Narrative review – Barriers and facilitators to promotion of physical activity in primary care

The objective: to provide an overview of the literature on the barriers and facilitators to physical activity (PA) promotion in primary care, as experienced by practitioners and patients. Method: A search strategy of the English-language literature was conducted in EMBASE, MEDLINE and the COCHRANE LIBRARY. Search terms were primary care OR general practice OR family medicine OR family practitioner AND physical activity OR exercise AND barriers OR facilitators. Databases were searched from inception until 21 October 2022. Results: After screening, 63 articles were included within the summary and content analysis of this review. Analysis of the barriers to the implementation of PA highlighted four main themes perceived by practitioners: time, knowledge/skills, resources/support and financial implications. Analysis of the patient perspective identified themes which were categorised into individual (pre-existing health conditions, knowledge of benefits of PA, time/capacity), societal (social support and cultural norms) and environmental (availability of facilities and weather). Conclusions: As the importance of PA increases through the manifestation of sedentary behaviour-related disease, a combined primary care and public health approach to increase PA is required. By identifying the main barriers to PA promotion in primary care, resources and funding can be directed to address this. This is particularly relevant in the United Kingdom, with the re-negotiation of the primary care contract and the changes to healthcare delivery as a consequence of the Covid-19 pandemic. Throughout this review, we have explored ways of addressing the identified barriers through evidence-based interventions. © 2023 The Authors. Lifestyle Medicine published by John Wiley & Sons Ltd.

Cystic fibrosis mental health research priorities: Qualitative content analysis of cystic fibrosis community and provider survey

Background: Mental health is among the top three research priorities of the CF community [1]. In 2020-21, the Cystic Fibrosis Foundation Mental Health Research Prioritization Working Group met to designate areas of focus for CF mental health research [2]. To elicit broad input to inform this work, a mixed-methods study was conducted. In June 2020, a 22-item survey was sent via email and social media to CF health care providers, people with CF, family caregivers, and other CF community members. We aimed to analyze qualitative content to add depth to quantitative findings. Method(s): Three hundred fifty-two providers and 693 community members completed the survey, which included three open-ended questions: Q1) When thinking about research topics specific to mental health, where are the current gaps in knowledge that should be prioritized for future research? Q2) Is there anything else regarding mental health and the needs of the community you would like to share? Q3) Considering the impacts of the COVID-19 pandemic, are there additional mental health topics that are (Figure Presented) Figure 1.: Cystic fibrosis (CF) mental health research priorities of all respondents according to frequency. Overarching top-line categories and general codes for open-ended survey responses of CF health care providers, people with CF, family caregivers, and other CF community members not covered by the survey questions? Reponses containing more than one main idea were subdivided into topic-specific codable items. For Q1 and Q2, a codebook guided hierarchical placement of each item into an overarching top-line category with corresponding general code and, if applicable, one or more specific codes and populations or settings. A simplified process designated only one major theme per item for Q3. Three teams of one CF researcher and two CF community members coded the first 20% of their assigned items by consensus and then worked in pairs to independently double code the remaining 80%. Two-sided t-tests were adjusted with the Bonferroni correction using a significance level of less than 0.1. Result(s): One thousand three hundred ninety-one provider items and 1638 community items were coded for Q1 and Q2, and 565 provider and 323 community items were coded for Q3. Strong inter-rater agreement was obtained across coding dyads (71-90%). For Q1 and Q2, the most common top-line priorities were mental health conditions;living with CF;screening, assessment, and intervention;systems-level barriers and facilitators;and effects of modulators (Figure 1). Strong agreement was found in the ranking of top priorities by community members and providers, although providers were significantly more likely to mention effects of modulators;screening, assessment, and intervention;and substance misuse, and community members were significantly more likely to mention stress and trauma. Respondents also noted concerns captured by a wide range of specific codes (e.g., access to mental health care, role and life changes, family relationships), populations (e.g., children), and settings (e.g., inpatient). For Q3, isolation and anxiety emerged as the top COVID-19 concerns, with isolation more salient forcommunity members and anxiety for providers. Conclusion(s): Qualitative analysis of a large survey of multiple stakeholders provided input on top research priorities for CF mental health. This information facilitated consideration of diverse perspectives to identify gaps and select areas of focus for future researchCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

A Demand Systems Approach to Understanding Medium-Term Post-Pandemic Consumption Trends

Recent research has documented the immediate negative impact of the COVID-19 pandemic on household and business consumption, but there is still limited investigation into the medium-term effects in specific consumption categories. This paper addresses this gap using a vector autoregression analysis of a system of aggregated consumer final demand across Australia. We highlight the importance of studying a demand system, as opposed to investigating independent consumption categories, due to the interactive evolution of consumption during the pandemic. Modelling the paths of various consumption categories in response to shocks from one another, we find that, despite the large and abrupt shocks to consumption during the first two quarters of 2020, most categories reverted to pre-COVID levels when restrictions were lifted. Importantly, transportation had the largest and most persistent decline. Overall, shocks to sectors other than food, alcohol and education were outside the counterfactual forecast confidence intervals estimated based on pre-COVID information. © 2023 The Authors. Economic Papers;A journal of applied economics and policy published by John Wiley & Sons Australia, Ltd on behalf of The Economic Society of Australia.

Entrepreneurs' Response to the Dark Side of Knowledge During Covid19

Small business entrepreneurs faced tremendous knowledge-based challenges during COVID19. Some entrepreneurs, even in the same industry sector and city, with similar offerings, responded to these knowledge challenges in diverse ways. For instance, some chose to adopt online store technologies while others did not. In this study, we investigate differences in retail small business entrepreneurs' COVID19 resilience enactment using a qualitative retroductive-analytic approach. Identity motives were uncovered as a likely explanatory construct, as those with externally-focused identity motives generally adopted these technologies while those with internally-focused identity motives generally did not. In addition, identity motives appear to influence entrepreneurs' perceptions of technology affordances, potentially moderating the impact of these perceptions on technology adoption decisions. Contrary to conceptualizations of individual resilience being a trait, we find support that resilience is a mindset. Implications for entrepreneurship theory, practice, and education are discussed. © 2022 IEEE Computer Society. All rights reserved.

Rapid cytokine release assay in whole blood determines longitudinal T-cell responses against ancestral, Delta, and Omicron SARS CoV-2 variants

Background: A simple, accurate and rapid whole blood-based T-cell test was previously developed to determine SARS-CoV- 2- specific T-cell immunity. Herein, the test was utilized to measure the magnitude of T-cell responses up to 6 months post-vaccination, assess the effects of vaccine boosters, and to elucidate any effect that Delta and Omicron variants may have on T-cell immunity. Method(s): Immunocompetent individuals (n = 44) were recruited to donate a blood sample between one-and six-months post-vaccination. Whole blood was stimulated overnight with peptides spanning immunodominant regions specific for ancestral SARS-CoV- 2. Blood plasma samples were analysed for IL-2 production via Luminex xMAP cytokine array, as this was previously demonstrated to be the most accurate biomarker for the test. Following booster vaccinations, 58 individuals donated a blood sample between one-and four-months post-booster and T-cell responses after overnight stimulations were assessed. Additionally, 30 samples were stimulated with peptides from the immunodominant regions of the Delta and Omicron SARS-CoV- 2 variants and IL-2 levels were compared. Result(s): A comparison of T-cell responses from samples donated up to one-month and six-months post-vaccination revealed no significant differences in the magnitude of IL-2 production (p = 0.9252), with near equivalent means. Booster vaccinations increased the magnitude of the T-cell response in 69% of individuals analysed, with the mean production of IL-2 rising from 77pg/ml six-months pre-booster to 141pg/ml 3-weeks post-booster. Analysis of the longevity of post-booster T-cell response demonstrated no significant differences in the magnitude of IL-2 (p = 0.8141) production, with near equivalent means at one-month and 4-months post-booster (119pg/ml and 111pg/ml, respectively). Finally, no significant differences in the magnitude of IL-2 were observed between samples stimulated with either ancestral, Delta or Omicron peptides, with the means of each group being highly comparable. Conclusion(s): Results from this rapid whole blood-based T-cell test indicate that T-cell immunity to multiple variants of SARS-CoV- 2 within immunocompetent cohorts does not wane significantly over time. However, booster vaccinations may be important for individuals who have lower levels of immunity following their first complete vaccination doses. This test could be a valuable tool in the assessment of SARS-CoV- 2 immunity in multiple cohorts of clinical vulnerable individuals.

