Psychosocial Wellbeing among Patients with Breast Cancer during COVID-19

The impact of coronavirus disease 2019 (COVID-19) on the wellbeing of breast cancer (BC) patients is not well understood. This study described psychosocial problems among these patients in the United States (US) during the COVID-19 pandemic. Data were collected from BC patients via an online self-report survey between 30 March–6 July 2021 to assess the prevalence of COVID-19 diagnosis history and potential depression, health-related quality of life, COVID-related stress, and financial toxicity. Patients with early-stage (eBC) and metastatic (mBC) disease were compared. Of 669 patients included in the analysis, the prevalence of COVID-19 diagnosis history (10.9% versus 7.7%) and potential depression (33.7% versus 28.3%) were higher in mBC than eBC patients. Patients with eBC (versus mBC) had higher scores on nearly all Functional Assessment of Cancer Therapy-Breast scales (all, p < 0.001). For the Psychological Impact of Cancer subscales measuring negative coping strategies, the emotional distress score was the highest (9.1 ± 1.8) in the overall sample. Comprehensive Score for Financial Toxicity scores were higher in eBC than in mBC patients (24.2 ± 11.3 vs. 21.3 ± 10.2, p < 0.001). Overall, the COVID-19-related stress score was highest for danger/contamination fears (8.2 ± 5.6). In conclusion, impairments to psychosocial wellbeing among patients during the pandemic were observed, particularly financial toxicity and poor mental health and emotional functioning, with greater problems among mBC patients.

Social media use for coping with stress and psychological adjustment: A transactional model of stress and coping perspective.

Introduction: The psychological well-being of individuals has become an essential issue during the global pandemic. As a pervasive activity for individuals to pull through COVID-19, social media use may play a role in psychological well-being. Drawing on the transactional model of stress and coping, the current study investigated the relationships between COVID-19-related stressors and the use of social media to facilitate specific coping strategies. We further investigated how social media coping strategies impact users' psychological adjustment. Methods: We collected the data from 641 quarantined residents through a two-wave survey that was conducted in two cities in China during government-mandated lockdowns. Results: The results showed that perceived COVID-19 stress was related to the intensity of social media use for problem-focused coping, socioemotional coping, and mental disengagement. In addition, individuals' psychological adjustment was positively associated with social media use for socioemotional coping and mental disengagement while negatively related to problem-focused coping. Age was also found to be a moderator of the relationship between socioemotional coping and psychological adjustment. Discussion: To relieve pandemic-related stress, individuals can actively utilize social media to implement various coping strategies. However, coping activities with social media may not always induce psychological benefits. By revealing the different levels of psychological adjustment among social media users with specific coping strategies, the current research enriched the literature on the effects of social media use on mental health. Findings from this study suggest the need for the prudent use of social media to cope with public health crises.

The Overdose Conundrum

The article discusses the impact of patients' overdose on psychiatrists. It discusses the case of a 45-year-old woman with an opioid addiction and anxiety who was enrolled in an addictions treatment program. Topics covered include how the psychiatrists cope with patient suicide or overdose, how to promote honesty about recurrence of substance use and how psychiatrists can find the right balance in setting boundaries.

Evolving practice in global healthcare: Remote physics support for low- and middle-income countries.

The COVID-19 pandemic has disrupted traditional onsite support for radiotherapy clinics in low- and middle-income countries (LMIC). Clinics there have struggled to commission new techniques and receive onsite training for their staff. We sought to evaluate whether an offsite approach could fill this gap at a clinic in Jordan by requesting a clinical audit and attempting to commission volumetric modulated arc therapy (VMAT). Over 13 months, a consultant provided remote support for a radiotherapy center that had already obtained treatment equipment and licenses. The consultant began by conducting a virtual audit, using a remote login to the center's R&V and TPS, to identify any gaps in the clinical workflow. Suggestions for improving the clinical workflow were proposed, and change implementation was tracked through emails, social media apps, and video conferencing. An extensive table outlined the commissioning process, including all measurements to be done. Social media apps and shared documents were used to track measurements and analysis. The lack of person-to-person interaction in this new remote-support ecosystem created conflicts; we have highlighted some of these, as well as their resolution and the lessons learned from them. The virtual audit identified gaps categorized as machine QA, treatment plan review, and treatment delivery processes. Following the implementation of the proposals, motion management was added, and machine QA became more comprehensive. VMAT was commissioned using the reports of the AAPM and the IAEA. The main challenges for remote support were time difference, establishing an appropriate form and frequency of communication, tone of voice used in messages, and buy-in from local staff. This evolving practice will enable medical physicists to use modern, multimodal remote communication pathways to effectively transfer knowledge to centers in LMICs. The audit-proposal-improvement pathway for remote support can be incorporated to help others while avoiding the pitfalls we faced.

