Ahead of the Curve - Experience from the Uk's First Dedicated Specialist Crm Clinic for Achd Patients

Background: The population of Adults with Congenital Heart Disease (ACHD) is expanding. A significant number will require Cardiac Rhythm Management (CRM) devices. In current UK practice, these patients are routinely seen in non-specialist CRM clinics and little is published regarding best-practice CRM programming and management in the ACHD population. Objective(s): Our objective was to establish a new model of patient-centred/-specific care delivered by specialist CRM physiologists, supported by an EP consultant (with a special interest in ACHD) in a dedicated clinic. We hoped to set new standards of care and patient experience, and improve efficiency and outcomes. Method(s): Data was collected from the electronic record system and CRM device database. A control group of non-ACHD patients was selected at random at our institution over the same period (2018-2022). Result(s): The clinic population n = 468 had a sex ratio of 0.92 (M:F) and mean age of 44 years (range 16 - 86). Mean time since primary implant was 9 years. All device types were represented: loop recorder (52), pacemaker (262), cardioverter defibrillator (116) and cardiac resynchronisation therapy devices (38). The underlying ACHD condition was: simple 46%, moderate 28% and complex 26%. Outcomes of appointments (n = 1,234) are shown vs controls (n = 126) (figure 1). Appointment and patient numbers rose year-on-year (100 to 226 patients, 281 to 367 appointments). There was a lower incidence of 'no review / reprogramming ' in ACHD CRM clinic appointments compared to the non-ACHD population, as well as a higher incidence of programming changes, however the trend over time within the ACHD group showed an increase in 'no review / reprogramming' and a decrease in reviews / reprogramming events. In contrast, non-ACHD patients had an increase in medical reviews and reprogramming required between 2018/19 and 2021/22. This is likely due to the COVID pandemic and deferred time to appointments and review. Conclusion(s): Our data demonstrate that the ACHD CRM population require additional input from the medical and scientist teams when compared to non-ACHD patients, however over time there has been a reduction in major programming/review and a commensurate increase in minor programming/discussion and no review. A reverse trend was observed in the non-ACHD patients pre- and post- COVID. These data support the proposal that specialised clinics provide the optimal management ACHD CRM clinics and should be delivered by dedicated practitioners. [Formula presented]Copyright © 2023

The National Guard and Reserves

The reserve component of the U.S. military includes the Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and Coast Guard Reserve as well as the Army National Guard and Air National Guard. Together these elements are some of the most complex and contentious, but also most essential, of the U.S. military. A member of the Army National Guard might be, in one month, deployed overseas and in the next administering treatments for COVID in a civilian hospital in the U.S. This chapter provides one of the only existing introductory descriptions of the structures of the reserve component. Most importantly, it introduces the crucial concept of "duty status” (Title 10, Title 32, State Active Duty, etc.) which, among other things, sets limits on what members of the National Guard can legally do during deployments. This information is embedded in a deep history of the National Guard as America's historic militia reconfigured for the modern era. © 2023 selection and editorial matter, Katherine Carroll and William B. Hickman. individual chapters, the contributors.

Peer teachers taking the lead in classroom instruction: program creation and challenges faced

Purpose: This paper discusses a program to train undergraduate students as near peer teachers delivering course-embedded information literacy instruction to undergraduate students. Design/methodology/approach: The approach involved the development and delivery of a curriculum combining information literacy concepts and teaching pedagogy. Significant student feedback was gathered which determined the final program structure. Findings: While the curriculum was successful in developing students' information literacy competencies and pedagogical skills, stakeholder buy-in and the COVID-19 pandemic hindered the program. Additionally, the goal of the program – solo student teaching, was not realized. Originality/value: Peer teaching is widely implemented in many disciplines;however, its application in academic libraries has focused more on peer reference, rather than peer teaching. This case study adds to the body of literature on this topic related to student peer teaching in academic libraries. © 2023, Emerald Publishing Limited.

EXPERIENCES during the COVID-19 PANDEMIC among PEOPLE with INFLAMMATORY ARTHRITIS. 'rEOPENING of SOCIETY IS HARDER THAN LOCK-DOWN'-A QUALITATIVE INTERVIEW STUDY

