Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

Patient satisfaction and patient costs associated with telephone clinic appointments in Inflammatory Bowel Disease (IBD) following the pandemic

Background: Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Method(s): A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Result(s): 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either 'very satisfied' or 'somewhat satisfied' with their most recent telephone consultation, while 22 (6%) were either 'very dissatisfied' or 'somewhat dissatisfied'. 247/408 (61%) were also either 'very satisfied' or 'somewhat satisfied' with the ease of accessing further care if required, compared to 33/408 (8%) who were either 'very dissatisfied' or 'somewhat dissatisfied'. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future;147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was 5.55 (S.D. = 15.74, n=408), compared to 43.42 (S.D. = 31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion(s): Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments. (Figure Presented).

Awake Not Sleeping The Power of Storytelling to Activate Gender Equality and Respectful Relationships in Our Minds, Homes, and Communities

As the COVID-19 pandemic swept the world in 2020, UN Women Europe and Central Asia's Awake Not Sleeping: Reimagining Fairy Tales for a New Generation Initiative brought over 120 feminist writers and gender experts together through a series of online workshops and writers' circles. The key purpose of these workshops was to consider how gender inequality and its intersecting issues could be explored and reimagined in fairy tales and to support writers to create a decidedly different and transformative fairytale collection. Written from multiple perspectives this article describes the development and editing process that shaped this collection, the principle of care that was core to the initiative, and the importance of engaging storytelling with deep respect for the reflective and creative capacity of young readers. © 2022 by Wayne State University Press, Detroit, MI.

A new normal or the calm before the storm?

Background: One of the highest risk factors for morbidity and mortality for general surgery patients is having their surgery in the emergent rather than elective setting. Patients are presenting older, with often complex pathology on a background of multiple medical comorbidities and sometimes extensive surgical history. NELA (national emergency laparotomy audit) and similar projects have looked at assessing and improving upon the management of such cases. These have produced valuable data and improvement in outcomes but there remains a lack of information around the acuity of surgery and the provision of services in response to demand. This study sought to assess the number of NELA cases in hospitals around the UK and compare this to historical data pre-pandemic. Method(s): Acute trusts admitting adults under general surgery in England were identified from the online NHS Service Directory. This list was cross referenced with the National Emergency Laparotomy Audit (NELA) list of participating hospitals to check for completeness. This generated 123 acute trusts in England. Contact details for each trust's Freedom of Information (FOI) department was identified from publicly available data on each trust's website. Questions were submitted to the FOI via email for 112 trusts, and online form submission for 11 trusts. Responses were collected for 8 weeks from the date of submission and analysed in Microsoft Excel. Trusts were asked to provide the number of general surgery admissions, inpatient bed numbers and NELA numbers. These were cross-referenced with publicly available data from NHS and NELA websites. Comparisons were made to similar data from 2014. Result(s): 101 out of 124 trusts responded within the 8-week timeframe. 14,497 NELA cases were recorded from the national total of 21,846 stated in the NELA Year 7 report (66.36%). The mean number of beds reported per NELA case was 5.76 (+/- 1.46 CI 95%), with histogram peaking between 3 and 5 beds with a right skew distribution. The mean number of admissions per NELA case was 30.81 (+/- 3.29 CI 95%), with histogram data peaking between 21 and 26 admissions with right skew distribution. A comparison with data from 2014 can be seen below (table 1). Conclusion(s): The Covid-19 pandemic had significant and widespread effects on the provision of services but also to demand. We now know that presentations to hospital reduced as did subsequent inpatient admissions. Our study shows that the number of NELA cases decreased across England and this was independent of hospital size. The largest decrease was seen in quartile 2 followed by quartile 3 representing mid-sized hospitals. Whilst not certain it is likely that this decrease was secondary to the pandemic rather than any change in practices. The results from this study can be used to help hospitals and departments plan their provision of services and training. (Table Presented).

Establishing a new public hospital vitreo-retinal surgical service, during COVID: Our experience

