Outcomes Research on Telemedicine-Delivered Gender-Affirming Health Care for Transgender Youth Is Needed Now: A Call to Action.

This article is a call to action for outcomes research on telemedicine-delivered gender-affirming health care (GAH) for transgender youth. Transgender youth, especially rural youth, are severely underserved and face many obstacles to GAH. Telemedicine reduces access barriers for underserved populations, but telemedicine for this population can be complex. Our literature search identified only five studies exploring the use of telemedicine for GAH for transgender youth. Coronavirus disease 2019 (COVID-19)-related regulatory and reimbursement changes for telemedicine may have increased transgender youths' access to such care. Research is urgently needed to increase understanding regarding access, satisfaction, safety, and health-related outcomes of telemedicine-delivered GAH for transgender youth.

National census of UK endoscopy services 2021.

Introduction: The Joint Advisory Group on Gastrointestinal (GI) Endoscopy (JAG) biennial census provides a unique view of UK endoscopy. The 2021 census was conducted to understand the impact of ongoing pressures, highlighted in the previous census, as well as COVID-19. Methods: The census was sent to all JAG-registered services in April 2021. Data were analysed across the domains of activity, waiting time targets, workforce, COVID-19, safety, GI bleeding, anaesthetic support, equipment and decontamination. Statistical methods were used to determine associations between domain-specific outcome variables and core demographic data. Results: 321 services completed the census (79.2% response rate). In the first 3 months of 2021, 57.9% of NHS services met urgent cancer waits, 17.9% met routine waits and 13.4% met surveillance waits. Workforce redeployment was the predominant reason cited for not meeting targets. There were significant regional differences in the proportion of patients waiting 6 or more weeks (p=0.001). During the pandemic, 64.8% of NHS services had staff redeployed and there was a mean sickness rate of 8.5%. Services were, on average, at 79.3% activity compared with 2 years ago. JAG-accredited services are more likely to meet urgent cancer waits, with a lower proportion of patient waiting 6 weeks or more (p=0.03). Over 10% of services stated that equipment shortage interfered with service delivery. Conclusions: Services are adapting to continued pressure and there are signs of a focused response to demand at a time of ongoing uncertainty. This census' findings will inform ongoing guidance from JAG and relevant stakeholders.

Attitudes towards COVID-19 mitigation measures implemented at St Mark's Bowel Cancer Screening Centre: a cross-sectional analysis of survey data from an ethnically diverse region in London

Background Negative attitudes towards, and experiences with, health services can negatively affect attendance at diagnostic investigation. Since services resumed in June, 2020 (ie, following the first months of the COVID-19 pandemic), several new procedures to reduce COVID-19 transmission have been implemented, but the extent to which these measures are acceptable to patients has not yet been examined. We aimed to assess patient attitudes towards the measures implemented within St Mark's Bowel Cancer Screening Centre, St Mark's Hospital, Harrow, UK. Methods We surveyed patients who underwent colonoscopy after their procedure and asked a series of questions using the five-point Likert scales. Factor analysis was used to group questions into mutually exclusive groups, with three factors were subsequently identified: attitudes towards measures to reduce hospital-based COVID-19 transmission (factor 1;five items), attitudes towards precolonoscopy COVID-19 swabbing (factor 2;two items), and attitudes towards protective clothing (factor 3;two items). Scales ranged from five to 25 for factor 1 and two to ten for factors 2 and 3 (with higher scores representing more positive attitudes). Descriptive statistics were used to calculate means, whereas linear regression was used to test associations between participant demographics, COVID-19 anxiety, and bowel cancer anxiety with attitudinal factors. Participation in the study was voluntary and consent was obtained from all participants. Findings Of the 408 patients invited, 288 patients (71%) who underwent colonoscopy between July 1, 2020, and May 1, 2021, were surveyed. Participants were predominantly men (n=182;63%) and of White (n=167;58%) or South Asian ethnicity (n=59;20%;the mean age of all participants was 66·52 years [SD 5·29]). The mean score was 23·12 for factor 1, 7·60 for factor 2, and 8·15 for factor 3. South Asian adults were less positive towards measures to reduce COVID-19 transmission (factor 1;23·04) than White adults (23·18;β coefficient 0·31;p=0·035). COVID-19 anxiety was the only predictor of attitudes towards protective clothing (factor 3), with higher COVID-19 anxiety being associated with more positive attitudes towards protective clothing (0·25;p=0·037). Interpretation Attitudes towards COVID-19 prevention measures were highly positive. Future service evaluation should focus on reassuring South Asian patients of measures to reduce hospital-related infection (eg, through information provision). South Asian patients are more likely to be diagnosed at a later stage, so reducing barriers to diagnosis to prevent COVID-19 from widening inequalities in cancer even further is imperative. Funding This study was funded by St Mark's Bowel Cancer Screening Centre. RSK is supported by a Cancer Research UK Population Research Fellowship (C68512/A28209).

Patient reported anxiety, before and after colonoscopy, during the COVID-19 pandemic

IntroductionAt the start of the covid-19 pandemic, many invasive diagnostic tests had to be stopped to avoid patients catching covid-19 as a result of attending hospital. Several procedures to reduce COVID transmission have been implemented as services resumed (e.g. COVID testing). Despite this, some patients may still experience what is now called ‘COVID anxiety’. The aim of this study was to monitor satisfaction with covid mitigation measures and anxiety among patients attending colonoscopy following an abnormal screening result.MethodsWe surveyed patients who were invited for colonoscopy at St Mark’s Hospital between July 2020 and May 2021. Data on anxiety and worry were collected, 3 days before and after colonoscopy;scales ranged from 6-24 for general anxiety, 0-20 for COVID-anxiety and 1-4 for bowel cancer worry (with higher scores representing greater anxiety for all three measures). Descriptive statistics were used to assess mean pre- and post-procedure anxiety scores. Inferential statistics were used to test for differences in anxiety, before and after colonoscopy. All analyses were performed using SPSS (Ver 27.0).Results205 patients (mean age 67 years;114 males, 91 females;121 White, 55, South Asian, 27 any other ethnicity;142 English first language speakers) completed the pre-procedure questionnaire and were enrolled into the study. 89 (43.4%) completed the post-procedure questionnaire and were analysed.Pre- procedure, mean general anxiety, COVID-anxiety, and bowel cancer worry scores were 10.94, 0.93 and 1.95, respectively. Post-procedure, the general anxiety, COVID-anxiety and bowel cancer worry scores were 8.92, 1.03 and 2.11, respectively. The change in general anxiety (-2.02) was statistically significant (p=0.015), while the changes in COVID anxiety (+0.1) and bowel cancer worry (+0.16) were not (both ps<0.05).Significant reductions in general anxiety were observed for women (pre- and post-procedure general anxiety scores were: 13.05 vs. 8.33, respectively;p<0.001), White British adults (pre- and post-procedure general anxiety scores were: 11.47 and 8.90, respectively;p<0.001) and adults whose first language was English (pre- and post-procedure general anxiety scores were: 11.49 and 9.08, respectively;p<0.001).The majority of patients were highly satisfied with the covid-measures put in place. There was no association between satisfaction and changes in COVID Anxiety (p<0.05).ConclusionsCOVID anxiety was low among people who attended colonoscopy. General anxiety, however, was moderate, although it was reduced following the procedure. General anxiety was not reduced for some groups, including those whose first language is not English, highlighting the need for further research into factors affecting experience in these groups.

Teamworking in endoscopy: a human factors toolkit for the COVID-19 era.

BACKGROUND: Endoscopy services have had to rapidly adapt their working practices in response to COVID-19. As recovery of endoscopy services proceeds, our workforce faces numerous challenges that can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic. METHODS: A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals, which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a 6-week period. RESULTS: The toolkit consists of four cognitive aids that can be used to support team huddles, briefings, and debriefs, alongside techniques to optimize endoscopic nontechnical skills across the patient-procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit. CONCLUSION: A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.