Videoconferencing and Work-Family Conflict: Exploring the Role of Videoconference Fatigue

Videoconferencing has become an essential communication tool for employees to engage in virtual meetings with their colleagues and complete work tasks remotely. However, there have been reports of a phenomenon termed videoconference fatigue. Concurrently, there has been an increase in work-family conflict among individuals working from home, due to an imbalance from role demands and expectations between work and family. With the rise of videoconferencing that has come to characterize work-from-home setups, it is important to explore the role videoconferencing plays on work-family conflict. We propose a model where the increase in use of videoconferencing as a result of working from home may lead to higher levels of videoconference fatigue, which will in turn result in greater work-family conflict. An online nationwide survey was conducted in Singapore with 590 respondents to test the proposed hypotheses. Results of serial mediation analyses conducted using PROCESS macro supported all hypotheses and indicated support for serial mediation. Emotional and occupational videoconference fatigue were further found to be significantly related to work-family conflict, whereas physical videoconference was not. Our results suggest that as videoconferencing continues to become the default mode of work-related communication, sustained investigation on its implications on work-family conflict is crucial.

From frequency to fatigue: Exploring the influence of videoconference use on videoconference fatigue in Singapore

The use of videoconferencing platforms has increased drastically as a result of the COVID-19 pandemic. As a result of work-from-home orders, many employees found themselves attending meetings through virtual communication technologies instead of usual face-to-face discussions. As employees spend more time on videoconferencing, there have been increasing concerns of users affected by an occurrence we define as videoconference fatigue (VF). In this study, we explore the link between frequency of videoconferencing and VF. We further explore videoconference users' satisfaction with their internet connection as a moderator of this relationship. We study these in the context of the Technology Acceptance Model (TAM), which provides a framework for us to understand the factors leading to VF. A survey was conducted in Singapore with 1145 respondents who use videoconference apps. Results from structural equation modeling supported a model where perceived ease of use of videoconference apps led to perceived usefulness of these apps, which led to an increased frequency of use. There was a significant relationship between frequency of use and feelings of videoconference fatigue, with this relationship moderated by users’ perceived satisfaction with their internet connection. When usage frequency is low, having a reliable internet connection helps mitigate the impact of use on VF. However, high levels of usage can override the mitigating impact of internet satisfaction. We discuss the implications of these findings, which lend understanding into potential factors that can result in VF.

Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study

Background Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America. Methods Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included sixteen weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed. Results One hundred and seventy-three radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p<0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p<0.001). Conclusion Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries.

Early identification of patients admitted to hospital for covid-19 at risk of clinical deterioration: model development and multisite external validation study.

OBJECTIVE: To create and validate a simple and transferable machine learning model from electronic health record data to accurately predict clinical deterioration in patients with covid-19 across institutions, through use of a novel paradigm for model development and code sharing. DESIGN: Retrospective cohort study. SETTING: One US hospital during 2015-21 was used for model training and internal validation. External validation was conducted on patients admitted to hospital with covid-19 at 12 other US medical centers during 2020-21. PARTICIPANTS: 33 119 adults (≥18 years) admitted to hospital with respiratory distress or covid-19. MAIN OUTCOME MEASURES: An ensemble of linear models was trained on the development cohort to predict a composite outcome of clinical deterioration within the first five days of hospital admission, defined as in-hospital mortality or any of three treatments indicating severe illness: mechanical ventilation, heated high flow nasal cannula, or intravenous vasopressors. The model was based on nine clinical and personal characteristic variables selected from 2686 variables available in the electronic health record. Internal and external validation performance was measured using the area under the receiver operating characteristic curve (AUROC) and the expected calibration error-the difference between predicted risk and actual risk. Potential bed day savings were estimated by calculating how many bed days hospitals could save per patient if low risk patients identified by the model were discharged early. RESULTS: 9291 covid-19 related hospital admissions at 13 medical centers were used for model validation, of which 1510 (16.3%) were related to the primary outcome. When the model was applied to the internal validation cohort, it achieved an AUROC of 0.80 (95% confidence interval 0.77 to 0.84) and an expected calibration error of 0.01 (95% confidence interval 0.00 to 0.02). Performance was consistent when validated in the 12 external medical centers (AUROC range 0.77-0.84), across subgroups of sex, age, race, and ethnicity (AUROC range 0.78-0.84), and across quarters (AUROC range 0.73-0.83). Using the model to triage low risk patients could potentially save up to 7.8 bed days per patient resulting from early discharge. CONCLUSION: A model to predict clinical deterioration was developed rapidly in response to the covid-19 pandemic at a single hospital, was applied externally without the sharing of data, and performed well across multiple medical centers, patient subgroups, and time periods, showing its potential as a tool for use in optimizing healthcare resources.