Simultaneous Individual Complicated Grief Treatment With a Couple

Persistent complex bereavement/complicated grief occurs when, after a period of 12 months following a death, there remains an ongoing intense yearning and sorrow for the deceased, preoccupation with the death and its circumstances, difficulty accepting its reality, and disruption in personal identity. This case study illustrates the successful application of Complicated Grief Treatment (CGT), a manualized research-supported intervention, with a husband and wife each receiving individual therapy simultaneously with separate clinicians. The core of CGT involves graded completion of imaginal and situational revisiting (i.e., exposure) exercises. To target maladaptive rumination and counterfactual thinking more explicitly, strategies from a research-based treatment for trauma, Cognitive Processing Therapy, were also incorporated for one member of the couple. To our knowledge, CGT has not been examined with couples receiving individual therapy delivered simultaneously. As such, practitioners have little information about how to proceed with cases where multiple members of the same family are experiencing complicated grief. We will detail the treatment provided, outlining the course of care for each member of the couple, highlighting unique adjustments made to tailor implementation to each individual and to deliver the intervention simultaneously. Quantitative and qualitative data show the effects of treatment on symptoms of complicated grief, depression, and relationship satisfaction.Copyright © The Author(s) 2022.

Evaluation of a pharmacist-led drive-up anticoagulation clinic during the coronavirus 2019 pandemic

Background: The University of Kentucky HealthCare Anticoagulation Clinic at the Gill Heart and Vascular Institute in Lexington, Kentucky, designed and implemented a drive-up clinic for warfarin management with the goal to minimize person-to-person exposure during the coronavirus disease 2019 (COVID-19) pandemic. Objective: The purpose of this study was to evaluate the effect on warfarin management in a pharmacist-led anticoagulation service when transitioned from an in-person clinic to a drive-up clinic during the COVID-19 pandemic. Methods: This is a retrospective observational cohort study of 68 patients seen in the University of Kentucky HealthCare Anticoagulation Clinic on warfarin therapy for any indication. Patients were included if they had scheduled visits at least 3 times in the period 6 months before, during, and after the initiation of the drive-up clinic. The primary outcome is the difference in time in therapeutic range (TTR) before and during the drive-up clinic. Results: The difference between the mean TTR in period 1 (69.1% ± 23.2%) and period 2 (69.6% ± 19.2%) was not statistically significant (P = 0.882). The mean TTR in period 3 (70.5% ± 20.8%) did not differ in statistical significance from either period 1 (P = 0.688) or period 2 (P = 0.746). Safety outcomes including reported bleeding events and emergency department visits or hospital admissions for bleeding or thrombotic events were consistently low across each period. Conclusion: The results of this study illustrate that a drive-up clinic for warfarin management may be a reasonable alternative approach to providing care for outpatient anticoagulant management and may support nontraditional clinic models for long-term management of anticoagulation and other chronic disease states.

Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action

Background. Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI. Methods. We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheterassociated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression. Results. Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (< 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative toWhite patients in both study periods (pre-pandemic, 49% vs 38%;during pandemic, 47% vs 31%;respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30;95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51;95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3). Conclusion. We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes. (Figure Presented).

Comparison of Trends in Hospital-Onset Bloodstream Infections (HOBSIs) and Central Line Associated Bloodstream Infections (CLABSIs) across a Three-Hospital Health System in the COVID Era

