Reconceptualizing principal well-being: state, measurement and consequences

PurposePrincipals' well-being worldwide is under increasing threat due to the challenging and complex nature of their work and growing demands. This paper aimed at developing and validating a multidimensional Principal Well-being Inventory (PWI) and examining the state and consequences of principal well-being.Design/methodology/approachThis paper involves four independent samples of principals working in schools from Hong Kong and Mainland China. The research design consisted of four phases with four sequential empirical studies. Phase 1 was to establish the content validity (literature review and Study 1);Phase 2 was to test the construct validity (Study 2 and Study 3);Phase 3 was to build the criterion validity (re-use the data from Study 3) and Phase 4 was to test the cross-validity of the PWI (Study 4).FindingsBased on published literature and four successive empirical studies, a 24-item PWI was created via a theoretical-empirical approach of test construction. Validity was confirmed through construct-, content-, criterion- and cross-validity testing. The PWI covers the six important well-being dimensions - physical, cognitive, emotional, psychological, social and spiritual - to present a general picture of principals' occupational well-being associated with job nature, well-being literacy, leadership and context.Research limitations/implicationsThe inventory will aid efforts to promote principal well-being as an essential component of schoolwide well-being, quality education and a wellness society.Practical implicationsDuring the post-COVID-19 period, this project is deemed both critical and timely so that quality education will not be sacrificed due to factors affecting principal well-being.Originality/valueThis theoretically and empirically validated inventory serves as a robust tool for comprehensively understanding principal well-being and a fuller exploration of their well-being literacy, drivers and outcomes.

Pims-Ts Mdt - Where Do We Go from Here?

Introduction/Background: Following first reports of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) in April 2020, services have rapidly been developed to manage these patients. In our tertiary paediatric rheumatology service a daily virtual PIMS-TS multidisciplinary (MDT) team meeting was set up in January 2021. This meeting facilitates discussions between the tertiary centre (routinely including paediatric rheumatology and infectious diseases/immunology teams) and general paediatric teams in district general hospitals (DGHs) and within our centre. The aim of this project was to evaluate the service and understand general paediatric opinion in order to consider the future direction of the meeting. Description/Method: We looked at a one month period after meetings were initiated and compared it with a one month period a year later (February 2021 and February 2022) to define patient numbers and outcomes. Alongside this we constructed an online survey aimed at general paediatricians to determine opinion of the current structure of the MDT and how it may be developed in the future. The survey was sent to general paediatricians within our own centre and in the eleven DGHs falling within our region. Results were analysed descriptively. Discussion/Results: During February 2021, 19 new referrals were discussed within the PIMS-TS MDT;each referral was discussed for a median of 5 days (interquartile range (IQR) 3-6 days). Of these, 11/19 (58%) had a final primary diagnosis of PIMS-TS and 5/19 (26%) patients were transferred for tertiary care (of whom 4/5 (80%) had PIMS-TS). In February 2022, 14 new referrals were discussed for a median of 2.5 days (IQR 2-5.75 days). Of these, 3/14 (21%) had a final diagnosis of PIMS-TS and 2/14 (14%) were transferred for tertiary care (of whom neither had PIMS-TS). We received responses from 20 general paediatricians covering 9/11 (82%) DGHs within our region plus our own centre. Most clinicians had discussed up to 6 patients in the meeting (9/20 (45%) 1-3 patients;9/20 (45%) 4-6 patients;2/20 (10%) >6 patients). All clinicians felt the MDT helped facilitate appropriate diagnostic work-up and treatment decisions. 18/20 (90%) felt that the meeting helped avoid unnecessary tertiary paediatric transfers. Interestingly, 9/20 (45%) felt that a routine PIMS-TS MDT meant they were more likely to discuss a patient with rheumatology (1/20 (5%) less likely). All clinicians felt the meeting improved care for patients and most felt it increased their confidence in looking after patients with PIMS-TS (19/20, 95%) and was useful for continuing professional development/training experience (19/20, 95%). Considering the future direction of the meeting, all clinicians felt it should be continued but most (16/20, 80%) felt it should be aimed at a wider patient group. 11/20 (55%) felt a later time of day would be more convenient (currently 11am). Over half (11/20, 55%) thought it should be combined with a currently separate meeting for acute COVID-19 patients (7/20 (35%) don't know;2/20 (10%) no). A minority (4/20, 20%) reported difficulty accessing the meeting. Key learning points/Conclusion: As the initial phase of the pandemic draws to a close and numbers of PIMS-TS cases decline this is important data to reflect on how services can go forward into the next phase. While numbers of PIMS-TS cases reduced, the meeting was still wellused and evolved to include patients with other diagnoses. The survey confirms that most general paediatricians believe it improves patient care and would like the meeting to continue but that review of the format may be helpful. Particular considerations are to broaden the scope of the meeting beyond PIMS-TS, revise the timing and consider how to improve ease of access to the meeting for all. Further work will focus on evaluating patient numbers and diagnoses over the full period of the PIMS-TS MDT and adapting the format of the current MDT in response to the feedback received.

