Psychological Impacts of the COVID-19 Pandemic

The COVID-19 pandemic has had sweeping effects that have disrupted almost every part of society worldwide. In this chapter, we discuss the psychological impacts of the COVID-19 pandemic. We begin with a review of psychological distress and psychiatric symptoms arising with the onset of the pandemic, focusing on the general population as well as specific groups such as children, students, parents, medical providers, essential workers, and disadvantaged populations, among others. We then evaluate the potential impact of the pandemic on suicide and how patterns of adverse psychiatric effects have varied over time. We also provide a comprehensive overview of both risk and protective factors for psychological distress and psychiatric disorders during the pandemic. After a discussion of psychiatric manifestations and sequelae reported in those affected by COVID-19, we conclude with an exploration of putative strategies to promote mental health in a world with COVID-19. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

USE OF TELEMEDICINE IN GENERAL PRACTICE IN EUROPE SINCE THE COVID-19 PANDEMIC: A SCOPING REVIEW OF PATIENT AND PRACTITIONER PERSPECTIVES

General practice is generally the first point of contact for patients presenting with COVID-19. Since the start of the COVID-19 pandemic general practitioners across Europe have had to adopt to using telemedicine consultations in order to minimise the number of social contacts made.(1). The aim of this study was to conduct a scoping review of the literature examining the use of telemedicine for delivering routine GP care since the start of the pandemic from the perspectives of patients and practitioners. We used the six-stage scoping review framework developed by Arksey and O'Malley (2). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 19 studies across nine countries were included in the review. Thirteen studies explored the practitioner perspective of the use of telemedicine in general practice since the COVID-19 pandemic, while six studies looked at the patient perspective. The types of studies included in this review were: qualitative studies, literature reviews, a systematic review, observational studies, quantitative studies, Critical incident technique study, and surveys employing both closed and open styled questions. Key themes identified related to the patient/ practitioner experience and knowledge of using telemedicine, patient/ practitioner levels of satisfaction, GP collaboration, nature of workload, and suitability of consultations for telemedicine. Our findings suggest a level of acceptability and satisfaction of telemedicine by GPs and patients during the pandemic;however, further research is warranted in this area.

Reducing Donor Acceptance Practice Variation- Learnings from a Discussion Forum

Purpose: Many acceptable donor hearts are turned down by pediatric centers with varying criteria for an acceptable donor. Advanced Cardiac Therapy Improving Outcome Network (ACTION) and Pediatric Heart Transplant Society (PHTS) centers convened a multi-institutional donor decision discussion forum (DDDF) aimed at assessing donor acceptance practice and reducing practice variation across centers. Methods: The team hosted an hour-long monthly virtual DDDF among pediatric transplant centers across North America, UK and Brazil. Each call had two case presentations posing a donor decision challenge for the presenting center at the time of donor offer. Following each presentation, the attendee group was polled to obtain insight on donor acceptance practices after which the presenting center's decision was revealed. Then, group discussion occurred including a review of relevant literature and latest PHTS data related to the case. Metrics of participation, participant agreement with presenting center decision and impact on future decision making were collected and analyzed. Results: Over 14 months, 23 cases were discussed;an average of 50 physicians, nurses and fellows attended each call. The mean donor age was 8.2 ± 3.3 years (28.6% infants, 52.4% young adults), and the mean recipient age was 8.36 ± 3.3 years (27.3% infants and 40.9% teenagers). Reason for listing was congenital heart disease in 10, cardiomyopathy in 5 and retransplantation in 3. Risk factors influencing decision making included size discrepancy (4), Infection (5), COVID (2), Prolonged QT (2), Malignancy (2), Drugs (2), Distance (1) Prolonged CPR (1) high inotrope use (1) Dialysis (1) Diabetes (1) HLA mismatch (1). Of the 23 cases, 15 were declined by presenting center. Donor characteristics influenced 45% of the decisions and recipient only 20%, with rest being other factors. Participants agreed with the decision made by the presenting center 55% of the times. The post-presentation discussion resulted in 30% of participants changing their original decision. Conclusion: DDDF identified significant variation in pediatric donor acceptance practices;with donor characteristics most influential in decision-making. Given that the discussions changed decisions in 1/3rd of the participants, DDDF may be a useful format to reduce practice variation, provide education to decision makers and eventually increase donor utilization.

How Did We Get Here? One District’s Approach to Device Assisted Learning Technology Implementation

The COVID-19 pandemic necessitated the importance of online and device-assisted learning. What was demonstrated at this time was how prepared districts were to make this transition. Lincoln Public Schools, in Lincoln, Nebraska, was one district that successfully planned and implemented device-assisted learning technology into their school system ahead of the pandemic. This study sought to better understand the process that district leadership enacted to inform practice on developing a technology plan and its implementation. The study's findings show that five key elements are required for successful replication: (a) shared goals, (b) right people and right-fit, (c) cross-communication, (d) implementation, and (e) growth and support. This article serves as a practitioner's guide to implementation as many districts across the country are still trying to figure out how best to serve their students and families. © 2021, Journal of School Administration Research and Development. All Rights Reserved.

Oncology clinical nurse specialist versatility: Ensuring a safer, continued day oncology environment throughout COVID

Background: The COVID pandemic has forced organisations to adapt to restrict spread of the virus while continuing to function. Oncology Clinical Nurse Specialists (CNS) have been forefront in these endeavours, often below the radar, ensuring coordination and administration of complex care. Nursing / Midwifery National Planning & Development Unit funding was awarded for a "task versatile" (tv) CNS in 2019 to focus on non ED direct access to a CNS. The key areas of this analysis were telephone triage and the ability of tvCNS COVID screening pre-chemotherapy visits to maintain a safe environment. Methods: Changes in primary roles of individual oncology CNS posts were recorded for 1/20 to 12/20. Data on the activity of the varied adaptive roles of the CNS were captured from the hospital information systems. All patients attending for chemotherapy were contacted 24 hours prior to their planned visit for chemotherapy to screen for COVID symptoms. Patients on arrival for chemotherapy were screened again prior to being allowed up to the chemotherapy unit. Those with concerning COVID symptoms were referred for COVID testing. Activity numbers were recorded by the tvCNS. Results: Nurse-lead telephone triage (NLTT) was assessed from 1/20 to 12/20. From the outbreak of COVID on 1/3/20 the "tv"CNS moved from the NLTT to that of COVID screening / risk reduction. A new CNS was appointed to continue NLTT. Of the 1837 telephone calls received requesting help from 1/20 to 12/20, 93% were resolved by the triage nurse, with only 121 cases attending the ER. In that time period 1304 individual patients made 11606 attendances to the oncology day unit for treatment. From 3/20 to 12/20 COVID pre-screening was performed for 10,417 patient visits. Screening was performed by phone the day before attendance, and on arrival on the day of planned treatment. 133 patients required COVID swab in view of symptoms. No day unit linked outbreaks of COVID occured. Conclusions: The COVID pandemic has demonstrated that versatility is essential in adjusting to the ever-changing scenarios which arise during peaks and troughs of COVID outbreaks. The broad skill mix within specialist oncology nursing were key to such adaptations, allowing continued availability of essential anti-cancer therapies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Maintaining intravenous anti-cancer systemic therapy during COVID: Pharmacy and nursing factors

Background: The COVID-19 pandemic has impacted many aspects of the practice of oncology around the world. COVID was first detected in Ireland on 29/2/20. Many oncology units saw dramatic changes in activity in the face of rising infection rates. We aim to assess compare pharmacy activity, day unit systemic therapy adminstration and nursing staffing levels during the pre- and COVID periods. Methods: Hospital information systems were used to retrieve numbers of patients attending, numbers and types of items dispensed by pharmacy, and available nurses to deliver the systemic therapies from March 2019 to Feb. 2021. The data was analysed to identify trends in prescribing and dispensing practices for this period. Supportive medications such as anti-emetics, bisphosphosphonates were not included. Subgroup analysis on numbers of chemotherapy, immunotherapy, monoclonal antibody drugs dispensed per month was performed. A paired t-test was used to compare means. Results: 9410 non-clinical trials and 411 clinical trials items were dispensed from March 2019 until February 2020 (pre-COVID) for 11,606 patient attendances. From March 2020 until February 2021 (COVID period), 8931 non-clinical trials and 826 clinical trials items were dispensed for 10818 patient attendances. The mean number of non-clinical trials items dispensed per month were 784 and 744 respectively, with no statistical difference being found (p=0.11). There was a doubling in the number of clinical trials agents dispensed. The mean number of nurses available to administer therapies per day was 5.7 (SD=0.78) compared to the projected 7.8 WTE (whole time equivalents) ideally required. [Formula presented] Conclusions: Despite COVID restrictions it was possible to administer comparable numbers of cancer treatments throughout the COVID period, when compared to the previous year despite modest nursing staff numbers due to the dedication and selflessness of nursing, oncologists and oncology pharmacy staff. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Analysis of disease severity and sex specific data among hospitalized covid19 patients

Rationale: It is critical to identify factors that contribute to disease severity among patients diagnosed with COVID-19. A recently published meta-analysis of over 3 million global admissions demonstrated that male patients have higher rates of ICU admission and mortality. This abstract details an investigation of the correlation between biological sex and predisposing conditions as well as COVID-19 disease severity among 1816 patients hospitalized within the St. Luke's Hospital Network in Eastern PA/Western NJ. Methods: Data were extracted from patients' electronic medical records both during their admission and after discharge. Chi-squared test of independence was performed to examine the relation between known COVID-19 risk factors and COVID-19 infected female patients (n=865) compared to male patients (n=951). The sample is comprised of 47.6% female participants and 52.4% male, of whom 23.5% identify as Hispanic or Latino, and 68.9% identified their race as Caucasian. The mean age of the participants is 66.0 years (+/- 17). Results: Risk factors stratified by biological sex showed that female patients with COVID were more likely to have asthma (p < 0.001) and male patients were more likely to have diabetes (p = 0.014). There was a statistically significant higher incidence of intubation (p < 0.001), tocilizumab administration (p < 0.001), and ICU admission (p < 0.001) among male patients. There was no statistically significant difference in disease severity between the sexes with respect to mortality, dialysis, and remdesivir administration.Conclusion: The results of this study show that male patients admitted within this hospital network have increased incidence of disease severity with regards to ICU admission, ventilation, and Tocilizumab administration, without an increase in 90 day all-cause mortality. Limitations of this study include small sample size, and ongoing treatment protocol modifications with provider treatment bias.