Background. Hospital-onset bloodstream infection (HOBSI) incidence has been proposed as a complementary quality metric to central line-associated bloodstream infection (CLABSI) surveillance. Several recent studies have detailed increases in median HOBSI and CLABSI rates during the COVID-19 pandemic. We sought to understand trends in HOBSI and CLABSI rates at a single health system in the context of COVID-19. Methods. We conducted a retrospective analysis of HOBSIs and CLABSIs at a three-hospital health system from 2017 to 2021 (Figure 1). We compared counts, denominators, and demographic data for HOBSIs and CLABSIs between the prepandemic (1/1/2017-3/30/2020) and pandemic period (4/1/2020-12/31/2021) (Table 1). We applied Poisson or negative binomial regression models to estimate the monthly change in incidence of HO-BSI and CLABSI rates over the study period. Figure 1: Definitions applied for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs). Potentially contaminated blood cultures were identified by microbiology laboratory technicians as any set of blood culture in which a single bottle was positive for organisms typically considered as skin contaminants. Uncertain cases undergo secondary review by senior lab technicians. Table 1: Count, denominator, and device utilization ratio data for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs) Note that central line utilization increased upon regression analysis (p<0.001). Results. The median monthly HOBSI rate per 1,000 patient days increased from 1.0 in the pre-pandemic to 1.3 (p< 0.01) in the pandemic period, whereas the median monthly CLABSI rate per central line days was stable (1.01 to 0.88;p=0.1;Table 2). Our regression analysis found that monthly rates of HO-BSIs increased throughout the study, but the increase was not associated with the onset of the COVID-19 pandemic based on comparisons of model fit (Figure 2;Table 3). Despite an increase in central line utilization, regression modelling found no changes in monthly CLABSIs rates with respect to time and the COVID-19 pandemic. Incidence of HOBSIs and CLABSIs by common nosocomial organisms generally increased over this time period, though time to infection onset remained unchanged in our studied population (Table 2). Conclusion. HOBSIs rates did not correlate with CLABSI incidence across a three-hospital health system from 2017 and 2021, as rates of HOBSI increased but CLABSI rates remained flat. Our observed increase in HOBSI rates did not correlate with the onset of the COVID-19 pandemic, and caution should be used in modeling the effects of COVID-19 without time-trended analysis. Further evaluation is needed to understand the etiology, epidemiology, and preventability of HO-BSI.

Modeling Diagnostic Testing Strategies for SARS-CoV-2 to Minimize Societal Costs and Return People to Work

Background. The shift to more transmissible but less virulent strains of SARS-CoV-2 has altered the risk calculation for infection. Particularly among young adults, the economic burden of lost work due to isolation exceeds the economic burden of morbidity due to infection. Testing strategies must adapt to these changing circumstances. Methods. We modeled six testing strategies to estimate total societal costs for symptomatic people 18-49 years old: isolation of all individuals with no testing, rapid antigen test (RAg), RAg followed by a second RAg 48h later if first negative, RAg followed by a polymerase chain reaction (PCR) if negative, RAg followed by a PCR if positive, and PCR alone. We calculated costs for hypothetical cohorts of 100 symptomatic healthcare workers tested with each strategy;we included testing costs, lost wages, and hospitalization costs for the index, secondary, and tertiary cases. Key assumptions were 5% prevalence of infection, sensitivity of first/second RAg 40/80% with 97% specificity, PCR sensitivity/specificity 95/99%, all individuals isolate at symptom onset, are tested the same day, and isolate for 5 days if positive. RAg results were available the same day, PCR results were available the next day (Figure 1). One-way sensitivity analyses were performed for RAg sensitivity (20-80%) and positivity rate (1-80%). Results. The least expensive strategy was RAg alone (Figure 2). This was primarily driven by its low sensitivity, which reduced lost wages at the expense of missing cases. At a threshold for RAg sensitivity lower than 29%, PCR testing alone became the cheapest strategy. When the positivity rate was > 6% confirming a negative RAg with a PCR became the cheapest strategy, closely followed by PCR alone. At a positivity rate of > 29%, isolation without testing was cheapest followed by confirming a negative RAg with a PCR and by the serial RAg test strategies (Figure 3). Conclusion. In relatively young, healthy populations, a single rapid test was the least expensive strategy when the positivity rate was < 6%, testing that included PCR became cheapest at intermediate positivity, and empiric isolation was cheapest at positivity > 29%. Calibrating SARS-CoV-2 test strategies based on epidemiology may save societal costs.

Engineering a Pseudotyped Lentiviral Platform to Enable Lineage-Specific Transduction of Immune Cells