Background: People with infammatory arthritis (IA) treated with conventional or biological immunosuppressive disease-modifying anti rheumatic drugs (DMARDs), were initially considered to have an increased risk of severe illness from SARS-CoV-19 (COVID-19) infection compared to the general population. Although resent studies have not confrmed this, people with IA have reported high level of anxiety and self-isolation during the pandemic (1). Only few studies have qualitatively explored how people with IA experience the impact the COVID-19 pandemic and the SARS-CoV-19 vaccinations. Objectives: To explore how people with IA experienced restrictions during the COVID-19 pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives. Methods: Semi-structured in-depth interviews were conducted via telephone or video with 19 people with IA in May-August 2021, shortly after they were enrolled in the national COVID-19 vaccination programme (all Danish citizens >18 years of age invited for SARS-CoV-19 vaccination, free of charge, with timing depending on age and comorbidities). At the same time, society gradually reopened after a complete lock-down. Qualitative content analysis, inspired by Graneheim and Lundman (2), was applied to analyse the data. Two patient research partners were involved in development of the study protocol, an interview guide and in the interpretation of fndings. Results: The participants' age ranged from 21 to 64 years, median 50 years. 7 male and 12 female, all diagnosed with IA (Psoriatic arthritis n=4, Axial Spondyloarthropathy n=4, Rheumatoid arthritis n=9, and Juvenile arthritis n=2) and 14 were treated with DMARDs. Two had not accepted vaccination. The analysis derived five themes: 1: 'Changing and divergent information'. The participants experienced there was an overload of general information to the public, while targeted information on the specific risk for people with IA was lacking;2: 'Individual interpretation of own risk', refilecting that participants had to find their own level of daily-life restrictions, a task they found to be very difficult;3: 'Impact on everyday life'. They took self-imposed precautions to protect themselves and their families from attracting COVID-19;4: 'Position in society and the vaccination programme', emphasizing that participants were affected by the inconsistent announcements from authorities whether they were considered to be in particular risk or not, and some expressed concerns regarding the DMARDs influence on the effect of the vaccine and 5: 'Reopening is somehow harder than lock down'. A societal spirit of being 'in this together' emerged through the lock-down and some were concerned that fewer restrictions during reopening of the society would put them in higher risk of a COVID-19 infection and force them to continue self-isolation. Conclusion: The COVID-19 pandemic affected the everyday lives of people with IA due to the authorities' restrictions and further self-imposed precautions throughout lock down and reopening of society. People with IA experienced a lack of consistent information and felt alone to assess their own SARS-Cov-19 infection risk.

Implementing, launching and sustaining a quality improvement initiative in the era of covid-19: Challenges and successes

Introduction: Only 60% of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Closing this gap in AC use is particularly challenging in the face of the COVID19 pandemic. Electronic health record (EHR) alerts integrated into in-person and telehealth visits have the potential to close the gap. Hypothesis: A triad approach consisting of interventions at the practice provider at patient level could improve anticoagulation rates in patients with atrial fibrillation. Methods: In collaboration with the Heart Rhythm Society Quality Improvement Committee and UMass, University of Florida (UFL) Jacksonville launched a 2020 quality improvement (QI) intervention, including several Plan-Do-Study-Act (PDSA) cycles, centered around an outpatient, electronic health record (EHR) alert linked to an order set for AC meds, labs, and specialty referrals. The alert fired when cardiologists or primary care physicians saw AF patients in clinic with a CHA2DS2-VASc score of ≥2 who were not on AC. Due to COVID-19, several of the PDSA interventions required adjustments due to redeployment of information technology staff mobilized to generate COVID-19 reports, a pivot for clinicians and patients to telehealth visits, and a change in clinician and patient priorities from routine cardiovascular/preventive care to COVID-19 diagnosis and prevention. To assess intervention effectiveness, the change in AC use as a function of time was measured using a weighted least squares linear regression. Results: At time of launch, 2357 of 3555 eligible patients (56.3%) were on AC. At study end, six months later, the percentage of patients on AC increased by 1.5% to 57.8 %. Based on the population of untreated patients at UFL and the stroke rate for untreated patients (available from large registry data), and assuming absence of any competing/secular trend to explain the growth in AC use, we calculated that a 1.5% increase in the AC treatment percentage could result in the prevention of 1.5 strokes over one year. Conclusion: We demonstrated that an EHR alert can raise the rate of AC use in patients with AF after several rounds of PDSAs. In future efforts, we plan to reassess the AC percentage in our population and confirm the sustainability of our QI efforts as attention focuses back from the pandemic to routine cardiovascular/ preventive care.

COVID-19 Highlights the Need for Inclusive Responses to Public Health Emergencies in Africa

WATERLIT Abstract: COVID-19 is a global public health emergency affecting many countries around the world. Although African governments and other stakeholders are making efforts to contain the pandemic, the outbreak continues to impact human rights and exacerbates inequalities and disparities that are already in existence. The concept of inclusive health focuses on good health and well-being for everyone, and this entails health services that are equitable, affordable, and efficacious. Creating equitable access to mainstream health and healthcare services and ensuring inclusive health responses remain a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive responses to public health emergencies in Africa using COVID-19 as a case example. Africa's response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important to strategize to address their particular needs in such a way to surmount any barrier to the right to health. For Africa's public health response to be more inclusive, we therefore need to be more strategic and proactive in reaching out to specific groups and to identify and address their needs. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies