exercise programs transitioned to an online format. This systematic review and case study examines the effectiveness of older adult live video exercise group interventions on physical health with insights from a Los Angeles VA program, Gerofit. Methods: PubMed was searched for live video older adult exercise groups from database inception to November 2021. All eligible studies included assessments of physical health and were limited to participants with an average age of 65 years or greater. Ten Veterans, who had participated in both in-person and virtual Gerofit sessions, were surveyed in the case study. Results: Nine studies met the inclusion criteria. Four studies included an equivalent in-person group as a comparator to the live video group and reported no significant between-group differences in outcomes, including energy expenditure and 6-minute walking distance test (6MWD). The other five studies reported statistically significant in-group improvement in outcomes including isokinetic knee strength. Case study participants reported similar attendance rates and perceived benefits, such as improved balance, when comparing virtual and in-person sessions. Discussion: Live video exercise groups in older adults demonstrated an improvement in physical function that was not statistically different from the comparison in-person sessions with the added benefit of averaging a higher attendance rate, providing initial support for the use of live video in older adult exercise programs. Insights from the case study supplement this by demonstrating older adults' positive attitude on these groups.

Mothers' accounts of the impact of being in nature on postnatal wellbeing: a focus group study.

BACKGROUND: The postnatal period is a vulnerable time for mothers to experience stress and mental health difficulties. There is increasing evidence that spending time in nature is beneficial for wellbeing. Nature-based interventions have been developed to support mental health, but not specifically tailored for mothers during the postnatal period. Understanding mothers' views and experiences of nature would help determine the suitability for and potential impact of such interventions on postnatal wellbeing. AIMS: To explore mothers' views on the impact of spending time in nature on their postnatal mental wellbeing. METHODS: Focus groups were held with mothers of young children (under five), including mothers from migrant and refugee communities, mothers living with mental health difficulties, and disabled mothers. Data were analysed using reflexive thematic analysis. RESULTS: Four focus groups were held, with a total of 30 participants. Six themes were developed: (1) mothers' experiences of what constitutes 'nature'; (2) sensing nature improves wellbeing; (3) natural spaces facilitate human connection; (4) nature provides escape and relief from daily indoor stressors; (5) nature allows new perspectives; and (6) mothers face a variety of environmental, practical, psychological, physical, socioeconomic, and cultural barriers to spending time in nature during the postnatal period. CONCLUSIONS: Mothers report significant benefits to their postnatal wellbeing when spending time in nature. Further research is warranted to understand whether nature-based interventions have the potential to support postnatal wellbeing, socially, mentally, and physically.

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study.

OBJECTIVE: To identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice. DESIGN: An explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants were asked to describe their most transformative learning experiences. Heuristical TCs were identified from the thematic analysis. SETTING: Aotearoa/New Zealand (A/NZ). PARTICIPANTS: Fifty participants, mostly comprising current trainees and educators from urban centres, and of NZ/European ethnicity. RESULTS: Twenty TCs covering many aspects of postgraduate general practice experience were derived from themes identified in the data. Presented in medical proverbial form for ease of recollection, these included: Money makes the practice go round; Be a legal eagle; Manage time or it will manage you; Guidelines, GPs' little helpers; Right tool, right word, right place; The whole of the practice is greater than the sum of the parts; The personal enhances the professional; Beat biases by reflection; Chew the Complexity, Unpredictability, Diversity; Embrace the uncertainty; Not knowing is knowing; Seek and you shall find; Waiting and seeing, waiting and being; Look, listen, think between the lines; Treat the patient beyond the disease; No patient is an island; Words work wonders; Hearing is healing; Being you and being there; and; The relationship is worth a thousand consults. These TCs mapped onto core competencies in A/NZ's PGME in general practice curriculum. CONCLUSIONS: Participants readily identified transformative and troublesome moments in their PGME in general practice. These findings confirmed evidence for a wide range of TCs with many newly identified in this study. All TCs were fundamentally based on the doctor-patient relationship, although often involving the context and culture of general practice. Actively incorporating and teaching these identified TCs in PGME in general practice may enable trainees to grasp these important learning thresholds earlier and more easily and aid in identity and role formation.