Background Cell-specific transduction remains one of the next frontiers for virally-delivered gene therapy. Efforts to achieve cell-specific transduction have largely been limited to borrowing of preexisting viral glycoproteins and pseudotyping viral surface envelopes to result in altered tropism. VSVG is derived from vesicular stomatitis virus (VSV) and is one of the most commonly used lentiviral (LV) pseudotype glycoproteins as its cognate receptor (LDLR) is present on nearly all dividing and non-dividing cells, enabling broad tropism of VSVG-pseudotyped LVs. Methods Our lab recently developed a receptor-blinded version of VSVG, in which point mutations (K47Q, R354A) of this glycoprotein results in a mutated VSVG with inability to bind and infect LDLR-expressing cells. This mutant viral glycoprotein, which we call VSVGmut, thereby loses its broad tropism, but critically retains its fusogen ability, enabling codisplay of a new LV pseudotype ligand to drive LV tropism. Results Initial experiments displaying high-affinity anti-CD19 scFvs alongside VSVGmut on the LV surface demonstrated infection of CD19+, but not CD19- cells. Subsequent work using endogenous ligands (CD80), Fabs (a-CD3e), cytokines (IL-13), viral glycoproteins (SARS-CoV-2 RBD), and peptide MHCs (pMHCs) revealed the modularity of this platform for achieving potent transduction of on-target cells, with minimal infection of bystander cells, across a range of affinities (pM to uM) and at frequencies as low as 1 in 100,000. This technology allowed for library on library screening of 96 viral pMHC-displaying LVs against a repertoire of >450,000 TCRs in pool, which accurately uncovered EBV- and Flu-specific TCRs through scRNA sequencing. Conclusions The VSVGmut platform has resulted in our lab's ability to pair pMHCs with cognate TCRs and viral surface antigens with cognate BCRs, in addition to achieving lineagespecific transduction of T and B cell subsets, setting the stage for cell-specific gene therapy.

A Qualitative Evaluation of a Community-Led Telehealth Training Program for Cancer Survivors

INTRODUCTION: Telehealth services are increasingly used to facilitate cancer survivorship care. Barriers including unreadiness, digital literacy, and access may be overcome with dedicated patient training programs. This study assesses experiences of educators and cancer survivors in a community-led telehealth training pilot program. METHOD(S): Individual semi-structured interviews with Cancer Awareness Network educators and patients conducted October 2021 to February 2022 were transcribed and analyzed in NVivo 12 using thematic analysis. RESULT(S): Participants include 6 educators (19 to 68 years old, 83% Black, 100% female) and 3 patients (60 to 85 years old, 100% Black, 67% female). Educators and patients found training acceptable, with successful techniques including repetition, encouragement, and demonstration followed by teach-back. Both endorsed increased confidence, and patients used telehealth without significant issues after one session. The COVID-19 pandemic was both a facilitator and barrier to training as it motivated patients to use telemedicine to avoid in-person visits but hindered in-person training. Other facilitators included family/caregiver support and provision of devices and WiFi. Patient-level barriers included apprehension, older age, limited digital literacy, old devices, remembering passwords, and WiFi setup. Organization/system-level barriers included interparty communication for training setup, participant recruitment, and knowledge of hospital-specific telehealth platforms. Suggestions included instructional videos, increased outreach, and follow-up for reinforcement. Conclusion(s): Telehealth training improves patient confidence and uptake using various teaching techniques. Future steps include program expansion and incorporation of suggestions. Training programs with supplemental resources are a feasible and seminal intervention for telehealth equity among cancer survivors with low digital literacy, increased age, and/or digital poverty.

Evaluation of a pharmacist-led drive-up anticoagulation clinic during the coronavirus 2019 pandemic

Background: The University of Kentucky HealthCare Anticoagulation Clinic at the Gill Heart and Vascular Institute in Lexington, Kentucky, designed and implemented a drive-up clinic for warfarin management with the goal to minimize person-to-person exposure during the coronavirus disease 2019 (COVID-19) pandemic. Objective(s): The purpose of this study was to evaluate the effect on warfarin management in a pharmacist-led anticoagulation service when transitioned from an in-person clinic to a drive-up clinic during the COVID-19 pandemic. Method(s): This is a retrospective observational cohort study of 68 patients seen in the University of Kentucky HealthCare Anticoagulation Clinic on warfarin therapy for any indication. Patients were included if they had scheduled visits at least 3 times in the period 6 months before, during, and after the initiation of the drive-up clinic. The primary outcome is the difference in time in therapeutic range (TTR) before and during the drive-up clinic. Result(s): The difference between the mean TTR in period 1 (69.1% +/- 23.2%) and period 2 (69.6% +/- 19.2%) was not statistically significant (P = 0.882). The mean TTR in period 3 (70.5% +/- 20.8%) did not differ in statistical significance from either period 1 (P = 0.688) or period 2 (P = 0.746). Safety outcomes including reported bleeding events and emergency department visits or hospital admissions for bleeding or thrombotic events were consistently low across each period. Conclusion(s): The results of this study illustrate that a drive-up clinic for warfarin management may be a reasonable alternative approach to providing care for outpatient anticoagulant management and may support nontraditional clinic models for long-term management of anticoagulation and other chronic disease states. Copyright © 2022 American Pharmacists Association

Impact of a Comprehensive SARS-CoV-2 Infection Prevention Bundle on Rates of Hospital-Acquired Respiratory Viral Infections

Background: We evaluated the impact of a comprehensive SARS-CoV-2 (COVID-19) infection prevention (IP) bundle on rates of non–COVID-19 healthcare-acquired respiratory viral infection (HA-RVI). Methods: We performed a retrospective analysis of prospectively collected respiratory viral data using an infection prevention database from April 2017 to January 2021. We defined HA-RVI as identification of a respiratory virus via nasal or nasopharyngeal swabs collected on or after hospital day 7 for COVID-19 and non–COVID-19 RVI. We compared incident rate ratios (IRRs) of HA-RVI for each of the 3 years (April 2017 to March 2020) prior to and 10 months (April 2020 to January 2021) following full implementation of a comprehensive COVID-19 IP bundle at Duke University Health System. The COVID-19 IP bundle consists of the following elements: universal masking;eye protection;employee, patient, and visitor symptom screening;contact tracing;admission and preprocedure testing;visitor restrictions;discouraging presenteeism;population density control and/or physical distancing;and ongoing attention to basic horizontal IP strategies including hand hygiene, PPE compliance, and environmental cleaning. Results: During the study period, we identified 715 HA-RVIs over 1,899,700 inpatient days, for an overall incidence rate of 0.38 HA-RVI per 1,000 inpatient days. The HA-RVI IRR was significantly higher during each of the 3 years prior to implementing the COVID-19 IP bundle (Table 1). The incidence rate of HA-RVI decreased by 60% after bundle implementation. COVID-19 became the dominant HA-RVI, and no cases of HA-influenza occurred in the postimplementation period (Figure 1). Conclusions: Implementation of a comprehensive COVID-19 IP bundle likely contributed to a reduction in HA-RVI for hospitalized patients in our healthcare system. Augmenting traditional IP interventions in place during the annual respiratory virus season may be a future strategy to reduce rates of HA-RVI for inpatients.Table 1.Figure 1.

Physician Perspectives on Telemedicine Implementation in Radiation Oncology

Background: The use of telemedicine in radiation oncology increased dramatically during the COVID-19 pandemic. While prior surveys suggest high levels of satisfaction with telemedicine among radiation oncologists, the published literature is limited regarding provider-specific factors impacting satisfaction and provider preferences regarding how telemedicine is implemented. Objective(s): To assess provider characteristics associated with satisfaction and perceived adoption of telemedicine in radiation oncology, and to characterize implementation preferences of providers at our institution. Method(s): We distributed a survey to all attending radiation oncologists at our large academic institution in October 2021 to assess several measures of satisfaction with telemedicine. We also asked providers to estimate metrics suggestive of successful telemedicine use. Univariate logistic regressions were performed to assess the role of physician characteristics (including age, gender, years in practice, main vs satellite location, disease site treated, annual new patient volume, and selfreported comfort with technology) on satisfaction and on whether physicians reported telemedicine was easy to use. We also performed descriptive statistics to characterize provider-estimated time-savings and training preferences. Kruskal-Wallis tests were used to assess whether provider characteristics or scheduling strategy (telemedicine scheduled separately from in-person visits) were associated with the rate of missed video visits. Result(s): A total of 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department and 78% felt telemedicine was easy to use. None of the tested factors on univariate analysis were statistically significant predictors for these outcomes. 38% of providers believed telemedicine encounters resulted in time savings of at least 10% compared to in-person visits, while 20% of providers reported virtual encounters took at least 10% more time. A median (IQR) of 10% (5%-20%) of video visits were estimated to be missed, and none of the tested provider characteristics or scheduling preferences were associated with a significantly greater proportion of missed visits. 78% of respondents reported having adequate training and support to perform telemedicine. Text, video, and private instruction were nearly equally preferred training modalities (31%, 31%, 34% respectively). Conclusion(s): Nearly 80% of surveyed radiation oncologists were satisfied with telemedicine, felt it was easy to use, and reported adequate training and support to perform telemedicine. In this highly technologically advanced field, age and years in practice were not significantly associated with satisfaction or self-reported success rates with telemedicine. Future directions include addressing actionable concerns and correlating these findings with patient impressions.

Strengthening health systems from the bottom up: example from Lesotho

In Africa, there is frequently an extreme need for nurses and other healthcare professionals. Overcrowding, a lack of administrative oversight, and a lack of resources are all problems in health settings. Health professionals may develop psychological damage referred to as "insufficient resource trauma" as a result of these difficulties, which can lower morale and motivation. Such trauma reduces the standard of treatment provided and causes professional "burn-out," a problem that has become more significant in the wake of the SARS-CoV-2 pandemic. One of the nurses who received training in PSBH-N in 2006 was promoted to the position of MoH Nursing Director by 2019. This nurse reflected on her personal experience and said, "The nurses trained in PSBH are among the top nurses in the country today," when she learned of the new PSBH training for MoH QAU employees. In order to train all 877 registered nurses and 373 licensed practical nurses (LPNs) in the nation during the following three to five years, the director requested that LeBoHA host PSBH-N workshops. The countrywide rollout's training and evaluation are now under progress. Priority setting may result from centralized, "top-down," problem-solving techniques that are not always appropriate for the district. A poll of healthcare professionals in South African hospitals revealed that administrators of hospitals were regarded as effective leaders if their leadership style encouraged engagement and problem-solving. An emphasis on a decentralised and egalitarian (equity-fostering) approach, where problem-solving is the duty of all health workers, is emphasized in a national quality assurance plan that includes PSBH.

Physician Perspectives on Telemedicine in Radiation Oncology

Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be utilized after the COVID-19 public health emergency (PHE) ends. Despite ongoing COVID-19 risks and public payer support for telemedicine, several private payers have stopped reimbursing telemedicine weekly see video visits. We performed a large single-institution assessment of provider perspectives on telemedicine after we had achieved a more mature level of adoption to better understand factors considered when determining to use telemedicine and to estimate the percent of visits that could be safely performed with telemedicine. We distributed a survey to all radiation oncology attendings at our large academic institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and to identify factors influencing whether telemedicine is employed. For the qualitative analysis, two authors independently coded open-ended survey responses and identified categories and themes following established content analysis methodology. We calculated the average proportion of visits that providers expected could be appropriately performed with telemedicine without a clinically significant decline in the quality of care for each disease site and visit type. 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department, and 83% wished to continue offering video visits after the COVID-19 PHE ends. Common reasons providers endorsed for wanting to integrate telemedicine into practice included: patient and provider preference, increased access to care and clinical trials, allowing for greater relationship with the care team, and improved clinical safety, efficiency, and quality. Patient factors influencing whether physicians offer telemedicine included the patient's travel burden, patient preferences, and whether a physical exam is required. About 20% of new consultations and 50% of weekly management visits were estimated to be clinically appropriate for telemedicine. Central Nervous System/Pediatrics and Thoracic faculty considered telemedicine appropriate for the greatest proportion (50%) of new consultations. 93% of respondents felt comfortable determining whether telemedicine was appropriate. Surveyed radiation oncologists were satisfied with telemedicine in their practice and wished to continue offering video visits in the future. Although provider perceptions of clinical appropriateness of telemedicine varied widely based on disease site and visit type, providers felt comfortable determining when telemedicine would be appropriate for patients. Our data suggest payers should continue to support this patient-centered technology. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Integrating Hybrid and Remote Workplaces into the Post COVID-19 Engineering Corporate Landscape

The COVID-19 pandemic has forced engineering firms to reconsider the role of traditional, corporate work facilities for their full-time workers. During the height of the pandemic, over 40% of engineering employees worked remotely. This greatly changed their perceptions and expectation about the remote work environment. Over 40% of engineering employees are now willing to “take a salary cut in order to have more flexible work arrangements, such as full-time remote and hybrid work facilities arrangements, from their employers.” Employers also learned firsthand the limitations and benefits of a large-scale remote workforce including cost savings. This has forced engineering managers to consider how to integrate remote and hybrid corporate work facilities into the traditional workplace, post COVID-19. We examined the data on the dynamics of traditional, hybrid, and remote workplace facilities to determine the best default work facilities arrangement. While we suspected the traditional work facilities arrangement would be the least viable option, we were surprised to find the benefits of hybrid work facilities be so clearly dominant, that we consider it to be the default engineering workplace of the future. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.