Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays.

INTRODUCTION: Growing numbers of older patients occupy hospital beds despite being 'medically fit' for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge. METHODS: A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months. RESULTS: Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview-generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care. CONCLUSION: Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient-centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital. PATIENT OR PUBLIC CONTRIBUTION: The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID-19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.

Moving From Peripheral Project to Integrated Governance: Developing System Sustainability in Excellence Reporting

Aims There has been increasing recognition that healthy cultures within NHS organisations are key to delivering high-quality, safe care (King's Fund). A focus towards developing systems which recognise and learn from excellence has been shown to improve services’ safety and contribute to staff's morale (Kelly et al. 2016). In 2019 Secure Services at Devon Partnership NHS Trust (DPT) developed an Excellence reporting system. Once successfully piloted, the intention was to extend to other departments before expanding to the entire Trust. Our aims initially were SMART: for 13 reports per week in Secure services and 8 in Perinatal (a smaller team). As we expanded the aim became qualitative: for a system to be embedded so staff could as readily and instinctively report Excellence as they could an error. Methods We developed our Theory of Change using Deming's theory of profound knowledge, ran a series of PDSAs, and introduced an Excellence system. We engaged early adopters, sent hand-written cards and shared data widely. Learning included understanding setting up the system, and the importance of a team rather than an individual holding the system. We took this forward to bring the system to Perinatal. We continued to run PDSAs, then ran monthly trust-wide meetings providing space to learn from other directorates. Results Staff were initially excited, reports submitted, feedback good, then a plateau and slump. Something was stopping the system perpetuating. When staff received timely thanks, and others heard about it, staff would go on to promote excellence. However, this was not possible without sufficient admin resources. In early 2021 we changed tact and approached the top: we presented data to Directors who recognised the value and agreed to support. We then set about publicising the system, and demonstrating at trust-wide meetings. By July 2021 we saw 10 reports per week in the Specialist Directorate. By early 2022 reports were being inputted from staff across all directorates and our monthly meetings began to focus on sharing the learning. Conclusion We recognised the system's potential impact on safety and staff morale but struggled to sustain the system and support dwindled when staff were stretched. After approaching leaders, then allocated resources, it allowed for more success. However, it is not yet fully embedded in our Trust's culture. A lot of our work happened during COVID-19 and despite challenges there has been a new-found flexibility to innovate, greater ease to negotiate, and instigate change.

Perceived Stress and Interest in Non-Invasive Aesthetic Procedures During the COVID-19 Pandemic.

Purpose: Multiple effects of the COVID-19 pandemic have been described, including an increase in concerns about one's facial appearance resulting in greater interest in cosmetic procedures. However, additional research is required to examine the impact of the pandemic on patients' overall stress levels and whether this reported stress is associated with an interest in facial aesthetic procedures. We aimed to describe perceived stress and to identify factors associated with increased stress among patients seeking aesthetic treatments during the pandemic. Patients and Methods: Patients coming to a Singapore-based clinic and who completed a questionnaire over a one-month period were included. Stress was evaluated using the Perceived Stress Scale (PSS); additional questions sought to understand factors associated with perceived stress and future interest in aesthetic procedures. Results: Two hundred and thirteen respondents participated in the study. Separation from family and inability to travel for leisure were major stressors in 54% and 55%; getting COVID-19 was less frequently a stressor (11%). Patients reported greater concern with appearance (increased worry in 32%, comparison to others in 41%). Ninety-one percent of patients continued aesthetic procedures despite the pandemic and 75% reported interest in proceeding with treatments not previously tried before. PSS scores were higher than published norms. Factors associated with increased scores included residency status, job insecurity and markers of increased concern about appearance. Finally, higher stress scores were observed in patients with greater likelihood of receiving future aesthetic treatments, although this was not statistically significant after applying the Bonferroni correction for multiple comparisons. Conclusion: Significantly higher stress scores were seen in patients seeking aesthetic treatments. We identified factors associated with increased stress with a suggested association between increased likelihood of proceeding with any aesthetic procedure and higher levels of stress. These highlight the importance of caution in treating patients given their increased stress levels and potential vulnerability.