"There is a huge need, and it's growing endlessly": perspectives of mental health service providers to ethnic Chinese in Aotearoa New Zealand

AIM: Little is known about the experiences of ethnic Chinese accessing mental health services in Aotearoa New Zealand, resulting in uncertainty around their service preferences, and facilitators or barriers to their mental health help-seeking. This paper investigated the experiences of providers of specific mental health services for ethnic Chinese in Aotearoa, their opinions regarding their patients' experience, and their suggestions to improve the system. METHOD: Sixteen health professionals with experience and expertise delivering mental health services for ethnic Chinese were interviewed at 12 organisations across Aotearoa. Interviews were recorded, transcribed and analysed using general inductive methods and thematic analysis. RESULTS: Practitioners' experiences revolved heavily around cultural brokerage, which is vital for culturally appropriate care, but this is time-consuming and receives little formal support. Practitioners thought the patient experience was inadequate, with a lack of language and culturally appropriate services leading to delays in help-seeking. Practitioners' suggestions for system improvement included increasing resourcing for research, and for expanding the availability of language and culturally appropriate services. CONCLUSION: Current mental health service provision is inadequate for ethnic Chinese seeking help in Aotearoa, and is causing harm by delaying mental health help-seeking. Decisive Government leadership and deeper collaboration between non-Government organisations (NGOs) will be key to improving mental health service accessibility and outcomes.

Impact of the COVID pandemic on the percentage of adult hospital inpatients in the last year of life: data from the dudley group NHS foundation trust

BackgroundA third of hospital patients are in their last year of life and almost 50% of people die in hospital. Gold Standards Framework (GSF) is a quality improvement programme enabling coordinated care for people in the last year of life. A yearly audit is completed at Dudley Group NHS Foundation Trust (DGFT) to support implementation of GSF and identification of patients in the last year of life to enable an individual plan of care for patients.MethodThe inpatients on adult wards were identified on the 1st April 2019 through the information team and the number of deaths in the following year recorded in order to review the% of adult inpatients in the last year of life within the hospital and broken down by ward. This was repeated for the 1st April 2020 during the first wave of the COVID pandemicResultsThe results for 2019 were that of 566 adult inpatients on the 1.4.2019, 187 died within 12 months (33%). This last year has been unprecedented due to COVID pandemic and the results for 2020 demonstrated that of the 407 inpatients on the 1.4.20, 167 died within 12 months (40%). This provides the ward with information for their speciality as a number of wards were identified as having a higher percentage of patients die within the year for example, elderly care, respiratory, gastroenterology and oncology wards.ConclusionDespite this year’s challenges with Covid-19, this audit has supported the implementation of the Gold Standards Framework within DGFT and provided the wards with evidence regarding the percentage of patients on their ward in the last year life with the aim of implementing an individual plan of care.

What Was It Like to Deliver Psychotherapy During the COVID- 19 Pandemic? Understanding Therapists' Perspectives Using a Phenomenological Collaborative Writing Approach

COVID-19 presented rapid challenges to usual practice within mental health services. Despite the suspension of face-to-face psychotherapy, as a group we felt compelled to adapt so that our relationships with patients could continue. This article documents some of the challenges and opportunities faced by our group. We use collaborative writing as a method of inquiry, informed by a phenomenological approach. Each of the six therapists in the group and the supervisor wrote a freestyle personal reflection;when these reflections were viewed together, noticeable themes emerged which bear relevance to future practice. We present here anonymised vignettes (excerpts from therapists' reflections) under thematic headings, to bring to life the collaboratively written discussions that follow. These include important moments related to the transition from face-to-face practice, and new perspectives on beginnings and endings in therapy. We highlight the power of holding onto hope for those that we work alongside, of advocating for the importance of these relationships, and of the vital role played by regular supervision meetings. The pandemic has prompted us to question our way of working and has shown us new ways to be flexible in the future. We invite others to reflect on whether they relate to our experiences or have different perspectives on the delivery of psychotherapy during such unpredictable times.

