"I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer.

PURPOSE: Patients with advanced cancer experience many complicated situations that can make self-advocacy (defined as the ability speak up for yourself in the face of a challenge) difficult. Few self-advocacy interventions exist, and most are atheoretical with minimal patient engagement. The purpose of this study is to describe participant perspectives of a novel, self-advocacy serious game intervention called Strong Together. METHODS: This was a qualitative cross-sectional descriptive study among women receiving cancer care at an academic cancer center within 3 months of an advanced gynecologic or breast cancer diagnosis. Participants randomized to receive the intervention completed one-on-one semi-structured interviews 3-months post Strong Together and had the option to share voice journals about their experiences. Inductive qualitative approaches were used to descriptively analyze transcripts and voice journals. Descriptive content analysis approaches were used to group similar codes together into themes summarizing participants' experiences engaging with the Strong Together intervention. RESULTS: Participants (N = 40) reported that the Strong Together intervention was acceptable, noting that it was realistic and reflective of their personal experiences. Overarching themes included seeing myself in most scenarios and wanting more content; giving me the go ahead to expect more; offering ideas for how to stand up for myself; reinforcing what I am already doing; and reminding me of what I have. Participants suggested adding additional content including diverse characters. CONCLUSION: This study demonstrated that women with advanced cancer were receptive to a self-advocacy skills-building intervention. Future research should explore the mechanisms linking serious games to learning and health outcomes.

Effects of the Perceived Risk of Contracting COVID-19 on Nursing Students' Well-Being.

BACKGROUND: Although mental health symptoms increased during the coronavirus disease 2019 (COVID-19) pandemic, little is known about the associations between nursing students' perceived risk of contracting COVID-19 and their academic and psychological well-being. This study examined associations between perceived COVID-19 risk, likelihood of completing nursing education, and mental health factors of nursing students. METHOD: A total of 979 nursing students completed self-report measures of perceived COVID-19 risk, anticipated academic completion, anxiety and depressive symptoms, stress, coping self-efficacy, hope, and social support. RESULTS: Students with higher perceived COVID-19 risk reported increased anxiety and depression as well as decreased likelihood of graduating, coping self-efficacy, and levels of social support. CONCLUSION: Findings indicate the need for increased mental health support for nursing students for successful completion of their programs. Educators should increase support and proactively strengthen positive psychology factors to mitigate the effects of COVID-19 and other crises on nursing students' well-being. [J Nurs Educ. 2022;61(11):641-645.].

Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19.

Objectives: To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. Design: Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU). Setting: A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021. Interventions: Not applicable. Main Outcome Measures: Types and themes of hallucinations. Results: Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay. Conclusions: More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.

CA-125 monitoring in gynecologic cancer patients with COVID-19: A case series (413)

Objectives: CA-125 has long been utilized as a marker for gynecologic malignancies but can be elevated in many other inflammatory conditions, including lung disease. A retrospective study of tumor markers in non-cancer patients saw a rise in CA-125 values during severe COVID-19 infections. Similarly, a case report published on June 17, 2020, described a significant rise in CA-125 values during an ovarian cancer patient’s COVID-19 infection without evidence of disease progression. Given the potential confounding effect this could have on surveillance and treatment planning, we sought to describe the impact of COVID-19 infections on CA-125 trends in a gynecologic oncology patient population. Methods: We conducted a retrospective chart review of patients treated at a UPMC hospital during the COVID-19 pandemic from March 2020 through July 2021. Patients were included for analysis if they had a confirmed gynecologic malignancy, a COVID-19 infection, and had more than one CA-125 value drawn. The CA-125 values were plotted against the timeline of their COVID-19 infections to assess for trends in CA-125 values during and after infection. Results: There were 78 individuals identified with a COVID-19 infection and a CA-125 drawn following their positive COVID-19 test. Of these 78 patients, 18 had both gynecologic malignancy and more than one CA-125 drawn. Of these 18 patients, only one had an appreciable rise in their CA-125 values at the time of their COVID-19 diagnosis that resolved following their infection and could not be attributed to disease progression. Four patients were diagnosed with cancer at the time of COVID-19 diagnosis and had elevated CA-125 values. One patient passed before receiving treatment, and the other three had CA-125 values that trended down as they received treatment for their cancer. Two patients were noted to have a mild rise in their CA-125 at the time of their COVID-19 infection that continued to rise as they were diagnosed with the progression of their cancer. Most of the 18 patients (n=11, 61.1%) did not show an increase in CA-125 coinciding with their COVID-19 infection. They had either stable or decreasing CA-125 at the time of and following their COVID-19 diagnosis. Conclusions: This case series illustrates that while CA-125 values may increase during acute COVID-19 infection, cancer remains the most likely cause of a CA-125 increase. Clinical suspicion should remain high for a possible change in cancer status.