A comparative study of formal coaching and mentoring programmes in higher education

Purpose>The purpose of this paper is to evaluate two coaching and mentoring programmes focused on the ever-increasingly important aim of enhancing the chances of professional level employment for undergraduate students, at two UK universities. In addition, to offer recommendations to enhance coaching and mentoring success within higher education (HE).Design/methodology/approach>Two similar programmes are compared;the first study is a coaching programme delivered in two phases involving over 1,500 students within the business school. The second study is a mentoring programme involving over 250 students over a ten-year period within the business school at a different institution.Findings>The two programmes have been compared against the key success criteria from the literature, endorsed by coaching and mentoring experts. The results highlight the importance of integrating with other initiatives, senior management commitment, budget, an application process, clear matching process, trained coaches and mentors, induction for both parties, supportive material, ongoing supervision and robust evaluation and record keeping.Research limitations/implications>The research focuses on two similar institutions, with comparable student demographics. It would have been useful to dig deeper into the effect of the diverse characteristics of coach/mentor and coachee/mentee on the effectiveness of their relationships. In addition, to test the assumptions and recommendations beyond these two institutions, and to validate the reach and application of these best practice recommendations further afield.Practical implications>The results identify a number of best practice recommendations to guide HE institutions when offering coaching and mentoring interventions to support career progression of their students.Originality/value>There are limited comparison studies between universities with undergraduate career-related coaching and mentoring programmes and limited research offering best practice recommendations for coaching and mentoring programmes in HE. The top ten factors offered here to take away will add value to those thinking of running similar programmes within HE.

The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review.

BACKGROUND: Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. OBJECTIVE: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. METHODS: We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. RESULTS: The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. CONCLUSIONS: Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health.

Paediatric pneumonia research priorities in the context of COVID-19: A eDelphi study.

Background: Pneumonia remains the leading cause of infectious deaths in children under-five globally. We update the research priorities for childhood pneumonia in the context of the COVID-19 pandemic and explore whether previous priorities have been addressed. Methods: We conducted an eDelphi study from November 2019 to June 2021. Experts were invited to take part, targeting balance by: gender, profession, and high (HIC) and low- and middle-income countries (LMIC). We followed a three-stage approach: 1. Collating questions, using a list published in 2011 and adding newly posed topics; 2. Narrowing down, through participant scoring on importance and whether they had been answered; 3. Ranking of retained topics. Topics were categorized into: prevent and protect, diagnosis, treatment and cross-cutting. Results: Overall 379 experts were identified, and 108 took part. We started with 83 topics, and 81 further general and 40 COVID-19 specific topics were proposed. In the final ranking 101 topics were retained, and the highest ranked was to "explore interventions to prevent neonatal pneumonia". Among the top 20 topics, epidemiological research and intervention evaluation was commonly prioritized, followed by the operational and implementation research. Two COVID-19 related questions were ranked within the top 20. There were clear differences in priorities between HIC and LMIC respondents, and academics vs non-academics. Conclusions: Operational research on health system capacities, and evaluating optimized delivery of existing treatments, diagnostics and case management approaches are needed. This list should act as a catalyst for collaborative research, especially to meet the top priority in preventing neonatal pneumonia, and encourage multi-disciplinary partnerships.

