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A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

The impact of COVID-19 on nurse leadership characteristics.

BACKGROUND: Nurse leaders are vital for improving nursing efficiencies and the quality of care that they provide during a crisis and its aftermath. The value of positive leadership characteristics has never been more critical than during the COVID-19 pandemic. Functioning in a crisis mode required nurse leaders to demonstrate the necessary skills for clear communication and solid leadership. Therefore, nursing leadership, especially in emergencies such as the COVID-19 pandemic, needs to be transformative in the sense that leaders are informational, motivating, and able to advance the organization, notwithstanding a global pandemic. Timely leadership research during and after COVID-19 is crucial for filling the literature gap resulting from the unique changes in the nursing profession in the post-pandemic period. OBJECTIVE: This study aimed to investigate leadership characteristics shown by nurse leaders during the COVID-19 pandemic, and investigate nurses' perceptions of nurse leader effectiveness based on leaders' work roles. METHODS: An exploratory, quantitative study was conducted 18 months after the declaration of the COVID-19 pandemic (June-August 2021). The Multifactor Leadership Questionnaire (MLQ 5X) was sent to registered nurses (RNs) in Texas using the State Board's listing of active RNs. In total, 70 practicing RNs participated in the study. Data were analyzed using descriptive statistics and multivariate correlational analysis. RESULTS: Perceived leadership characteristics remained primarily transformational. Nurse directors and executives reported positive leadership characteristics more frequently than did staff and charge nurses. LINKING EVIDENCE TO ACTION: Specific tactics and strategies must be adopted to support nurses and nursing leadership during ongoing healthcare challenges. Close monitoring of leadership characteristics will enable organizations to support and provide educational opportunities for ongoing organizational success.

Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19.

ABSTRACT: Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.

Learning From Experience- Confronting Challenges and Adapting to Change in a Large Academic Abdominal Radiology Practice: Insights From a Faculty Retreat.

RATIONALE: Substantial organizational changes, increasing clinical volumes, and the COVID-19 pandemic presented compound stressors to faculty radiologists in our large academic abdominal radiology division and necessitated multiple changes in our practice. METHODS: To address the challenges and establish group consensus, we conducted a virtual divisional faculty retreat centered on themes of team building, clinical work, trainee education, and faculty mentorship. A pre-retreat survey evaluated satisfaction with aspects of professional life and clinical work practices and invited personal reflections. Survey data were presented in the retreat segments focused on each theme, and subsequent discussion was facilitated in small group breakouts. RESULTS: Responses to the team-building survey revealed common values and sources of gratitude, including health, family and meaningful work and relationships. Faculty reported a strong sense of personal accomplishment, but with varied emotional exhaustion scores. Faculty were satisfied with remote work assignments but identified opportunities to improve the clinical work schedule including reversion of some remote assignments to in-person and increased interventional radiology shift staggering. Compared to pre-COVID practice, faculty respondents perceived giving lower quality and less frequent feedback to trainees; evolving educational resource needs were identified. A more formal approach to faculty mentoring was sought. A post-retreat survey revealed high participant satisfaction. OUTCOMES: In the future, we plan to continue divisional retreat activities to respond to evolving challenges and further improve team building, clinical workflow, trainee education, and faculty mentorship.

The Association Between Social Network and Fear of COVID-19 Among Older Adults.

The COVID-19 pandemic and associated restrictions pose a significant health threat to older adults. Fear of COVID-19 is associated with increased disease transmission and numerous psychosocial health challenges. While social support has been studied extensively in gerontological literature, there is a gap in understanding how social networks influence fear of COVID-19. This study drew from a convenience sample of 239 adults 60+ years of age in the United States who completed a 20-min survey. Regression results indicate that higher social network was significantly associated with decreased fear of COVID-19. Identifying as female and as an ethnic minority were associated with increased fear of COVID-19. These findings document the need for social workers to promote enhanced social networks in reducing fear of COVID-19 among older adults and attend to disparate levels of fear among older women and people of color.

