Overcoming adversity: Insights into an acute hospital service of supported viewing for families bereaved during the Covid-19 pandemic

The number of people bereaved due to the Covid-19 pandemic is a major health and social care concern. At a time of unprecedented demand on acute and critical care services, restricted family presence to reduce transmission of the disease had a profound impact on the way bereavement support could be provided in the hospital setting. In response, relatively rapid adaptions to practices were required. This paper provides inspiration and guidance on an acute hospital initiative designed to address the emotional needs of the immediately bereaved. The core features of a supported viewing service are presented through the lens of key employees who played a central role in its development and delivery, and with reference to the prevailing literature. Formal evaluation of the service through qualitative inquiry is recommended, complementary to anecdotal evidence of appreciative uptake of the service during the pandemic. © 2022, Cruse Bereavement Care. All rights reserved.

Traditional Cardiopulmonary Resuscitation In Cardiac Arrest For Patients On Venovenous Extracorporeal Membrane Oxygenation

Introduction: Mortality for patients on VV-ECMO remains high despite increased use during the COVID-19 pandemic. Unlike VA-ECMO which provides life support for cardiac failure and can be used as a bridge to definitive therapy during cardiac arrest (e-CPR), patients who arrest while on VV-ECMO currently may undergo traditional cardiopulmonary resuscitation (CPR). This poses many challenges such as potential cannula position disruption of the VV-ECMO system during compressions and it is unclear if patients on VV-ECMO will benefit from being offered traditional CPR. Hypothesis: Traditional CPR is effective in patients who arrest while on VV-ECMO. Method(s): A retrospective chart review of inpatient cardiac arrest data from a high-volume ECMO center was performed. Patients who arrested while on VV-ECMO were included. Data including demographics, etiology of arrest, return of spontaneous circulation (ROSC) and survival to discharge were reviewed. Survival data was compared with the ECLS International Summary of Statistics. Result(s): We identified 19 patients on VV-ECMO who underwent CPR for cardiac arrest between September 2012 and November 2021. The average age of the patients was 42.7 years and 89.5% (n=17) were men. Seven of the nineteen total patients (36.8%) were being treated for ARDS from COVID-19 pneumonia. The arrest occurred on average 35.6 days into hospitalization (range: 1-132 days). The initial rhythm was pulseless electrical activity in 13 patients (68.4%), and the etiologies of arrest included hypoxemia (n=10, 52.6%), ECMO machine failure or during oxygenator exchange (n=3, 15.8%), pneumothorax (n=2, 10.5%), and cardiac tamponade (n=1, 5.3%). ROSC occurred in all 19 patients (100%), however only 4 patients (21.1%) survived to discharge with good neurologic recovery. Survival to discharge for all-comers on VV-ECMO is 66%. Conclusion(s): While there is limited evidence for the effectiveness of traditional CPR for patients on VV-ECMO, in this sample, ROSC was universal and one-fifth of patients survived to discharge. Future studies should continue to study the utility of CPR on VV-ECMO and how to optimize technique to improve outcomes for these critically-ill patients.

From Physical to Virtual: Reflections on the Move from the Lecture Hall to the Digital Classroom

This chapter describes our reflections on the lived experiences during the rapid pivot to Emergency Remote Teaching (ERT) in March 2020. Drawing on the narratives of academics from two disciplines – Law and Psychology, we focus on the Continuing Professional Learning and Development (CPLD) offered in the immediate aftermath of the initial UK lockdown. We further describe the support available to staff as they scaffolded and supported students through the transition to online learning. Such students, although accustomed social digital users, were less skilled in digital learning, having chosen to study in-person within a physical campus-based institution. We conclude by making recommendations for sustainable training and development as we move towards the implementation of a blended learning experience for campus learners. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The Impact of COVID-19 on the Medical Student Emergency Department Clinical Experience