Delivery of seasonal malaria chemoprevention with enhanced infection prevention and control measures during the COVID-19 pandemic in Nigeria, Burkina Faso and Chad: a cross-sectional study.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is a WHO-recommended intervention for children aged 3-59 months living in areas of high malaria transmission to provide protection against malaria during the rainy season. Operational guidelines were developed, based on WHO guidance, to support countries to mitigate the risk of coronavirus disease 2019 (COVID-19) transmission within communities and among community distributors when delivering SMC. METHODS: A cross-sectional study to determine adherence to infection prevention and control (IPC) measures during two distribution cycles of SMC in Nigeria, Chad and Burkina Faso. Community distributors were observed receiving equipment and delivering SMC. Adherence across six domains was calculated as the proportion of indications in which the community distributor performed the correct action. Focus group discussions were conducted with community distributors to understand their perceptions of the IPC measures and barriers and facilitators to adherence. RESULTS: Data collectors observed community distributors in Nigeria (n = 259), Burkina Faso (n = 252) and Chad (n = 266) receiving IPC equipment and delivering SMC. Adherence to IPC indications varied. In all three countries, adherence to mask use was the highest (ranging from 73.3% in Nigeria to 86.9% in Burkina Faso). Adherence to hand hygiene for at least 30 s was low (ranging from 3.6% in Nigeria to 10.3% in Burkina Faso) but increased substantially when excluding the length of time spent hand washing (ranging from 36.7% in Nigeria to 61.4% in Burkina Faso). Adherence to safe distancing in the compound ranged from 5.4% in Chad to 16.4% in Nigeria. In Burkina Faso and Chad, where disinfection wipes widely available compliance with disinfection of blister packs for SMC was low (17.4% in Burkina Faso and 16.9% in Chad). Community distributors generally found the IPC measures acceptable, however there were barriers to optimal hand hygiene practices, cultural norms made social distancing difficult to adhere to and caregivers needed assistance to administer the first dose of SMC. CONCLUSION: Adherence to IPC measures for SMC delivery during the COVID-19 pandemic varied across domains of IPC, but was largely insufficient, particularly for hand hygiene and safe distancing. Improvements in provision of protective equipment, early community engagement and adaptations to make IPC measures more feasible to implement could increase adherence.

A mobile swabbing booth to address Singapore GPs' concerns about swabber protection: human-centred design during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, the Ministry of Health asked Singapore's private general practitioners (GPs) to perform swab testing in their clinics, but some GPs had concerns about swabber protection. Our aim was to develop a swabbing booth to address these concerns. METHODS: We developed a prototype with potential GP users using a human-centred design approach and piloted it with 10 GP clinics. The pilot was then extended to 170 GP clinics around Singapore. These GPs were then surveyed on user satisfaction. RESULTS: Ninety-three GPs (54%) responded. The majority (75%) practiced in public residential estates in small practices (mean 1.95 doctors). 86% requested the booth to enhance swabber protection. 74% "would recommend" or "would strongly recommend" the booth to colleagues. 79% continue to use the booth to conduct swab tests. 92% liked that it offered swabber protection. 71% liked that the booth created a separate space for swabbing and 64% liked its ease of disinfection. 47% started swabbing only after receiving the booth and 58% said the booth was "important" or "very important" to their decision to participate in swab testing. However, 34% disliked that it took up too much space and the most frequently critiqued area was the gloves. CONCLUSION: The human-centred design approach generated a product that had high user satisfaction, addressed GPs' concerns of swabber protection and increased GPs' participation in swab testing. The booth may be useful where GPs are concerned about swabber protection and space is limited.

Principles for pandemics: COVID-19 and professional ethical guidance in England and Wales.

BACKGROUND: During the arrival of the COVID-19 pandemic, various professional ethical guidance was issued to (and for) health and social care professionals in England and Wales. Guidance can help to inform and support such professionals and their patients, clients and service users, but a plethora of guidance risked information overload, confusion, and inconsistency. METHODS: During the early months of the pandemic, we undertook a rapid review, asking: what are the principles adopted by professional ethical guidance in England and Wales for dealing with COVID-19? We undertook thematic content analysis of the 29 documents that met our inclusion criteria. RESULTS: The 29 documents captured 13 overlapping principles: respect, fairness, minimising harm, reciprocity, proportionality, flexibility, working together, inclusiveness, communication, transparency, reasonableness, responsibility, and accountability. CONCLUSIONS: We intend this attempt to collate and outline the prominent principles to be helpful, particularly, for healthcare practice during the COVID-19 pandemic and, hopefully, for future pandemic planning. We also offer some reflections on the guidance and the principles therein. After describing the principles, we reflect on some of the similarities and differences in the guidance, and the challenges associated not only with the specific guidance reviewed, but also with the nature and import of "professional ethical guidance".

Teledermatology in Primary Care in Singapore: Experiences of Family Doctors and Specialists.