Virtual transition to leadership course: supporting senior house officers to step up as registrar in paediatric training through the COVID-19 pandemic

AimsTransition to Leadership course (T2L) is a well-established educational programme endorsed by RCPCH, aimed to guide senior house officers (SHOs) developing into paediatric registrars. Due to the Covid-19 pandemic, this face-to-face course was converted to the free virtual 3 days course since 2020, open to paediatric trainees national-wide. This course offered easily accessible online resources with educational materials and recordings, serial webinars and small group working based on clinical scenarios. The first course in 2020 was well-received with positive impacts (published in 2021 RCPCH conference). The faculty has taken recommendations from the candidates and modified the course contents in line with efficient virtual teaching with more comprehensive online resources. We evaluated the effectiveness of this virtual training, especially in boosting a confidence level in candidates in multiple domains in becoming a paediatric registrar.MethodsWe hosted two online courses in 2020 and 2021 during the height of the COVID-19 pandemic, made available national-wide. For the 2021 course, candidates were asked to fill two questionnaires based on the 4-point Likert scale, before and after the course. The questionnaire entailed 10 domains of being a great paediatric registrar such as dealing with common neonatal and paediatric presentations, leading resuscitations, child death, conflict, leading at night, dealing with mistakes, consents, calling consultants, safeguarding. We asked candidates in their confidence level before and after the course and their responses have been analysed using a paired T-test.ResultsA total of 39 anonymised and paired responses was received for analysis from pre and post course questionnaires. There was a significant increase in candidates’ confidence in almost all the domains;common neonatal problems, knowing when to call consultants, leading a team, dealing with mistakes and coping with a greater amount of responsibility and accountability (p<0.05). Even more significant benefit was seen in domains such as managing cases with safeguarding concerns, difficulties regarding consent and death in children (p<0.005). Confidence in dealing with common paediatric problems and leading a resuscitation did not change significantly, since SHOs are more frequently exposed to these scenarios. The difference in pre and post course survey on their overall confidence level to a specific question ‘How well prepared do you feel to become a paediatric registrar?’ was extremely statistically significant (p-value = 0.0002, confidence interval: -0.93 to -0.31).In the post course questionnaire of 60 responses, 56% would like to attend the course face-to-face, which remained similar to the last year of 53%. A remarkable 98% of candidates agreed that this course should be a mandatory training to aid the transition from SHOs to paediatric registrars.ConclusionFor 2 years in a row, T2L course from LSP helped SHOs transitioning to become paediatric registrars in a virtual set-up during the COVID-19 pandemic. We demonstrated that candidates gained significant confidence in multiple domains in their preparation to step up to a senior role.As we are rising from the pandemic as a society, we envisage to offer a hybrid programme with our well-established online resources, face-to-face peer discussion and networking in the future.

CA-125 monitoring in gynecologic cancer patients with COVID-19: A case series.