PIMS-TS MDT – where do we go from here?

Introduction/Background: Following first reports of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) in April 2020, services have rapidly been developed to manage these patients. In our tertiary paediatric rheumatology service a daily virtual PIMS-TS multidisciplinary (MDT) team meeting was set up in January 2021. This meeting facilitates discussions between the tertiary centre (routinely including paediatric rheumatology and infectious diseases/immunology teams) and general paediatric teams in district general hospitals (DGHs) and within our centre. The aim of this project was to evaluate the service and understand general paediatric opinion in order to consider the future direction of the meeting. Description/Method: We looked at a one month period after meetings were initiated and compared it with a one month period a year later (February 2021 and February 2022) to define patient numbers and outcomes. Alongside this we constructed an online survey aimed at general paediatricians to determine opinion of the current structure of the MDT and how it may be developed in the future. The survey was sent to general paediatricians within our own centre and in the eleven DGHs falling within our region. Results were analysed descriptively. Discussion/Results: During February 2021, 19 new referrals were discussed within the PIMS-TS MDT;each referral was discussed for a median of 5 days (interquartile range (IQR) 3–6 days). Of these, 11/19 (58%) had a final primary diagnosis of PIMS-TS and 5/19 (26%) patients were transferred for tertiary care (of whom 4/5 (80%) had PIMS-TS). In February 2022, 14 new referrals were discussed for a median of 2.5 days (IQR 2–5.75 days). Of these, 3/14 (21%) had a final diagnosis of PIMS-TS and 2/14 (14%) were transferred for tertiary care (of whom neither had PIMS-TS).We received responses from 20 general paediatricians covering 9/11 (82%) DGHs within our region plus our own centre. Most clinicians had discussed up to 6 patients in the meeting (9/20 (45%) 1-3 patients;9/20 (45%) 4-6 patients;2/20 (10%) >6 patients). All clinicians felt the MDT helped facilitate appropriate diagnostic work-up and treatment decisions. 18/20 (90%) felt that the meeting helped avoid unnecessary tertiary paediatric transfers. Interestingly, 9/20 (45%) felt that a routine PIMS-TS MDT meant they were more likely to discuss a patient with rheumatology (1/20 (5%) less likely). All clinicians felt the meeting improved care for patients and most felt it increased their confidence in looking after patients with PIMS-TS (19/20, 95%) and was useful for continuing professional development/training experience (19/20, 95%).Considering the future direction of the meeting, all clinicians felt it should be continued but most (16/20, 80%) felt it should be aimed at a wider patient group. 11/20 (55%) felt a later time of day would be more convenient (currently 11am). Over half (11/20, 55%) thought it should be combined with a currently separate meeting for acute COVID-19 patients (7/20 (35%) don’t know;2/20 (10%) no). A minority (4/20, 20%) reported difficulty accessing the meeting. Key learning points/Conclusion: As the initial phase of the pandemic draws to a close and numbers of PIMS-TS cases decline this is important data to reflect on how services can go forward into the next phase. While numbers of PIMS-TS cases reduced, the meeting was still well-used and evolved to include patients with other diagnoses. The survey confirms that most general paediatricians believe it improves patient care and would like the meeting to continue but that review of the format may be helpful. Particular considerations are to broaden the scope of the meeting beyond PIMS-TS, revise the timing and consider how to improve ease of access to the meeting for all.Further work will focus on evaluating patient numbers and diagnoses over the full period of the PIMS-TS MDT and adapting the format of the current MDT in response to the feedback received.