Learning Objective: Describe the impact of COVID-19 related restrictions in the clinical learning environment on the patients and chief complaints evaluated by students. Background(s): In March 2020, medical students across the nation were removed from the clinical learning environment in response to novel coronavirus. Upon returning, students found new precautions and restrictions around patient care to avoid exposure and curb PPE shortages. These restrictions often impacted which patients students could see, potentially changing their experience in comparison to students in typical years. Objective(s): With the restrictions placed on medical students on their return to the clinical learning environment, we anticipate that their experience would differ from students in the prior year. Specifically, we hypothesize that students would see fewer patients with respiratory or infectious symptoms as their presenting complaint. Method(s): Through a query of the electronic medical record, we obtained de-identified information for all patients seen in the Emergency Department at our large academic medical center for June 1 October 31 in 2019 and 2020, including age, chief complaint, and if the patient was seen by a medical student. Investigators categorized chief complaints into one of twelve categories and calculated the total number of student shifts during the study time period using the published student schedule. We calculated the average number of patients seen by students in each category per shift for 2019 and 2020. Result(s): In 2020, students saw on average fewer patients with respiratory, constitutional, and cardiac presenting complaints per shift. Students saw slightly fewer patients per shift overall in 2020 in comparison to 2019. Conclusion(s): Restrictions placed on medical students in the Emergency Department during the COVID-19 pandemic have had a significant impact the student clinical experience during their clerkships. Although the intent of these restrictions was to protect learners from the risks posed by caring for COVID patients, these restrictions had unintended consequences on which patients students evaluated.

Overcoming adversity: Insights into an acute hospital service of supported viewing for families bereaved during the Covid-19 pandemic

The number of people bereaved due to the Covid-19 pandemic is a major health and social care concern. At a time of unprecedented demand on acute and critical care services, restricted family presence to reduce transmission of the disease had a profound impact on the way bereavement support could be provided in the hospital setting. In response, relatively rapid adaptions to practices were required. This paper provides inspiration and guidance on an acute hospital initiative designed to address the emotional needs of the immediately bereaved. The core features of a supported viewing service are presented through the lens of key employees who played a central role in its development and delivery, and with reference to the prevailing literature. Formal evaluation of the service through qualitative inquiry is recommended, complementary to anecdotal evidence of appreciative uptake of the service during the pandemic.

The story of a model restorative school: creative response to conflict at MS 217 in Queens, NY

Purpose Restorative practice programs in the USA and Western elementary and secondary schools have been the focus of intensive, large scale field research that reports positive impacts on school climate, pro-social student behavior and aggressive behavior. This paper aims to contribute to a gap in the research by reporting a case study of transformation of an urban middle school in a multi-year implementation of restorative practices. Design/methodology/approach This paper reports how Creative Response to Conflict (CRC) supported the transformation of Middle School 217, in Queens, NY, from a school with one of the highest suspension rates in New York City to a model restorative school. CRC's model, which incorporates the themes of cooperation, communication, affirmation, conflict resolution, mediation, problem-solving, bias awareness, bullying prevention and intervention, social-emotional learning and restorative practices, helped shift the perspective and practice of the entire school community from punitive to restorative. Findings Implementation of a full school advisory program using restorative circles for all meetings and classes and development of a 100% respect program committing all school community members to dignified and respectful treatment aided the transformation. Key to MS 217's success was the collaboration of multiple non-profit organizations for provision of peer mediation training, after-school follow-up work, staff coaching and preventative cyberbullying training through the Social Media-tors! Program. Research limitations/implications Challenges to the restorative practices implementation are reviewed with attention to the implementation online during COVID-19. Originality/value Next steps in the program post-COVID are articulated as a best practice model for other schools interested in adopting MS 217's commitment, creativity and community-building to become a model restorative school.

Thinking outside of the Box: Medical Provider Perspectives on Adaptive Reuse of Closed Mall Sites for Mixed-Use Dementia Programs and Services

The double societal hit of dementia and infectious disease outbreaks like the COVID-19 pandemic have raised a convergence of concerns for the future of care settings for people living with dementia. It is estimated that 5.4 million Americans have some form of dementia and these numbers are expected to rise in the coming decades, leading to an unprecedented demand for memory care housing and services. In searching for innovative options to create more autonomy and better quality of life in dementia care settings, repurposing existing structures, in particular vacant urban malls, may be one option for the large sites needed for the European model of dementia villages. These settings may become sustainable Dementia Friendly City Centers, because with enclosed mall construction, the internal infrastructure is in place for lighting and HVAC, with varied spatial configuration of public spaces. This paper describes the community-based focus group research with medical providers who addressed designs for adaptive reuse of an existing dosed mall case study site. Focus group outcomes included discussions on four central themes about the adaptive reuse including: applicability of the concept, spectrum of programs, economic feasibility and onsite medical care.

Reflections on involving Experts by Experience in interviews for the Doctorate in Clinical Psychology

A discussion of the value of having Experts by Experience involved in interviews and assessments of trainees for the DClinPsy course at the University of Bath, especially in the context of digital interviewing due to the Covid-19 pandemic. © 2022, British Psychological Society. All rights reserved.