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BACKGROUND: Global healthcare systems have been particularly impacted by the COVID-19 pandemic. Healthcare workers (HCWs) are widely reported to have experienced increased levels of baseline psychological distress relative to the general population, and the COVID-19 pandemic may have had an additive effect. However, previous studies are typically restricted to physicians and nurses with limited data available on hospital HCWs. We aimed to conduct a cross-sectional, psychological evaluation of Irish HCWs during COVID-19. METHODS: HCWs across five adult acute level-4 Dublin-based hospitals completed an online survey of wellbeing and COVID-19 experience. RESULTS: There were 1898 HCWs who commenced the survey representing 10% of the total employee base. The sample comprised nurses (33%), doctors (21%), Health and Social Care Professionals (HSCPs) (24%) and 'Other' disciplines (22%), and 81% identified as female. Clinical levels of depression, anxiety and PTSD symptoms were endorsed by 31%, 34% and 28% of respondents, respectively. Professional grouping effects included: nurses reporting significantly greater levels of COVID-19 exposure, infection, COVID-fear, moral injury, and post-traumatic distress; HSCPs were significantly less likely to report mood dysfunction. In terms of gender, males were significantly less likely to report negative pandemic experiences, low resilience, and significantly more likely to endorse 'minimal' depression, anxiety, and traumatic distress. Logistic regression modelling revealed mental health outcomes (depression, anxiety and PTSD symptoms) were associated with increased frontline exposure, fewer career years' experience, elevated pre-pandemic stress, and female gender. DISCUSSION: To our knowledge, this is the largest evaluation of psychological wellbeing amongst HCWs in acute hospitals in the Dublin region. Our findings have implications for healthcare workforce wellbeing and future service delivery.
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COVID-19 pandemic mitigation measures, including travel restrictions, effectively limited global circulation of influenza viruses for much of 2020 and 2021. Travel bans and quarantine requirements were lifted on 1 November 2021 enabling recirculation of influenza. In Victoria, follow up of early influenza cases detected Dec-Feb revealed a history of travel or contact with a recent traveller. Cases were few during the Omicron epidemic in January-February. However, in late March, there was a sharp increase in cases, which in Victoria was associated with an outbreak in university residential colleges. Genomic sequencing supported a likely point-source outbreak that spread throughout the state and to other jurisdictions. In the Northern Territory and New South Wales circulation of A(H1N1)pdm09 preceded circulation of A(H3N2) and was associated with a high rate of paediatric hospitalisations. Both the A(H1N1)pdm09 and A(H3N2) viruses that circulated were well matched to the vaccine, but the early onset of the epidemic meant that many cases were infected prior to availability of vaccines in April. Nationally, circulation declined sharply in June-July coincident with another COVID-19 wave. Circulation of influenza may continue to be disrupted by SARS-CoV-2 epidemics until it establishes a seasonal pattern, which may impact seasonal influenza preparedness. Copyright © 2021
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Introduction: Due to an increase in heroin use and subsequent high demand for treatment services, community pharmacies are nearing saturation for opioid supervision services for patients on buprenorphine. The Covid-19 pandemic exacerbated this issue, highlighting the need for alternative forms of opioid substitution therapy (OST). Buvidal is a long-acting injectable form of buprenorphine for the treatment of opioid dependence. It comes in two formulations - weekly or monthly subcutaneous injection. The availability and use of Buvidal would help to reduce pressure on community pharmacy and provide an alternative treatment option to assist patients in their recovery journey. Aim(s): To provide safe and consistent service for the administration of Buvidal across Northern Ireland (NI). Objective(s): The development of a regional pathway to provide a framework to: ** Better support clinicians to initiate and use Buvidal safely and effectively. ** To ensure adequate physical health checks are carried out at initiation. ** To improve documentation. ** To ensure equitable care for all patients prescribed Buvidal across Northern Ireland. Method(s): ** Mental Health Pharmacists from each trust in NI met to determine the feasibility of introducing Buvidal . ** The group met with the Department of Health regarding the CD regulatory requirements in outpatient settings. ** The group met with the Health and Social Care Board (HSCB) to secure funding for Buvidal ** A regional pathway and kardex were developed to ensure consistency of prescribing across trusts. ** The pathway was shared with the addiction teams and prison services across NI for agreement. ** Adjustments were made and the pathway was piloted in different regions. Result(s): ** An agreed regional pathway for Buvidal developed. ** A regional kardex for Buvidal was developed. ** Funding was approved for each trust. ** A mixture of stock orders and individual patient prescriptions are used for the ordering of Buvidal across trusts. ** An electronic care record alert was developed for all forms of OST. ** Feedback was requested from those prescribed Buvidal and of those who responded 95% stated their life has improved on Buvidal and would recommend it to a friend. Discussion(s): Following