CA-125 has long been utilized as a surveillance biomarker for gynecologic malignancies but can be elevated in other conditions, including infection. A study of tumor markers in non-cancer patients saw a rise in CA-125 values during severe COVID-19 infections. Given the potential confounding effect this could have on surveillance and treatment planning, we sought to describe the impact of COVID-19 on CA-125 trends in a gynecologic oncology patient population. We conducted a retrospective chart review of patients treated at a UPMC hospital during the COVID-19 pandemic from March of 2020 through September of 2021. Patients were included for analysis if they had confirmed uterine or ovarian malignancies, a COVID-19 infection and more than one CA-125 value drawn within one year of their COVID-19 diagnosis. The CA-125 values were plotted against the timeline of their COVID-19 infections to assess for trends in CA-125 during and after infection. There were 17 patients who met the above criteria. Of these 17 patients, three had a rise in their CA-125 trend at the time of their COVID-19 diagnosis. Another three had newly elevated CA-125 values, without a prior documented baseline level, at the time of their infection. In all six of these patients, their CA-125 elevations could be attributed to malignancy. The remaining 11 patients showed stable or decreasing CA-125 values coinciding with their COVID-19 infection. This case series illustrates that while CA-125 values may increase during an acute COVID-19 infection, cancer remains the most likely cause of a CA-125 increase. Clinical suspicion should remain high for a possible change in cancer status.

Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection Part 1: Cognitive functioning.

OBJECTIVE: Long-term cognitive sequelae of COVID-19 have not been extensively studied. This study provides initial results on cognitive outcomes in Post-Acute Sequelae of COVID-19 (PASC).Participants and Methods: This study examined 53 consecutive outpatients diagnosed with COVID-19. Four participants were excluded due to performance validity test failure. All participants had positive COVID-19 tests, reported cognitive concerns, and completed neuropsychological tests to assess performance validity, attention/working memory, processing speed, memory, language, visual-spatial, executive functioning, motor, and emotional functioning. The sample was mostly white (89.8%), female (83.7%), and never hospitalized (69.4%) for COVID-19. RESULTS: Analyses indicated no mean scores in the Impaired range (>2 standard deviations [SD] below normative mean) on objective cognitive testing and a low base rate of Impaired test scores. Higher (>20%) base rates of Borderline performance (1-2 SDs below normative mean) were found on some measures. There was also evidence for frequently elevated mean scores on mood measures which correlated with some cognitive measures and the number of Borderline scores per participants. CONCLUSIONS: The results were noteworthy for infrequent Impaired scores, and significant correlations between cognition and mood/anxiety measures, but not between cognitive performance and premorbid vascular risk factors, psychiatric diagnoses, or COVID-19 disease severity. Results suggest that psychological distress was prominent in PASC and related to objective cognitive performance, but objective cognitive performance was unrelated to cognitive complaints. Other contributing factors may include fatigue/sleep issues. Neurologically based cognitive deficits were not suggested by the results.

Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection part 2: Psychological functioning.

Limited research investigating the long-term psychological and emotional correlates of COVID-19 infection has been completed. The current study begins to address this limitation in patients experiencing Post-Acute Sequelae SARS-CoV-2 (PASC; e.g. "Long COVID").Participants were 43 consecutive neuropsychological outpatients diagnosed with PASC and who completed the Personality Assessment Inventory (PAI). The sample was predominantly female (n = 36) and white (n = 32). Effect sizes compared to the normative mean T scores and base rates of elevated (T > 69) scores were calculated.PAI scales measuring somatic preoccupation and depression had large effect sizes and the highest base rates of scale elevations, with the mean T score at approximately the normative cutoff for clinical significance (T = 70). The Schizophrenia Thought Disorder subscale (SCZ-T) also had a large effect size and high base rate of elevation, likely reflecting cognitive concerns. Scales measuring anxiety had medium effect sizes. The other PAI scales generally had small to negligible effect sizes. There were no significant differences between hospitalized and non-hospitalized participants on the PAI.Overall, PAI scales measuring psychological distress, particularly somatic preoccupation and depression, were the most frequently elevated in the participants. The specific reasons for somatic preoccupation could not be determined in this study. Potential explanations include a vulnerability to distress in Long COVID patients, premorbid somatic preoccupation perhaps motivating these patients to seek clinical attention, or socioenvironmental factors leading some COVID patients to be somatically preoccupied with minor physiological changes and attribute those changes to COVID-19.