Most teledermatology studies focus on patients' satisfaction; fewer focus on the experiences of healthcare professionals. This qualitative study explored healthcare professionals' perceptions of teledermatology used for linking public primary care clinics with the specialist dermatology centre in Singapore. Semi-structured in-depth interviews were conducted with 25 family physicians and dermatologists. Six themes were identified: satisfaction with the service; perceived patient benefits; rationale for introducing teledermatology; educational impact; challenges of virtual consultations; and desirable service refinements for the future. Family physicians and dermatologists were positive about the service, but highlighted a need to streamline referral processes and improve the quality of transmitted images. Reduced need for referral to the specialist centre could be achieved by expanding the polyclinic's pharmacopoeia and treatment modalities. This study highlights the benefits of telemedicine for patient, professionals, and healthcare organizations, and these are reassuring given the widespread and rapid introduction of telemedicine through necessity during the COVID-19 pandemic.

An Overview of Commercially Available Apps in the Initial Months of the COVID-19 Pandemic.

Introduction: It has been 4 months since the discovery of COVID-19, and there have been many measures introduced to curb movements of individuals to stem the spread. There has been an increase in the utilization of web-based technologies for counseling, and for supervision and training, and this has been carefully described in China. Several telehealth initiatives have been highlighted for Australian residents. Smartphone applications have previously been shown to be helpful in times of a crisis. Whilst there have been some examples of how web-based technologies have been used to support individuals who are concerned about or living with COVID-19, we know of no studies or review that have specifically looked at how M-Health technologies have been utilized for COVID-19. Objectives: There might be existing commercially available applications on the commercial stores, or in the published literature. There remains a lack of understanding of the resources that are available, the functionality of these applications, and the evidence base of these applications. Given this, the objective of this content analytical review is in identifying the commercial applications that are available currently for COVID-19, and in exploring their functionalities. Methods: A mobile application search application was used. The search terminologies used were "COVID" and "COVID-19." Keyword search was performed based on the titles of the commercial applications. The search through the database was conducted from the 27th March through to the 18th of April 2020 by two independent authors. Results: A total of 103 applications were identified from the Apple iTunes and Google Play store, respectively; 32 were available on both Apple and Google Play stores. The majority appeared on the commercial stores between March and April 2020, more than 2 months after the first discovery of COVID-19. Some of the common functionalities include the provision of news and information, contact tracking, and self-assessment or diagnosis. Conclusions: This is the first review that has characterized the smartphone applications 4 months after the first discovery of COVID-19.

COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies.

Apps that enable contact-tracing are instrumental in mitigating the transmission of COVID-19, but there have been concerns among users about the data collected by these apps and their management. Contact tracing is of paramount importance when dealing with a pandemic, as it allows for rapid identification of cases based on the information collected from infected individuals about other individuals they may have had recent contact with. Advances in digital technology have enabled devices such as mobile phones to be used in the contract-tracing process. However, there is a potential risk of users' personal information and sensitive data being stolen should hackers be in the near vicinity of these devices. Thus, there is a need to develop privacy-preserving apps. Meanwhile, privacy policies that outline the risk associated with the use of contact-tracing apps are needed, in formats that are easily readable and comprehensible by the public. To our knowledge, no previous study has examined the readability of privacy policies of contact-tracings apps. Therefore, we performed a readability analysis to evaluate the comprehensibility of privacy policies of 7 contact-tracing apps currently in use. The contents of the privacy policies of these apps were assessed for readability using Readability Test Tool, a free web-based reliability calculator, which computes scores based on a number of statistics (ie, word count and the number of complex words) and indices (ie, Flesch Reading Ease, Flesch-Kincaid Reading Grade Level, Gunning Fog Index, and Simplified Measure of Gobbledygook index). Our analysis revealed that explanations used in the privacy policies of these apps require a reading grade between 7 and 14, which is considerably higher than the reading ability of the average individual. We believe that improving the readability of privacy policies of apps could be potentially reassuring for users and may help facilitate the increased use of such apps.

Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review.

BACKGROUND: In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. OBJECTIVE: The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. METHODS: To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: "NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID" and "mHealth OR eHealth OR text". Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. RESULTS: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. CONCLUSIONS: The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms.