Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context

This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team's maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.

A qualitative study of older adults' experiences of embedding physical activitywithin their home care services

Background: Physical activity programmes have been shown to improve older adults' functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the 'Care to Move' (CTM) programme. The aim of this qualitative study is to explore older adults' experiences of the CTM programme. Methods: We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results: Four themes emerged: i) 'I'm feeling good about it', ii) 'safety and security is the name of the game', iii) 'we're a team as it stands', iv) 'it's [COVID] depressing for everybody at the moment'. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA's in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery. Conclusion: Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.

Håndvask og fællessang Ritualer og ritualiserede handlinger i Coronaens tid

Based on data from the COVID-19 survey this article investigates how the pandemic has influenced the performance of rituals in Denmark. Based on a theoretical account of a number of theories of ritual, we present a heuristic model of the five dimensions of ritual: (1) the efficacy of ritual;(2) the meaning of ritual;(3) the coping potential of ritual;(4) the social solidarity dimension of ritual;and (5) anxiety reducing dimension of ritual. These five dimensions are then used to interpret the results of the quantitative survey. In particular, we direct our attention to potential ritualized properties of new instrumental behavior such as hand sanitation;to changes in both collective and private rituals as well as to the new virtual rituals;and, in particular, on how virtual community singing has flourished as a ritual of social cohesion. We conclude that the COVID-19 pandemic only to a limited degree has influences the attitude towards and use of rituals, and that the huge popularity of virtual community singing during the first wave of the pandemic in spring 2020 is the singular, most important ritual innovation. © 2021 Aarhus Universitet. All rights reserved.

Historiske og teoretiske baggrunde for COVID-19-pandemiens påvirkning af den danske befolkning

In this article, we present the historical and theoretical context informing the investigation into how the COVID-19 pandemic has influenced religiosity in Denmark. We have chosen four foci, each of which contributes to the formation of a historical and theoretical context. First, we embed representations of death within a broad horizon informed by history of religion and cultural history. Beginning with early Christianity's ascent in a cult of the dead and, later, a cult of saints, to the change from burials inside the church to graveyards, we track the coinciding weakening of representations of the afterlife in the modern era. This naturally leads to a discussion of two prior cases in which an epidemic has elicited reactions from Evangelical-Lutheran Church in Denmark: The Cholera epidemic of 1853 and the Spanish Flu in 1918-20. Then we expand our line of inquiry to a more general discussion of how major theories in the Study of Religion have modelled the relation between religion, death and suffering. Following a short introduction to how the human consciousness of death has been conceived as a major causal factor in both the emergence and maintenance of religious beliefs and institutions by major theoreticians of religion, we discuss a number of more recent psychological and sociological theories, that have informed the theoretical foundation of our investigation. In order to capture the praxis dimension of religion, we shortly discuss the particular role of ritual, before, finally presenting the 16 research questions that informed the construction of our survey. © 2021 Aarhus Universitet. All rights reserved.

COVID-19-krisen: Forløb og bekymringer

This article offers an overview over the political steps and containment proceedures during the first months of the COVID-19 pandemic in Denmark 2020. © 2021 Aarhus Universitet. All rights reserved.

We Didn't win the battle, but we are gonna win the war!

Funding is not always essential for performing good and relevant research, but it helps. Funding frees additional time and resources, as well as co-production and co-creational processes that may not be available to individual researchers alone but may grow from larger research collaboration. In 2019, we were both involved in an application for funding of the development of a Critical Pandemic Response (CPR) exercise. The aim was to improve multinational preparedness, cooperation, collaboration and response to the possible spread of public health risks and test a validated exercise model. The case was a pandemic. At the last minute, we were unable to apply due to unexpected causes. Little did we know how spot on our initiative was back then with the COVID-19 outbreak in December 2019. Copyright © 2020 Author(s).

Barriers and facilitators for implementing paediatric telehealth: Rapid review of user perspectives

Introduction: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telehealth for pediatric care incorporates additional layers of complexity compared with adult services for a variety of reasons including logistical, privacy, parental consent, child assent, child welfare, and quality concerns. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telehealth to pediatric services generally, or how users perceive these issues. Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing pediatric telehealth, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analyzed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesized. Results: We identified 27 eligible studies (19 quantitative;5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/ or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telehealth champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favorably. Concerns from parents included the responsibility of describing their child's condition in the absence of an examination. Conclusion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate pediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.

Cardiac mri productivity increases with high-quality structured pre-appointment telephone contact

Background Cardiac MRI is often an essential component for the diagnosis and follow-up of cardiac disease in both children and adults. These studies can be time intensive and often require anesthesia support. Unlled cardiac MRI appointments therefore unnecessarily delay availability and decrease productivity. At our institution, we recognized a backlog of cases due to a high number of patients canceling 2-4 days before the appointment during the pre-procedural telephone screening or simply not keeping their appointments. Such late cancelations were often unable to be lled due to a variety of barriers. This quality improvement project sought to increase the utilization of cardiac MRI by implementing new communication procedures prior the patient's study. Methodology A cardiology nurse was tasked with contacting each scheduled patient 21 days prior to their MRI and requiring conrmation within 7 days that the patient would be able to attend. In cases where a patient was unable to conrm, they were rescheduled, and their spot lled with another patient from the wait list who was able to conrm. To evaluate this intervention, we tracked service utilization for the 7 months before implementation of this policy, and for 10 months afterwards, up until the routine outpatientservice was suspended due to the COVID-19 pandemic. Monthly utilization was charted on a statistical processcontrol X-chart with control limits set at +/- 2.66 moving range averages. Consecutive data points above orbelow the mean indicated special cause variation, resulting in a shift of the mean line. Results and DiscussionThere was special cause variation associated with the new communication procedure, resulting in a signicantincrease in the average number of monthly studies from 18 to 24.3. Our utilization of available appointmentsalso increased from 59.4% to 75.3% following the policy change. A second shift back to baseline occurred onceour patient backlog was exhausted, though the utilization of available appointments remained slightly higherthan baseline at 64.2%. These results suggest that with this new policy, our cardiac MRI service can be run at autilization rate which exceeds our current demand. Future directions for improvement may include re-allocating cardiac MRI slots for other services, or adding other types of MRI into our waiting list. ConclusionOur policy intervention of calling all patients 21 days prior to their cardiac MRI studies to conrm theirappointments, resulted in a signicant improvement in service utilization. This persisted until our backlog of cases was exhausted, and suggests that this intervention allows our service to run at a utilization rate whichexceeds our current demand.