The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times

Background: There are well-established provincial guidelines surrounding target wait times for patients diagnosed with cancer. Wait 1 is the time from initial referral to a patient's first surgical oncology appointment. Wait 2 is the time from the decision to operate to the actual operation. During the first wave of the COVID-19 pandemic in March 2020, elective operations decreased and the majority of in-person appointments were cancelled or changed to telephone appointments. Oncologic operations were allowed to continue;however, routine screening temporarily stopped. The objective of this study is to determine the effect of the COVID-19 pandemic on overall case counts, Wait 1 and Wait 2. Methods: All patients diagnosed with cancer and referred for surgical management at our centre from Mar. 15 to June 30, 2019, were compared with those in the same time period in 2020. Results: In 2020, there was a significant decrease in new cases, from 666 to 588 (p < 0.001). Surgical specialties varied greatly in how much the case volume was affected. When we compared Wait 1 from 2019 to 2020, significantly more patients (p = 0.019) met the target time for Wait 1 in 2020 (89.4%) compared with 2019 (85.0%). However, significantly fewer (p < 0.001) patients met the target time for Wait 2 in 2020 (71.6%) than in 2019 (88.4%). Again, there was variability in the ability to meet target wait times for both Wait 1 and Wait 2 by surgical specialty. The decrease in overall case counts from 2019 to 2020 (11.7%) was less than the provincial decrease in cases (23.2%) over the same time period. Conclusion: While overall case volumes dropped, the decrease was not universal across surgical specialties. Further, the majority of subspecialties improved in Wait 1, while the majority had a lengthening of Wait 2. It remains to be seen whether individual patient outcomes will suffer because of the first wave of the COVID-19 pandemic.

Reduction in Standard Cancer Screening in 2020 throughout the U.S.

Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21-65), breast (ages 50-74), and colorectal cancer (ages 50-75) prior to the pandemic. Cancer screening percentages for 2020 (April-December excluding January-March) were compared to screening percentages for 2014-2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014-2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40-49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.

COVID-19 pandemic-related transition to telehealth in child and adolescent mental health.

Introduction: This article explores one mental health company's urgent response to the global COVID-19 pandemic, and the multifaceted implications of quickly transitioning to telehealth services. Objectives: The purpose of this article is to share information with interdisciplinary professionals about the planning, implementation, and results of transitioning to telehealth services during a pandemic. Procedures: We compiled practice-related data regarding company attendance rates and customer and employee satisfaction with telehealth. Data include feedback from more than 40 clinicians and 60 families. Results: The data suggest there are both benefits and limitations to engaging in telehealth services within a mental health company. Attendance rates increased dramatically, engagement improved with adolescents but proved challenging with the younger children. Telehealth helped overcome many typical barriers to mental health treatment. Concerns remain regarding confidentiality, assessment of abuse and neglect, and ability to read nonverbal social cues. Conclusion: Families and practitioners experienced the convenience and benefits of telehealth but also expressed concerns over certain limitations. Finding a responsible way to incorporate telehealth into practice postpandemic is a priority for mental health practitioners, both now and in the immediate future.

Trainee and Attending Perspectives on Remote Radiology Readouts in the Era of the COVID-19 Pandemic.

RATIONALE AND OBJECTIVES: Social distancing mandates due to COVID-19 have necessitated adaptations to radiology trainee workflow and educational practices, including the radiology "readout." We describe how a large academic radiology department achieved socially distant "remote readouts," provide trainee and attending perspectives on this early experience, and propose ways by which "remote readouts" can be used effectively by training programs beyond COVID-19. MATERIALS AND METHODS: Beginning March 2020, radiologists were relocated to workspaces outside of conventional reading rooms. Information technologies were employed to allow for "remote readouts" between trainees and attendings. An optional anonymous open-ended survey regarding remote readouts was administered to radiology trainees and attendings as a quality improvement initiative. From the responses, response themes were abstracted using thematic analysis. Descriptive statistics of the qualitative data were calculated. RESULTS: Radiologist workstations from 14 traditional reading rooms were relocated to 36 workspaces across the hospital system. Two models of remote readouts, synchronous and asynchronous, were developed, facilitated by commercially available information technologies. Thirty-nine of 105 (37%) trainees and 42 of 90 (47%) attendings responded to the survey. Main response themes included: social distancing, technology, autonomy/competency, efficiency, education/feedback and atmosphere/professional relationship. One hundred and forty-eight positive versus 97 negative comments were reported. Social distancing, technology, and autonomy/competency were most positively rated. Trainees and attending perspectives differed regarding the efficiency of remote readouts. CONCLUSION: "Remote readouts," compliant with social distancing measures, are feasible in academic radiology practice settings. Perspectives from our initial experience provide insight into how this can be accomplished, opportunities for improvement and future application, beyond the COVID-19 pandemic.