Adapting to the Changing Needs of Family and Consumer Sciences Students: Instructor Perspectives during the Pandemic

In March 2020, the pandemic brought significant changes to higher education modalities. This paper examines how family and consumer sciences (FCS) instructors in a comprehensive, multi-disciplinary department at a large 4-year university modified instruction and related activities as a response to the pandemic. Using the Family and Consumer Sciences Body of Knowledge as a framework, we illustrate approaches to meet students' basic needs and support their individual well-being during the crisis, and we provide a detailed description of changes in instructional strategies across different disciplines within the department. We highlight the lessons learned by instructors during the transition to fully online instruction and provide suggestions for other FCS programs moving forward.

Promoting early diagnosis and recovering from the COVID-19 pandemic in lung cancer through public awareness campaigns: learning from patient and public insight work.

COVID-19 has had a devastating impact on outcomes in lung cancer leading to later stage presentation, less curative treatment and higher mortality. This has amplified the existing problem of late-stage presentation in lung cancer and is a call to arms for a multifaceted strategy to address this, including public awareness campaigns to promote healthcare review in patients with persistent chest symptoms. We report the learning from patient and public insight work from across the North of England exploring the barriers to seeking healthcare review with persistent chest symptoms. Members of the public described how a lack of importance is placed on the common symptoms of lung cancer and a feeling of being unworthy of review by healthcare professionals. They would feel motivated to seek review by dispelling the nihilism of lung cancer and would be able to take action more easily by removing the logistical hassle in the process. We propose a four-pillar framework (validation-endorsement-motivation-action) for developing the content of any public awareness campaigns promoting early diagnosis of lung cancer based on the findings of this comprehensive insight work. All providers and commissioners must work together to overcome the perceived and real barriers to patients with persistent chest symptoms.

Preterm birth among Pacific Islander women and related perinatal outcomes: a scoping review protocol.

INTRODUCTION: Infants born alive <37 weeks are classified as premature. The global estimate of preterm birth in 2014 was 10.6%, and it is the leading cause of death of children under the age of 5 years. Preterm birth disproportionately affects women of minority populations, yet knowledge about the incidence and associated outcomes among Pacific Islanders is limited. The objectives of this scoping review are to identify studies that describe risk factors, maternal-child health outcomes and existing interventions to prevent preterm birth among Pacific Islanders, and to summarise the barriers and facilitators to decrease the burden. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute Manual for Evidence Synthesis for scoping reviews and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) to conduct this scoping review. The Covidence web application will be used for data management and consensus review. We will search on MEDLINE ALL (Ovid), EMBASE (Ovid), Web of Science Core Collection (as licensed at Yale), the Cochrane Library, CINAHL (EBSCOhost) and two non-indexed regional journals (Pacific Journal of Reproductive Health and Pacific Health Dialog). Title-abstract and full-text screening of eligible studies will be performed by two authors, and data will be extracted by the first author. Outcomes extracted will be presented using evidence mapping. ETHICS AND DISSEMINATION: Findings will drive suggestions for new data collection needed to fill knowledge gaps and improve future study designs to decrease the burden of preterm birth among Pacific Islanders. There are no ethical concerns. This protocol will be disseminated in related peer-reviewed journals.

An ST1 induction event in the era of COVID-19: lessons learnt

BackgroundPaediatric trainees organise an annual induction day to welcome new ST1 trainees across multiple sectors of the deanery. This event aims to prepare trainees not only to survive, but also to thrive, encouraging them to feel inspired and enthusiastic about their training journey. It is always well attended and has received consistently excellent feedback. Other deaneries have found it to be a key means of disseminating information not provided through other sources. Since up to 100 trainees were predicted to attend the 2020 event, the COVID-19 pandemic presented a challenge.ObjectivesTo design and run a virtual induction event for new ST1 trainees, whilst maintaining the success and positivity of previous face-to-face events.MethodsAttendees were surveyed in advance to allow the organisers to tailor the event to their needs, worries and interests. The event was discussed with key stakeholders within the relevant deaneries. In accordance with the feedback received, the event was tailored to suit a virtual platform.The induction ‘day’ was shortened to half a day and individual sessions were limited to maintain momentum and engagement. In light of the current events surrounding Black, Asian and minority ethnic groups, it was deemed important to include a new session focused on this topic. Traditionally, the chance to meet other trainees starting at the same Trust was a highlight of the event. Breakout groups were designed to facilitate this virtual meeting. A handbook and YouTube channel were created to complement the day, covering content which could not be included in the live event, and as an additional resource for the year ahead.ResultsThe virtual event received extremely positive feedback. Of 107 new ST1 trainees in the region, approximately 95 (88.8%) attended, and 68 (71.5% attendees) provided feedback. 92.6% of trainees felt more prepared to start training following the event. Trainees scored how prepared they felt before and after the event using a five-point Likert scale, with a mean increase in their score of 1.12 following the event (p<0.01).83.8% felt that the event worked well virtually, particularly highlighting the value of the breakout session, live chat and dedicated Q&A session. They rated the opportunity for networking as the most useful aspect of the event, and fed back that the enthusiasm and preparation by the team facilitated a smooth event. The newly-created resources were also considered relevant and useful.76.5% attendees said they would prefer a face-to-face event. They felt that opportunities for networking were more limited with fewer opportunities for questions.ConclusionsThe COVID-19 pandemic necessitated the transformation of the annual ST1 induction event to a virtual platform. A pre-questionnaire was crucial in identifying needs and concerns of trainees, enabling the event to be tailored accordingly. The networking element was retained through the use of breakout groups, and the enthusiasm of organisers and speakers continued to shine through. An overall positive atmosphere and engaging event was commended in feedback from trainees, proving the event to be successful in overcoming challenges presented by the current climate.

Supporting transition to leadership within a virtual learning environment

588 Table 1Comparison of candidates’ perceived competence ratings in various skills domainsRated Domain Mean Competency Rating (1–5) Pre-Course Post Course Mean Difference P value Knowing when to call my Consultant 2.98 3.22 0.23 0.050 Leading during a resuscitation 2.62 2.88 0.27 0.027 Managing conflict 2.57 2.78 0.22 0.046 Managing cases with safeguarding concerns 2.67 2.90 0.23 0.049 Difficulties regarding consent 2.37 2.80 0.43 <0.001 Managing when a child dies on the ward 2.07 2.70 0.63 <0.001 Leading and managing a team 2.92 3.08 0.17 0.106 Making mistakes and coping with increased responsibility and accountability 2.55 2.90 0.35 0.001 Control Domains Dealing with common neonatal problems 3.08 3.13 0.05 0.618 Dealing with common paediatric problems 3.12 3.18 0.07 0.464 ConclusionsOur newly curated virtual Transition to Leadership Course clearly provides SHOs with appreciable gains in core leadership and management attributes, as effectively as previous face-to-face courses, but with the ability to reach a much wider audience. Future courses must employ a blended-learning programme, creating easily accessible user-friendly online resources, alongside opportunities for peer discussion and networking, to deliver the best of both pre- and post- Covid-19 education models.

'Spending all this time stressing and worrying and calculating': marginal food security and student life at a Diverse Urban University.

OBJECTIVE: Food security status is a continuum ranging from high to very low food security. While marginal food security falls next to high food security on the spectrum, new quantitative research indicates marginal food security status is associated with negative health outcomes and poor academic performance among college students. Qualitative research focusing on college students experiencing marginal food security has not been conducted. The current study aims to qualitatively explore experiences of college students with marginal food security and to identify themes to better understand and provide context regarding how marginal food security impacts students. DESIGN: Students were recruited for semi-structured interviews with questions designed to study the challenges associated with students' food situations. All interviews were recorded and transcribed with themes identified via an inductive approach. SETTING: A large public university on the US west coast. PARTICIPANTS: Thirty college students. RESULTS: Key themes that emerged: purchasing cheap unhealthy foods, insufficient time to prepare and eat meals on a regular basis, stress and anxiety around the inability to eat healthy food and future health issues, self-perception of health when eating poorly along with physical symptoms and low academic motivation by not fully participating in their courses due to few healthy food options or missing meals. CONCLUSION: Marginal food security can potentially diminish students' health and their capacity to learn and succeed in their coursework. The results emphasise that students experiencing marginal food security should not be grouped with students experiencing high food security.