Quantifying caregiver workload during the COVID-19 pandemic using ambient intelligence

Introduction: The COVID-19 pandemic has increased caregiver workload [1]. It is unclear how this workload is distributed across patients with varying presentations. Ambient intelligence (AmI) utilizes neural networks to monitor multiple data points in video feeds, and automatically tracks various aspects of human movement [2]. AmI was used to examine the workload of healthcare staff in relation to temporal and patient characteristics on a COVID ward at a major metropolitan hospital. Method(s): Sensors were deployed in patient rooms on a COVID ward to detect caregiver visits at 5-min intervals. Electronic medical records were used to identify variables hypothesized to contribute to visits. Result(s): 5514 h across 55 patients (mean age 72, range 17-98) were analyzed. The primary reason for admission was medical in 45 cases (81.8%), psychiatric in 8 cases (14.5%) and surgical in 2 cases (3.6%). Medical emergency (MET) calls occurred in 21 (38.2%) cases. As summarized in Fig. 1, visitation was lowest between 0000 and 0400 (27.3 +/- 1.1 min/hour (min/hr)) and highest between 1200 and 1600 (65.5 +/- 1.3 min/hr). The mean +/- SE visitation spent with medical, psychiatric, and surgical patients was 51.7 +/- 0.6, 38.8 +/- 1.3, and 33.7 +/- 3.9 min/hr respectively (p < 0.005). Overall lowest visitation was in surgical patients between 0400 and 0800 (4.5 +/- 4.5 min/hr). Mean +/- SE visitation were 66.7 +/- 4.6 min/hr in the three hours preceding and following MET calls compared to 50.2 +/- 0.5 min/hr in periods without MET calls (p < 0.005). There was no difference in visitation time between patients with respiratory symptoms and those without (50.7 +/- 0.9 vs 48.8 +/- 0.7 min/hr, p = 0.1). Conclusion(s): AmI can help quantify patient workload, potentially improving staff planning. Further studies comparing healthcare attendance between patients on COVID wards and non-COVID wards may provide insight into the impact of unique factors associated with the pandemic.

Going viral: A science communication collaboration in the era of COVID-19 and social media

On 9 March 2020, 2 days before the World Health Organization declared COVID-19 a global pandemic, two of the authors (microbiologist and infectious diseases expert Associate Professor Siouxsie Wiles and cartoonist Toby Morris) released their first output together: an animated GIF (Graphics Interchange Format) known as "Flatten the Curve”. The graphic went viral on Twitter with over 10 million impressions in 3 days. Flatten the Curve was the first of more than 70 graphics produced by our collaboration, all designed as accessible visual communication about COVID-19. The graphics, all released under a Creative Commons CC-BY-SA-4.0 license, have been translated into multiple languages, used by communities, politicians, and public health officials around the world, and the collaborators have won multiple awards for their work. Copyright © 2023 Wiles, Morris and Priestley.

The Dementia Engagement Modelling Program (DEMP): a novel Australian model of care for aged care residents affected by COVID-19

Like other countries, aged care homes in Australia have been significantly affected by the COVID-19 pandemic. To ensure the safety of residents and staff, lockdown, and social restrictions (e.g., limited or no visits from family) have been introduced across Australia. These measures caused tremendous emotional, psychological, and physical burdens on residents, particularly those living with dementia. In response to the pandemic, the Australian Government has funded the Aged Care COVID-19 Grief and Trauma support package for older people receiving aged care, their families, and aged care staff. Part of this package is the Dementia Engagement Modelling Program (DEMP), a free national support program developed by Dementia Support Australia, HammondCare to help staff support residents whose wellbeing have been affected by COVID-19 with tailored engagement strategies. The program represents a first line multimodal support for people living with dementia in residential aged care who may have experienced withdrawal, frustration, or fear and at a greater risk of developing behaviors and psychological symptoms of dementia (BPSD), such as apathy, anxiety, and depression. Through a multidisciplinary team of dedicated consultants, the program delivers best practice, person-centered engagement strategies to support staff, providing meaningful engagement, comfort, and reassurance to residents living with dementia. DEMP consultants work collaboratively and closely with lifestyle and care staff to develop tailored activities and provide appropriate resources (e.g., brokerage items such as music therapy) for engagement. DEMP will also provide support and coaching to staff for the individual or small groups to ensure that both staff and residents gain the full benefit from the program. The eligibility criteria for DEMP support include aged care homes that: 1) experienced an outbreak of COVID-19 or those subject to a precautionary lockdown, and/or 2) sought engagement plans and strategies for residents living with dementia, or those at risk of developing BPSD due to COVID-19 restrictions. This descriptive study will discuss the DEMP's model of care, eligibility criteria, activities, and outcomes and provide case examples that can guide meaningful engagement for other aged care residents living in other countries during COVID-19.