initial reluctance for the need of a regional pathway and kardex it has now been established ensuring consistency across all trusts with regards to prescribing, baseline tests and advice a patient receives prior to the commencement of Buvidal . Staff have fed back that Buvidal use has been a positive service development and particularly beneficial for chaotic patients who struggled to go to the community pharmacy each day. They find the assessment page useful but the kardex can cumbersome at initiation and as such work is ongoing to streamline this. Conclusion(s): Buvidal is now prescribed across NI providing an alternative form of OST to patients. The regional mental health pharmacist group played a strategic role in developing this new service. This has exposed the addictions teams to the potential a pharmacist can play within their team resulting in the recruitment of addictions pharmacists in some trusts. The initial forecasted numbers were quickly exceeded resulting in ongoing service expansion. Consideration is now being given to the administration of Buvidal by community pharmacies in NI. The OST alert now available on NIECR improves communication at interfaces to highlight those patients prescribed OST.
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The COVID-19 pandemic has drastically affected how higher education operates, but relatively little is known about its effects on students enrolled in remote online classes. Across two data collection timepoints, we sought to examine college students' experiences, focusing particularly on their sense of belonging/loneliness, their course formats, and their experiences in the pandemic. Though some findings differed between data collected in fall 2020 and in spring 2021, we generally found that students' belonging/loneliness was linked with their class format, aspects of their virtual classes, social contact, and experiences in the pandemic. This research demonstrates the importance both of understanding students' experiences in general and of continuing to study students' experiences as we progress from one stage of the pandemic to the next. © 2022, The Online Learning Consortium. All rights reserved.
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The Royal Hawaiian groin is located on Waikiki Beach, Hawaii, and anchors 1,730 linear ft (527 m) of critical beach in the heart of Waikiki. The groin was originally constructed in 1927, and by 2012 was in very obvious need of replacement. Rock rubble mound breakwater and groin construction has been traditionally used in Hawaii, and is aesthetically the desired construction methodology for coastal structures. Oceanographic design parameters were based on a potential direct hurricane strike and likely future sea level rise. The groin design is a hybrid structure;the base is composed of armor stone, and the crest is made of cast-in-place fiber-reinforced concrete. The groin is also adaptable to sea level rise by permitting a relatively easy increase in the concrete crest cap elevation without the need for heavy equipment to dismantle and reconstruct the groin. Construction in normally densely crowded Waikiki was going to be difficult;however, when construction started in May 2020 Hawaii was in COVID-19 lockdown, the hotels were closed, and Waikiki was empty, with no one to be impacted by closed beach access or construction noise. © 2022 by the American Society of Civil Engineers.
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This paper contains the research proposal of Samantha O'Sullivan that was presented at the MMSys 2022 doctoral symposium. The use of wearable sensors for the understanding and quantification of movement within research communities working on Parkinson's Disease (PD) has increased significantly in recent years with a motivation to objectively diagnose, assess and then understand the progression of the disease. Most studies taking this approach for PD have stated that there is a need for a long-term solution, due to varying symptoms at different stages of the disease. COVID-19 has brought further limitations in the delivery of clinical care, reducing time with therapists and doctors whilst increasing the preference for at-home care. The necessity for a system for patients with PD is extremely significant. There is no clinically available long-term assessment for tremors, which is an issue highlighted in the literature. By using wireless sensors to track tremor severity continuously, and telehealth to create communication between patient and clinician, this proposed system will allow for better targeted therapy, accurate statistics, and constant accessible data. In this context, this work will design, build, and evaluate a novel system that would allow for constant monitoring of a patient with tremors. By using wireless sensors and telehealth, it will provide more detailed data that may enable directed and informed physical therapy. It will also improve communication creating a data flow constantly between clinician and patient to improve person-centered feedback, and aid towards the diagnosis and assessment of disease progression. The incorporation of a mobile/cloud-based application to assist this is due to the current heightened preference for home-based healthcare, long-term evaluation of tremors and personalized physical therapy. The primary focus of the PhD will be on capturing tremor activity and progression through a telehealth-based system. This proposed system will obtain real-time readings of tremors using wireless sensors and an application that will communicate consistently with healthcare professionals. The aim will be to provide better home-based care, person-centered physical therapy and improve quality of life. © 2022 ACM.
