Generating the place of self-compassion in higher education: An academic place of belonging as a catalyst of the COVID-19 pandemic

The pandemic has revealed the need to position compassion and (self-)care at the heart of what we do as educators, leaders, and researchers in higher education. As research collaborators, two women working in academia, one located in Australia and the other in New Zealand, we have found we have been able to connect more, reflect with each other and our colleagues, and embrace a common humanity that has enabled the harnessing of kindness, deep thinking, and expression of authentic self. We draw on a metalogue emergent methodology in this chapter and reconstruct our understanding of working together at this time of the pandemic where the place of belonging has enabled us to interrupt and reinterpret the halting of our collective lives and traditional ways of working that have been passed down to us. We view the pandemic as a catalyst for caring for self and one another, and in this way we are positioning our individual, collective and systematic conversations about wellbeing as integral to who we are. © 2023 selection and editorial matter, Narelle Lemon, Heidi Harju-Luukkainen, and Susanne Garvis;individual chapters, the contributors. All rights reserved.

Covid-19 abortion experiences on reddit: A qualitative study

We sought to document the effects of COVID-19 pandemic restrictions on people seeking abortion by analyzing posts on Reddit, a popular social media website. We compiled 528 anonymous posts on the abortion subreddit from March 20, 2020 to April 12, 2020 and applied deductive qualitative methods to identify codes and themes. In the first of four themes, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of self-managed medication abortion, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences — for example, being unable to bring a support person into the clinic due to pandemic visitor restrictions. This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited people's abortion access and affected their termination decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic- or policy-related, on abortion service delivery. [ FROM AUTHOR]

LIVING WELL WITH AN ADVANCED LUNG CONDITION

Background Whilst our established support for people living with breathlessness was long-standing, it was not multidisciplinary or fully evidence-based. We wanted to address this for the benefit of patients and the wider health system. The Cambridge Breathlessness Intervention Service (CBIS) model is an evidence-based approach to support people living with advanced lung conditions to manage their breathlessness (Higginson, Bausewein, Reilly, et al., 2014). Consultation with service users suggested that patients wanted support to: manage breathlessness, improve mental wellbeing, mobility and symptom management as well as help with planning ahead and reducing isolation. Aims To implement and evaluate a breathlessness intervention using a multidisciplinary skill mix and trained community volunteers. Methods Using the CBIS model as a framework, we reshaped, redeployed and trained our team to deliver this intervention at home. We supplemented this with a layer of social support provided by experienced compassionate neighbour volunteers. We evaluated the impact of the intervention through: before and after breathlessness self-rating scales, interviews with patients and case studies documenting the use of different parts of the service (e.g. physiotherapist, nurse, occupational therapist, rehabilitation assistant, complementary therapy). Results This project has been delivered during the COVID-19 pandemic, so there were practical issues around seeing patients face-to-face, and we were unable to support as many as expected. To date, 28 patients have been referred to the service. Of these, 18 received input. We will report on changes in self-rating scores and feedback from interviews with patients and families. To date, only a few participants opted to have a compassionate neighbour. Conclusions Initial findings suggest that although delivery of this project was hampered by the pandemic, patients valued the service and benefitted from practical input from the MDT. Limitations on being able to provide face-to-face support may have influenced uptake of compassionate neighbours and reduced the number of patients seen.

Confounders and co-interventions identified in non-randomized studies of interventions

Objectives: To identify potential confounders and co-interventions systematically to optimise control of confounding for three nonrandomized studies of interventions (NRSI) designed to quantify bleeding in populations exposed to different dual antiplatelet therapy (DAPT). Study Design and Setting: Systematic review, interviews, and surveys with clinicians. We searched Ovid Medline, Ovid Embase, and the Cochrane Library to identify randomized-controlled trials and cohort studies of DAPT interventions. Two researchers independently screened citations, identified eligible studies and extracted data. We conducted individual semi-structured interviews with six cardiologists and six cardiac surgeons to elicit factors clinicians consider when they prescribe DAPT. We administered two online surveys for members of professional cardiology and cardiac surgery organisations. Results: We screened 2,544 records, identified 322 eligible studies, and extracted data from 47. We identified 10 co-interventions and 70 potential confounders: review 31 (91%);interviews 19 (56%);surveys 31 (91%). 16/34 (47%) were identified by all three methods while, 3/34 (9%) were picked up by one method only. Conclusion: The review identified the majority of factors, but the interviews identified hard-to-measure factors such as perceived patient adherence and local prescribing culture. The methods could, in principle, be widely applied when designing or reviewing nonrandomized studies of interventions (NRSI). (c) 2022 Published by Elsevier Inc.

Promoting Wellness in Orthopaedic Surgery Residency

The challenges associated with surgical residency have been well documented and described. Despite implementation of work-hour restrictions, residency remains a balancing act between patient care, surgical and clinical education, medical record documentation, and research endeavors. The added challenge of balancing these duties with life outside of the hospital further complicates the situation. Multiple studies have documented the stress associated with residency training, highlighting the prevalence of emotional exhaustion, detachment from people both in and out of the hospital, and a concerning rate of clinical depression among residents. Moreover, this emotional exhaustion has been shown to directly correlate with residents' clinical performance and abilities to carry out academic duties. More recently, feelings of isolation and detachment have been exacerbated by the necessity of COVID-19 precautions and change in clinical duties. The Accreditation for Graduate Medical Education (ACGM) now requires all residencies to include programming that focuses on resident well-being. Programs have implemented various strategies in an effort to help their trainees cope with the stress associated with residency and beyond. Despite the variety in approaches of programs, these initiatives have the similar objective of teaching resilience and the ability to navigate stressors in a healthy and effective manner. The programming can also serve to promote resident interaction and develop camaraderie in an effort to minimize feelings of emotional exhaustion and isolation. In this article, we discuss the importance of sustained physician wellness and describe approaches from various professions that can be implemented into the wellness curriculum for residency programs across the country. By promoting a culture of wellness and incorporating effective wellness programming, our aim is that residents will be able to succeed not only in their training but also in their personal lives and professional endeavors after graduation.

COVID-19 lockdowns' effects on the quality of life, perceived health and well-being of healthy elderly individuals: A longitudinal comparison of pre-lockdown and lockdown states of well-being.

PURPOSE: . The concept of lockdown in relation to COVID-19 is thought to have an indirect impact on the quality of life and well-being of the elderly due to its consequences on the physical, psychological, and cognitive health of individuals. However, previous published studies on this subject are limited in terms of methodological approach used, including the absence of pre-confinement status and the type of experimental design, which is often cross-sectional. The present study proposes a longitudinal design with pre-confinement measures. It assesses changes in quality of life, perceived health, and well-being by comparing the period before lockdown (T1 = December 2019), three months after the start of the first lockdown (T2 = June 2020), and during the second lockdown (T3 = January 2021) due to COVID-19. MATERIALS AND METHODS: . This study is conducted with a group of 72 healthy elderly persons. They completed an electronic (online) survey assessing personal factors, activities, and participation as well as responding to the EuroQol-5D and Warwick-Edinburgh Mental Well-being Scale. RESULTS: . A decrease in quality of life, perceived health and well-being was observed between T1 and T2 and between T1 and T3, but no difference was reported between the two lockdown periods. The variables associated with these changes included energy level, level of happiness, physical activity, change in medical condition, memory difficulties, level of perceived isolation and age. CONCLUSION: . This study will help to target variables that may have a deleterious effect on older adults for consideration in future confinement settings and for preventive purposes.

Prolonged intubation in patients with prior cerebrovascular disease and COVID-19

Objective: To determine the odds of critical illness by day 28 and duration of mechanical ventilation (MV) over 45-day observation period in patients with history of cerebrovascular disease and COVID-19. Background: COVID-19-associated morbidity is correlated with multiple factors including age, comorbidities, and host response to the virus. Our understanding of the risk of critical illness due to prior neurological conditions remains limited. Here, we hypothesized that prior cerebrovascular disease is a risk factor for severe outcomes in COVID-19, including increased duration of MV. Design/Methods: A cross-sectional study of 1128 consecutive adult patients admitted to a tertiary care center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. The association between history of cerebrovascular disease and critical illness defined as MV or death was examined using logistic regression with inverse probability weighting of the propensity score. Cumulative incidence of successful extubation without death over 45 days was examined using competing risk analysis. Results: Of the 1128 adults admitted with COVID-19, 350 (36%) were critically ill by day 28. The median age was 59 years (standard deviation: 18 years), 640 (57%) were men, and 401 (36%) were Latinx ethnicity. As of June 2nd, 2020, 127 (11%) patients died. A total of 257 (23%) of patients had a prior neurological diagnosis;most common was cerebrovascular disease (16%). Prior cerebrovascular disease was significantly associated with critical illness (OR 1.54 [95% CI: 1.14 - 2.07]), lower rate of successful extubation (cause-specific HR 0.57 [95% CI: 0.33-0.98]), and increased duration of intubation (restricted mean time difference 4.02 days [95% CI: 0.34- 10.92]) compared to patients without cerebrovascular disease. Conclusions: History of cerebrovascular disease adversely affects COVID-19 outcomes including increased risk of critical illness and prolonged intubation. Further studies are needed to define measures that reduce risk of poor outcomes in this subpopulation.

Changes in objectively-measured adolescent sleep and light exposure during the COVID-19 pandemic

Introduction: U.S. adolescents have high rates of insufficient sleep. School closures and stay-at-home orders were implemented to mitigate disease spread during the Coronavirus 2019 (COVID-19) pandemic. Without the restriction of imposed early school start times, we hypothesized that adolescents would have longer, later, and less variable sleep compared to pre-COVID-19. We further hypothesized these changes would be associated with increased and later light exposure. Methods: High school students age 14-19 years with <7h sleep on school nights completed two weeks of at-home monitoring. The Pre-COVID-19 week took place between October 2018-February 2020 and the COVID-19 week occurred in May 2020 during statewide stay-at-home orders. Participants wore an accelerometer to assess sleep and light exposure while completing a concurrent sleep log. Paired-samples t-tests examined differences in sleep and light between Pre-COVID-19 and COVID-19. Pearson correlations assessed associations between change in sleep and change in light. Results: Participants (N=16) were 16.5 ±1.2-years-old at Pre- COVID-19, 70.6% female, 68.8% White, and 25.1% Hispanic. Youth were participating in online learning due to in-person school closures and only 2 participants (14.3%) had a set start time, while the remainder reported learning per their own schedule. Youth obtained approximately one hour more weekday sleep per night during the COVID-19 week compared to Pre-COVID-19 (p<0.001). Bed and waketimes were significantly delayed on weekdays and weekends during COVID-19 compared to Pre-COVID-19 (p< 0.01). The greatest change was a delay in weekday waketime of 2.9±0.9h (p<0.001). Social jetlag during COVID-19 was reduced by 1/3 compared to Pre- COVID-19 (p=0.02). Average 24h lux levels were 2.5x higher during the COVID-19 week compared to Pre- COVID-19 (p=0.008). Change in average lux and timing of light were not significantly associated with change in sleep duration or timing. Conclusion: An unintended effect of the switch to online learning may have been affording adolescents the opportunity to obtain longer and more regular sleep. Understanding the impact of these changed sleep behaviors on daytime functioning, academic performance, and health outcomes is particularly urgent as schools plan for the remainder of the academic year and eventual return to in-person learning.