Temporal associations between emergency department and telehealth volumes during the COVID-19 pandemic: A time-series analysis from 2 academic medical centers.

BACKGROUND: The COVID-19 pandemic compelled healthcare systems to rapidly adapt to changing healthcare needs as well as identify ways to reduce COVID transmission. The relationship between pandemic-related trends in emergency department (ED) visits and telehealth urgent care visits have not been studied. METHODS: We performed an interrupted time series analysis to evaluate trends between ED visits and telehealth urgent medical care visits at two urban healthcare system in Colorado. We performed pairwise comparisons between baseline versus each COVID-19 surge and all three surges combined, for both ED and telehealth encounters at each site and used Wilcoxon rank sum test to compare median values. RESULTS: During the study period, 595,350 patient encounters occurred. We saw ED visits decline in correlation with rising telehealth visits during each COVID surge. CONCLUSIONS: During initial COVID surges, ED visits declined while telehealth visits rose in inverse correlation with falling ED visits, suggesting that some patients shifted their preferred location for clinical care. As EDs cope with future staffing during the ongoing COVID pandemic, telehealth represents an opportunity for emergency physicians and a means to align patients desires for virtual care with ED volumes and staffing.

"The long-term mental health effects of COVID-19": Erratum

Reports an error in "The long-term mental health effects of COVID-19" by Syed Z. Iqbal, Benjamin Li, Edore Onigu-Otito, Mohammad Faraz Naqvi and Asim A. Shah (Psychiatric Annals, 2020[Dec], Vol 50[12], 522-525). In the original article, the name of author Edore Onigu-Otite was misspelled. The spelling has been corrected. The online article and its erratum are considered the version of record. The name now appears correctly in this and the original record. (The following abstract of the original article appeared in record 2021-32464-001). The novel coronavirus 2019 (COVID-19) has affected the mental health of health care professionals and the general population. Most of the research has focused on the immediate and short-term implications of the COVID-19 pandemic, with a paucity of research available exploring the longterm mental health effects. Experience with previous disasters has shown that survivors suffer from various mental health problems including posttraumatic stress disorder, major depressive disorder, anxiety disorders, phobias, fears with avoidant behaviors, and various neuropsychiatric disorders. There has been an increased incidence of substance use and internet addiction along with increased rates of domestic violence and child abuse. Social distancing is helpful in limiting the spread of the disease, but the impact of social distancing and quarantine has resulted in increased anxiety among the general population. The long-term mental health effects are anticipated to be intensified due to the pandemic affecting people worldwide. Mitigation strategies need to be implemented as there will be no vaccine available to limit the long-term mental health effects of this pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Evaluating a Widely Implemented Proprietary Deterioration Index Model among Hospitalized Patients with COVID-19.

Rationale: The Epic Deterioration Index (EDI) is a proprietary prediction model implemented in over 100 U.S. hospitals that was widely used to support medical decision-making during the coronavirus disease (COVID-19) pandemic. The EDI has not been independently evaluated, and other proprietary models have been shown to be biased against vulnerable populations. Objectives: To independently evaluate the EDI in hospitalized patients with COVID-19 overall and in disproportionately affected subgroups. Methods: We studied adult patients admitted with COVID-19 to units other than the intensive care unit at a large academic medical center from March 9 through May 20, 2020. We used the EDI, calculated at 15-minute intervals, to predict a composite outcome of intensive care unit-level care, mechanical ventilation, or in-hospital death. In a subset of patients hospitalized for at least 48 hours, we also evaluated the ability of the EDI to identify patients at low risk of experiencing this composite outcome during their remaining hospitalization. Results: Among 392 COVID-19 hospitalizations meeting inclusion criteria, 103 (26%) met the composite outcome. The median age of the cohort was 64 (interquartile range, 53-75) with 168 (43%) Black patients and 169 (43%) women. The area under the receiver-operating characteristic curve of the EDI was 0.79 (95% confidence interval, 0.74-0.84). EDI predictions did not differ by race or sex. When exploring clinically relevant thresholds of the EDI, we found patients who met or exceeded an EDI of 68.8 made up 14% of the study cohort and had a 74% probability of experiencing the composite outcome during their hospitalization with a sensitivity of 39% and a median lead time of 24 hours from when this threshold was first exceeded. Among the 286 patients hospitalized for at least 48 hours who had not experienced the composite outcome, 14 (13%) never exceeded an EDI of 37.9, with a negative predictive value of 90% and a sensitivity above this threshold of 91%. Conclusions: We found the EDI identifies small subsets of high-risk and low-risk patients with COVID-19 with good discrimination, although its clinical use as an early warning system is limited by low sensitivity. These findings highlight the importance of independent evaluation of proprietary models before widespread operational use among patients with COVID-19.