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Wearable sensors are worn by subjects to allow for continuous physiological monitoring. The use of wearable sensors for the quantification of movement within research communities has increased in recent years, with the purpose of objectively assessing and diagnosing the progression of Parkinson's Disease (PD). Most studies taking this approach for PD have stated that there is a need for a long-term solution, due to individuals having varying symptoms at different stages of the disease. Furthermore, a preference for home-based care has increased in recent times due to COVID-19, with clinical care being highly effected due to cancellations, delayed appointments, or a reduction of time spent with patients. The necessity for a system for patients with Parkinson's is extremely significant. There is no clinically available long-term assessment for tremors, and how these systems can be used to assess and aid in a clinical environment is still underdeveloped. The proposed system which includes wireless sensors, and results based off the clinical scale used currently for tremor assessment, may allow for constant, real-time, and accurate monitoring of a subject with tremors. This will provide more detailed medical data to enable long-term assessment, diagnosis, as well as person-centered physical therapy. © 2022 ACM.
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Objective: This survey is the first part of a regional improvement project for Gynaecological surgical training in Ireland. Initial step to ascertain current opinions and confidence levels of trainees in gynaecological surgery and develop an understanding of their career goals. Design: Many surveys have been conducted on training within Obstetrics & Gynaecology. However, with the devastating impact on gynaecological surgical training from the COVID-19 Pandemic, a new vigour has emerged to assess this area, enhanced via the publication of the RCOG Gynaecological Surgery Recovery Plan. Ireland equally has felt the impact to surgical training and our project hopes to start to address this. This survey was designed with specific focus on gynaecological surgical training and to identify the key areas to focus the recovery process on. Designed using the SurveyMonkeyR platform and distributed via email. Methods: The survey was circulated to all O&G trainees in Ireland. The 34 questions focused on the number of procedures performed over last 12 months, confidence levels on performing these procedures alongside management of complications. Questions also assessed future career aspirations. The returned results were anonymised and analysis performed using a password protected ExcelR database. Results: We received 76 respondents, with 46% (n = 35) having worked in O&G for more than 5 years. A concerning 51% of trainees had contemplated leaving the specialty in the last 12 months. Only 20% (n = 16) of trainees had access to a Laparoscopic box trainer in their hospital and of these, only 38% (n = 29) received dedicated teaching on the trainer. The only laparoscopic procedure in which >50% of trainees felt comfortable performing was Veres entry at laparoscopy. Two thirds of respondents (n = 51) believed that the lack of gynaecological surgery training has impacted decisions on future career choices. 43% of SpR (ST4-8) trainees experienced difficulty in annual training progression due to a lack of surgical numbers. 95% felt a forum for surgical education and career guidance was needed. Conclusions: Trainees are significantly impacted by a lack of surgical exposure and training. This has understandably affected their confidence but also career planning, which may in turn affect national workforce structure and patient care. Our project design has moved forward using this survey information to develop a regional laparoscopic simulation hub in Dublin following the award of funding from the Mater Hospital Foundation and SPARK initiative. A pilot programme for trainees will be offered from January 2022.