Recall intervals for periodontal health in primary care patients

Background & Aim: There is ongoing international debate about the optimal frequency of dental check-ups and the effects of different recall intervals on periodontal health. Recommendations vary between countries but six-month dental check-ups have traditionally been advocated by clinicians in many high-income countries.The aim of this systematic review was to determine the optimal recall interval for maintaining periodontal health in a primary care setting. Methods: Cochrane Oral Health methods were followed. Randomized controlled trials assessing the effects of different dental recall intervals in a primary care setting were included. Two authors screened search results, extracted data and assessed risk of bias. The certainty of the evidence was assessed using GRADE. Results: Two studies were included with data from a total of 1736 participants. The main outcomes considered were: percentage of sites with gingival bleeding, mean periodontal probing depths and oralhealth- related quality of life (OHRQoL) measured using Oral Health Impact Profile-14 (OHIP-14). This review found high-certainty evidence of little to no difference between risk-based and 6-month recall intervals after four years for the outcomes: gingival bleeding (MD 0.78%, 95% CI -1.17% to 2.73%);periodontal disease (MD 0.03 mm, 95% CI -0.01 to 0.07) and OHRQoL (MD -0.35, 95% CI -1.02 to 0.32). There is high-certainty evidence of little to no difference between risk-based and 24-month recall intervals after four years for gingival bleeding (MD -0.07%, 95% CI -4.10% to 3.96%);periodontal disease (MD 0.10 mm, 95% CI 0.01 to 0.19) and OHRQoL (MD -0.37, 95% CI -1.69 to 0.95). Conclusions: The results of this systematic review affirm that dentists can accurately assess patients' risk of periodontal disease and allocate appropriate risk-based recall intervals. This research is valuable when considering the impact of the COVID-19 pandemic on dental services and provides reassurance those intervals between check-ups can be extended beyond six months without detriment to periodontal health.

Patient and provider satisfaction with telemedicine in otolaryngology

Introduction: The year 2020 has been marked by the COVID- 19 pandemic, creating a worldwide public health emergency, resulting in otolaryngologists adopting telemedicine to facilitate access to care. The objective of this study is to evaluate patient and provider satisfaction with telemedicine encounters across 3 otolaryngology practices. Method: A telephone-based, cross-sectional survey of patients undergoing telemedicine encounters for routine otolaryngology appointments was performed between April and July 2020. Patients were asked about their satisfaction, the factors affecting care, and demographic information. A provider survey was emailed to staff otolaryngologists. The survey asked about satisfaction, concerns for reimbursement or liability, encounters best suited for telemedicine, and demographic information. The results were analyzed with descriptive statistics and a multivariable logistic linear regression model to determine odds ratios. Results: A total of 325 patients were surveyed, demonstrating high satisfaction with telemedicine (average score, 4.49 of 5 [best possible answer]). Patients perceived “no negative impact” or “minor negative impact” on the encounter due to the lack of a physical examination or face-to-face interaction (1.86 and 1.95 of 5, respectively). High satisfaction was consistent across groups for distance to travel, age, and reason for referral. A total of 25 providers were surveyed, with an average satisfaction score of 3.44 of 5. Providers reported “slight” to “somewhat” concern about reimbursement (40%) and liability (32%). Conclusion: Given patients' and providers' levels of satisfaction, there is likely a role for telemedicine in otolaryngology practice that may benefit patient care independent of the COVID-19 pandemic.

Characteristics and transmission dynamics of COVID-19 in healthcare workers at a London teaching hospital.

BACKGROUND: Healthcare worker (HCW)-associated coronavirus disease 2019 (COVID-19) is of global concern due to the potential for nosocomial spread and depletion of staff numbers. However, the literature on transmission routes and risk factors for COVID-19 in HCWs is limited. AIM: To examine the characteristics and transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HCWs in a university teaching hospital in London, UK. METHODS: Staff records and virology testing results were combined to identify staff sickness and COVID-19 rates from March to April 2020. Comparisons were made with staff professional groups, department of work, and ethnicity. FINDINGS: COVID-19 rates in our HCWs largely rose and declined in parallel with the number of community cases. White and non-White ethnic groups among our HCWs had similar rates of infection. Clinical staff had a higher rate of laboratory-confirmed COVID-19 than non-clinical staff, but total sickness rates were similar. Doctors had the highest rate of infection, but took the fewest sickness days. Critical care had lower rates than the emergency department (ED), but rates in the ED declined when all staff were advised to use personal protective equipment (PPE). CONCLUSION: Sustained transmission of SARS-CoV-2 among our hospital staff did not occur, beyond the community outbreak, even in the absence of strict infection control measures in non-clinical areas. Current PPE appears to be effective when used appropriately. Our findings emphasize the importance of testing both clinical and non-clinical staff groups during a pandemic.