Mediating Role of Resilience on Nursing Faculty and Student QoL during COVID-19.

COVID-19 greatly impacted nursing education and required nursing faculty and students to quickly adapt to changes caused by disease mitigation. The purpose of this study was to examine the mediating effects of resilience between the influence of demographics and school-related risk factors and nursing faculty and student quality of life (QoL) during the COVID-19 pandemic. A secondary data analysis was conducted using structural equation modeling to examine the mediating role of resilience on latent variables. Resilience had a positive, direct effect on nursing faculty and student QoL. Having a designated home workspace and being well-prepared for online learning had positive, indirect effects on QoL, mediated through resilience. Assisting children with schoolwork had a negative impact on the psychological and environmental QoL domains. Remarkably, having a caregiver role positively influenced the psychological QoL domain. Supporting and promoting faculty and nursing students' health and well-being is imperative during and after the pandemic.

Quality of Life, Resilience, and Related Factors of Nursing Students During the COVID-19 Pandemic.

BACKGROUND: COVID-19 and the associated measures to mitigate the spread of the virus have significantly disrupted nursing education. PURPOSE: The purpose of this study was to examine the relationship between quality of life (QoL), resilience, and associated factors among nursing students during the unprecedented COVID-19 pandemic and subsequent social distancing requirements. METHODS: A cross-sectional study using an anonymous survey with nursing students (n = 152) was conducted at a public university in rural Appalachia in April 2020. Instruments included World Health Organization Quality of Life-BREF, Connor Davidson Resilience Scale, demographics and school-related questionnaires, and an open-ended question. Data were analyzed using descriptive, bivariate, and multiple linear regression analyses. RESULTS: Resilience, having online experience, and being well prepared for online learning were associated with each QoL domain. Remarkably, 21% to 54% of nursing student QoL scores indicated poor QoL. CONCLUSIONS: Cultivating resilience among nursing students may improve QoL, help with academic success, and prepare students to sustain the demands associated with the nursing profession.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19.

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

Relationship of Quality of Life, Resilience, and Associated Factors Among Nursing Faculty During COVID-19.

BACKGROUND: The COVID-19 pandemic and subsequent social distancing guidelines greatly impacted the quality of life (QoL) of nursing faculty. PURPOSE: The purpose of this study was to examine the relationship of QoL, resilience, and associated factors among nursing faculty during the COVID-19 pandemic. METHODS: In April 2020, a cross-sectional, anonymous survey was conducted with nursing faculty in a public university in rural Appalachia (n = 52). Instruments included QoL, resilience scales, work-related, and demographic variables. Descriptive, bivariate, and multiple linear regression analyses were used to analyze data. A content analysis was used to analyze an open-ended question. RESULTS: Resilience was the strongest variable to predict each of the QoL domains. Nursing faculty who reported better QoL were those who were able to adapt to changes and challenges mandated during the COVID-19 pandemic. CONCLUSIONS: Evidence-based programs to build resilience and improve nursing faculty working conditions and their QoL are needed.

Role of mitochondria, oxidative stress and the response to antioxidants in myalgic encephalomyelitis/chronic fatigue syndrome: A possible approach to SARS-CoV-2 'long-haulers'?

A significant number of SARS-CoV-2 (COVID-19) pandemic patients have developed chronic symptoms lasting weeks or months which are very similar to those described for myalgic encephalomyelitis/chronic fatigue syndrome. This study reviews the current literature and understanding of the role that mitochondria, oxidative stress and antioxidants may play in the understanding of the pathophysiology and treatment of chronic fatigue. It describes what is known about the dysfunctional pathways which can develop in mitochondria and their relationship to chronic fatigue. It also reviews what is known about oxidative stress and how this can be related to the pathophysiology of fatigue, as well as examining the potential for specific therapy directed at mitochondria for the treatment of chronic fatigue in the form of antioxidants. This study identifies areas which require urgent, further research in order to fully elucidate the clinical and therapeutic potential of these approaches.