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The test-negative design has been used to estimate influenza vaccine effectiveness (VE) for many years and has more recently been employed for the estimation of COVID-19 VE. In these studies, patients meeting a pre-specified clinical case definition are tested for the disease of interest. Vaccine coverage is compared between those testing positive versus those testing negative to estimate VE. The key advantage of the test-negative design is cost-it can easily be incorporated into surveillance systems or applied to health management data if diagnostic and vaccination records are available. The design has been extensively validated for influenza but its adoption for COVID-19 has not always been accompanied by an assessment of its suitability to the data available. Blind application of the design may not overcome serious validity issues, especially when using administrative data. First, the test negative design reduces selection bias associated with differential health care-seeking behavior by vaccination status when patients are recruited based on clinical criteria thereby confirming they would have presented for testing when ill irrespective of vaccination. In studies where patients are tested for reasons other than symptoms, vaccine coverage in the test-negatives may not be representative of the source population. Second, the test-negative design should reduce outcome misclassification, because all participants are tested for the disease of interest. However, in the context of low prevalence or the use of less sensitive and less specific rapid antigen tests, the probability of misclassifying a case may increase. Third, test negative studies may be vulnerable to exposure misclassification, particularly when vaccination records must be linked to testing or case management records. Finally, test-negative studies cannot overcome the bias associated with confounding if relevant variables are unmeasured. For example, in a tiered vaccination framework, which prioritizes high-risk groups, information about vaccination eligibility is required for appropriate adjustment. The extent to which these biases might distort VE estimates will be explored using causal graphs and simulations. Rapid dissemination of COVID-19 VE estimates has been vital for ongoing pandemic management, but the speed with which estimates can be made should not come at the expense of validity.
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Background: The COVID-19 pandemic adversely affected socially vulnerable and minority communities in the US initially, but the temporal trends during the year-long pandemic remain unknown. Objective: We examined temporal association between county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in US in the year starting in March 2020. Methods: Counties (n=3091) with > 50 COVID-19 cases by March 6th, 2021 were included. Associations between SVI (and its subcomponents) and county level racial composition with incidence and death per capita were assessed using a negative-binomial mixed-effects model. This model was used to examine potential time varying associations between weekly number of cases/deaths and SVI or racial composition. Data was adjusted for percentage of population aged ≥65 years, state level testing rate, county-level comorbidities, and environmental factors. Results: Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio [IRR] per-10 percentile increase:1.02, (95% CI 1.02, 1.03, p<0.001), and death per capita (1.04, (95% CI 1.04, 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by winter, a period that coincided with sharp increase in infection rates and mortality, and when counties with higher proportion of White residents were disproportionately represented (“third wave”). By Spring 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of Blacks also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanics had worse outcomes throughout the duration of the analysis. Conclusion: Except for winter “third wave” when majority White communities had highest incidence of cases, counties with greater social vulnerability and higher minority populations, experienced worse COVID-19 outcomes.
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Background Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture. Methods Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants. Results The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions. Conclusion This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
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Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.
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Introduction: Ethylene glycol (EG) poisoning occurs over 5000 times annually in the US, but a poisoning outbreak (3 cases within 72 hours) has not previously been reported. We describe on an EG poisoning outbreak in January 2021, presenting at William Beaumont Army Medical Center. Case Description: Eleven soldiers presented to the emergency room over a twelve hour period after ingestion of an unknown alcohol, later identified as radar cooling fluid containing EG. Only the first two patients were symptomatic. Serum EG levels were not immediately available, therefore treatment decisions were based on surrogate markers (arterial pH, anion [AG] and osmolar [OG] gaps, serum bicarbonate [TCO2], lactate [Lac], and creatinine [sCr]). Discussion: Two patients received immediate hemodialysis (HD) in combination with fomepizole (FOM) due to severe acidosis plus elevated OG and AG (Table). These patients developed acute kidney injury (AKI) with renal recovery occurring within a 3-week period. Two patients with elevated Lac received bicarbonate-based intravenous fluids (IVF) and FOM. Two patients received IVF only and required prolonged observation for worsening acidosis and/or AKI. Five patients with normal lab values were treated with IVF and observation. All patients received cofactors including thiamine and pyridoxine. All patients survived. The outbreak occurred in the setting of limited dialysis resources and FOM availability and in a community with widespread COVID-19 activity. Additional guidelines are needed to determine allocation of limited resources and optimal dialysis and FOM treatment course, and identify comorbid conditions which may prolong recovery. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government.
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We demonstrate the use of Nitride semiconductors as the light emitting layer in a series of devices, from Visible emitting LEDs, to far-UVC LEDs and novel light emitting devices. © 2021 SID.