Characteristics and Outcomes of Patients with Severe Eosinophilic Asthma Treated with Benralizumab Enrolled in the Connect 360 Patient Support Programme

RATIONALE: Around 4.6 million people in the United Kingdom (UK) have asthma, with an estimated 5.7% treated for severe asthma. Benralizumab is indicated for the treatment of severe eosinophilic asthma (SEA) in adults inadequately controlled despite appropriate maintenance therapy. The Connect 360 Patient Support Programme (PSP) for patients on benralizumab includes options for home-based drug administration, education and adherence support by trained nurses - of particular relevance during the COVID-19 pandemic. Limited evidence exists on the benefit of PSPs for asthma patients or those administering biological therapies at home. This study aims to describe patient characteristics, key outcomes and experience with the PSP using UK data from Connect 360. METHODS: A non-interventional, retrospective cohort study of patients, enrolled in the PSP (Oct-2019 onwards) and consenting to the use of personal data for research purposes (“study cohort”). Patients opting for additional support services with at least one nurse interaction within described study timeframes formed the clinical cohort. Patients were observed up to 48 weeks post-PSP enrolment (interim data taken on 31-Mar-2021;data collection ongoing) with study endpoints assessed at baseline (0-4 weeks), 24 (±4) weeks and 48 (±8) weeks post-PSP enrolment. Characteristics at enrolment are described for the study cohort. Patient-reported clinical outcomes (hospitalisations, maintenance oral corticosteroid [mOCS] use, Asthma Control Questionnaire [ACQ-6] scores) and service satisfaction (1-5 point scale, 5 being most satisfied) were analysed where available from routine PSP nurse calls/visits. Analysis was descriptive;Kaplan-Meier estimators were used to estimate PSP discontinuation rates. RESULTS: The study cohort was 611 patients (mean enrolment age: 54.1 years, 63.2% female [N=323]). Most (98.9%) were benralizumab users on maintenance dosing (8-weekly) at enrolment. The clinical cohort consisted of 149 (baseline), 175 (24 weeks) and 195 (48 weeks) patients. PSP discontinuation rates were 4.4% and 11.6% at 24 and 48 weeks. Proportion of patients reporting mOCS use was 49.7%, 44.0% and 32.8% at each timepoint and hospitalizations were 10.9% and 4.1% at 24 and 48 weeks. Mean ACQ-6 scores decreased over time. Mean (SD) satisfaction scores were 4.6 (0.7) and 4.8 (0.5) at 24 and 48 weeks, respectively. (Table 1). CONCLUSIONS: Overall patients' experience with the PSP was positive, evidenced by high satisfaction with and persistence to the PSP. Where data were available, proportion of patients reporting mOCS and hospitalizations at 48 weeks were numerically lower than previous timepoints and mean ACQ-6 scores improved, suggesting a positive impact of benralizumab treatment within the PSP.

POS-894 PREDICTING PANDEMIC-RELATED EXCESS-DEATH USING PRE-PANDEMIC RISK OF MORTALITY IN INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

Introduction: Chronic Kidney Disease (CKD) is a global burden on public health, both as a risk factor for mortality, and as the end syndrome of underlying diseases. CKD is a common comorbidity associated with increased risk of severe coronavirus infection and poor clinical outcomes. The pandemic has had both direct (through infection) and indirect impact. The direct impact on individuals with CKD and other underlying conditions is related to baseline risk, influenced by age, multimorbidity and other socio-demographic factors. However, previous studies of COVID-19 in CKD have been small scale (12-1099 cases), mostly focused on end-stage CKD, and ignored major comorbidities. Thus, using large-scale, population-based electronic health records, in people with incident CKD we aimed to (a) identify the most common comorbidities;(b) estimate 1-year (pre-pandemic) risk of mortality and (c) predict excess deaths related to COVID-19 over 1-year of pandemic based on pre-pandemic risk of mortality at different population infection rates and relative risks. Methods: We used linked primary and secondary care records (Clinical Practice Research Datalink GOLD data) from England;of 3,862,012 individuals aged ≥ 30 registered with a GP practice between 1997 and 2017. Incident CKD was identified based on diagnosis codes and eGFR levels;classified mutually exclusively into five CKD Stages. The underlying conditions were obtained using validated phenotyping algorithms in CALIBER and the most prevalent ones were identified. The 1-year mortality were estimated using Kaplan–Meier survival analysis;stratified by key demographic factors and number of comorbidities. Using these pre-pandemic risk estimates and our recently published Lancet model, we calculated excess COVID-19 related deaths at different population infection rates and relative risks. For validation, we identified the number of people who died with both CKD and positive COVID-19 test result during 1-year of pandemic using the contemporary NHSD TRE data of England (NHS Digital Trusted Research Environment, n=54 million). Results: We identified 294,381 individuals with incident CKD (mean age 72.5 years;female: 59%). Multimorbidity was common among CKD patients especially the presence of hypertension (61.4%) and CVD complications (35.6%) (Fig 1 ). The proportion of CKD patients having at least one underlying condition increases significantly either by age or CKD stage whilst age was the main confounder within each CKD stage. Age, Stage of CKD and underlying conditions combined to influence pre-pandemic risk (Fig 2 ). At an IR of 10%, we predicted 31003 and 46505 excess deaths at RR of 2 and 3 respectively (Table 1 ) which is close to actual observed mortality (47214) from the NHSD TREin England. [Formula presented] [Formula presented] [Formula presented] Conclusions: Individuals with CKD have high risk of pre-pandemic mortality particularly those with comorbidities. The data on multimorbidity, CKD stage and age together could help prioritise patients for vaccination, post-COVID policy, and designing stratified pathways for CKD patients. We illustrate that the direct burden of pandemic could be predicted using pre-pandemic large scale EHR data. Conflict of interest Potential conflict of interest: This study was funded by AstraZeneca and Health Data Research UK. AB has received research grants from AstraZeneca. JBM and TM are employed full-time by AstraZeneca UK Ltd, a biopharmaceutical company who develops, manufactures and markets medicines in the cardiovascular, renal and metabolic disease area.

Meeting educational challenges of pre- and post-COVID-19 conditions through self-directed learning: considering the contextual quality of educational experience necessary

Purpose: Fostering the skills necessary for self-directed learning (SDL) competence could be considered the most essential goal of formal education, especially due to uncertainty and changing conditions – exampled by the COVID-19 pandemic. Importantly, SDL competence can afford a person the ability to adapt to changing social contextual conditions, thus facilitating personal growth and development – even in the face of volatile and rapidly changing social contextual conditions. The aim of this study is to explore, theoretically, the contextual quality of educational experience necessary for learners to secure adaptive meaning-making: in order to meet the demands of our changing world. Design/methodology/approach: To date, research has failed to comprehensively identify exactly what type of educational experience is necessary for such an adaptive meaning-making process during SDL. The present theoretical paper attempts to redress this concern. Findings: Highly contextualized educational experience is necessary to enable contextual-specific, adaptable, meaning-making. Two constituents of contextualized educational experience are proposed: contextual-specific information available during the educational experience;and contextual-specific meaning schemes resultant from the educational process. Originality/value: This novel work presents an important argument that education should encourage learners to construct knowledge that is adaptable and transferable to their context, rather than automatized knowledge that is not adaptable or transferable. This is a key concern for persons who face rapidly changing social contextual conditions and therefore should be given consideration in both the design of education and in further research on SDL. Like a vaccine in an arm provides a certain protection against COVID-19, fostering our populations’ SDL competence is fundamental for affording persons with an ability to meet the demands of our rapidly changing world. © 2021, Emerald Publishing Limited.

Supporting Caregivers During COVID-19: Transforming Compassionate Care From a Way of Doing to Being

The expectation by colleagues that fellow clinicians deftly manage the stresses of practice often predisposes healthcare professionals involved in an adverse event to experience isolation, blame, and shame. The peer support model has since been recognized as an important component of institutional wellness and follows a well-described and structured method. Although peer support programs have traditionally been established to support caregivers involved in adverse medical events, the relevance and applicability of these programs have found substantial traction across broader crisis domains. Interventions, including peer support, help mitigate the 3 components of burnout: emotional exhaustion, depersonalization (cynicism), and reduced efficacy. Copyright © by the American Association of Nurse Anesthetists.