Vulnerable Populations During the COVID-19 Pandemic

The coronavirus 2019 pandemic has affected people worldwide. The social determinants of health can disproportionately affect the outcomes of vulnerable populations, which include the elderly, racial or ethnic minorities, children and adolescents, as well as those with comorbid medical conditions. These populations may require additional resources and consideration in treatment of their mental health given the struggles they may face secondary to decreased resources, health care access, increased mortality and morbidity, lifestyle disturbances at crucial developmental times, and a host of other factors contributing to an increased vulnerability to the effects of the virus. This article provides background on those factors and reviews interventions to consider for treating these populations. [Psychiatr Ann. 2020;50(12):531–535.]

The Long-Term Mental Health Effects of COVID-19

The novel coronavirus 2019 (COVID-19) has affected the mental health of health care professionals and the general population. Most of the research has focused on the immediate and short-term implications of the COVID-19 pandemic, with a paucity of research available exploring the long-term mental health effects. Experience with previous disasters has shown that survivors suffer from various mental health problems including posttraumatic stress disorder, major depressive disorder, anxiety disorders, phobias, fears with avoidant behaviors, and various neuropsychiatric disorders. There has been an increased incidence of substance use and internet addiction along with increased rates of domestic violence and child abuse. Social distancing is helpful in limiting the spread of the disease, but the impact of social distancing and quarantine has resulted in increased anxiety among the general population. The long-term mental health effects are anticipated to be intensified due to the pandemic affecting people worldwide. Mitigation strategies need to be implemented as there will be no vaccine available to limit the long-term mental health effects of this pandemic. [Psychiatr Ann. 2020;50(12):522–525.]

COVID's Impact on Radiation Oncology: A Latin American Survey Study.

PURPOSE: The impact of the COVID-19 pandemic on Latin American radiation therapy services has not yet been widely assessed. In comparison to centers in Europe or the United States, the scarcity of data on these terms might impair design of adequate measures to ameliorate the pandemic's potential damage. The first survey-based analysis revealing regional information is herein presented. METHODS AND MATERIALS: From May 6 to May 30, 2020, the American Society for Radiation Oncology's COVID-19 Survey was distributed across Latin America with support of the local national radiation therapy societies. Twenty-six items, including facility demographic and financial characteristics, personnel and patient features, current and expected impact of the pandemic, and research perspectives, were included in the questionnaire. RESULTS: Complete responses were obtained from 115 (50%) of 229 practices across 15 countries. Only 2.6% of centers closed during the pandemic. A median of 4 radiation oncologists (1-27) and 9 (1-100) radiation therapists were reported per center. The median number of new patients treated in 2019 was 600 (24-6200). A median 8% (1%-90%) decrease in patient volume was reported, with a median of 53 patients (1-490) remaining under treatment. Estimated revenue reduction was 20% or more in 53% of cases. Shortage of personal protective equipment was reported in 51.3% of centers, and 27% reported personnel shortage due to COVID-19. Reported delays in treatment for low-risk entities included early stage breast cancer (42.6%), low-risk status prostate cancer (67%), and nonmalignant conditions (42.6%). Treatment of COVID-19 patients at designated treatment times and differentiated bunkers were reported in 22.6% and 10.4% of centers, respectively. Telehealth initiatives have been started in 64.3% of facilities to date for on-treatment (29.6%) and posttreatment (34.8%) patients. CONCLUSIONS: Regional information regarding COVID-19 pandemic in Latin America may help elucidate suitable intervention strategies for personnel and patients. Follow-up surveys will be performed to provide dynamic monitoring the pandemic's impact on radiation therapy services and adoption of ameliorating measures.