Purpose: To assess the clinical impact and surgical outcomes of a new public vitreo-retinal (VR) service established at Liverpool Hospital, a tertiary trauma referral centre in Sydney, in the context of the COVID-19 pandemic. Method(s): A retrospective surgical audit of all patients who had VR surgery at Liverpool Hospital from January 2020 to January 2021. Result(s): During the inception year of the new service, two surgeons performed 106 operations. Specifically, during the COVID-19 related suspension of elective surgery 22 emergency vitrectomy operations were performed. Of all operations performed, n = 40 (38%) were emergency procedures. The most common pathology was retinal detachment n = 32 (30%), 12 of which had Proliferative vitreoretinopathy at presentation. This was followed by diabetic vitrectomy n = 20 (19%) and nondiabetic vitreous haemorrhage n = 12 (12%). 8 patients had dropped nuclei (5 referred from peripheral hospitals) and 3 patients had endogenous endophthalmitis. Indications for vitrectomy were compared to the UK National Ophthalmology Database Study. Our service performed more operations for diabetic vitrectomy, nondiabetic vitreous haemorrhage and endophthalmitis compared to the UK cohort, while rates of surgery for retinal detachment were similar. At one month postoperatively, uncorrected visual acuity had improved to 6/12 or better in 41 patients (39%). 12 patients (11%) had uncorrected visual acuity worse than 6/60 at the same postoperative period, with limitations identified as PVR re-detachment (5), silicone oil (4), aphakia (2) and corneal scar (1). Conclusion(s): The results of the inaugural year of this VR service demonstrate its viability, despite COVID-19, and clinical results comparable to international standards.

Moving into year 7: A pilot study to assess to the usefulness of an on-line group session to prepare young people with cystic fibrosis for transitioning to secondary school

IntroductionStarting secondary school is a big step for any child and their family but particularly so if they have a chronic condition such as cystic fibrosis (CF). Hospital teams can assist with the preparation required for the transition. CF is different from other chronic conditions with respect to holding transition events, as face to face events are not possible due to the risk of cross-infection of different organisms between patients. In order to overcome this, the CF team at Alder Hey Children’s Hospital created a virtual event named ‘MI7’ (Moving Into year 7).MethodEvents were held via video conferencing software and questionnaires sent to all participants before the event and afterwards. All patients in year 6 cared for by the Alder Hey CF network were invited to participate with a maximum of 7 young people per group. Packs were sent out beforehand. Sessions consisted of ice-breaker games and CF team led discissions.ResultsA pilot event was held in 2019. This was well-received and follow-up from the families was sought after the first term at secondary school. Unfortunately, due to the COVID pandemic, the event could not be held in 2020, but it went ahead in 2021 and 2022.There was a distinct difference between the event held in 2019 and 2021/22, in that everyone (the hospital team members, and the patients and their families) was much more familiar with participating in a virtual event, due to the way this practice had become commonplace during the COVID pandemic.Overall 22 people have participated in these events to date. 25% described being worried about going to secondary school. All young people gave at least one thing that they were worried about and the most common finding was getting lost (21%). The most common CF related worry was regarding taking creon and 12% cited this as a concern. Less than 25% of all concerns given related to CF with the remainder being more generic concerns.All participants stated that they enjoyed the event and most found it useful.ConclusionTransition events to help this patient population move from primary to secondary school are feasible, enjoyable for young people with CF and useful.

The patient and public involvement of adults with cerebral palsy in doctoral research during the pandemic: ref lections on the process, chal lenges, impact and experiences

Background: Cerebral palsy (CP) is a lifelong disability, where people experience complications as they age in addition to their underlying condition. Including the views of people with CP through public and patient involvement (PPI) ensures that research is relevant and meaningful in addressing their concerns. However, there is a lack of evidence on incorporating the voices of adults with CP in the research process. Further, there is no guidance on how to involve people with CP in PPI during the COVID-19 pandemic. Therefore, this paper aims to provide an overview of how adults with CP were involved in a doctoral research process during the pandemic. Methods: This paper describes the PPI process and its impact at various stages of the doctoral research process and reflects on the experiences from the perspective of the researcher and adults with CP. Results: A panel of adults with CP was established and consulted throughout the research to support development of the research question, study documentation, data collection, analysis, interpretation and dissemination of findings. The researcher and adult reflections highlighted the value of collaboration and the positive impact on research at each stage. Although meetings were adapted due to the pandemic, the values of PPI were adhered to throughout the doctoral research. Conclusion: Involving adults with CP positively impacts the research process and ensures meaningful change. Reflective findings may help other researchers involve adults with CP and adapt to remote PPI processes.

Minimizing Communication Challenges Faced by Virtual Project Teams

During the 2020 spring semester, courses rapidly transitioned online in response to the COVID-19 pandemic. This rapid transition online and transformation of team projects presented a unique opportunity to study team dynamics, specifically communication challenges, within virtual team projects. For most students, the 2020 spring semester was the first time they had to complete a virtual team project;however, with the rise in remote work in industry, many students will have jobs that include virtual work on teams. As such, investigating the communication challenges undergraduate engineering students experienced provides important insights to guide classroom instruction and tips for students working on virtual teams. Furthermore, this work has the potential to improve both virtual and in-person team project designs and increase the impact of team projects on the education of engineering undergraduate students by encouraging effective communication. We collected open-ended survey responses and conducted interviews with a range of engineering majors and class standing. We analyzed the data with a conventional qualitative content approach allowing for the development of emergent codes. Throughout the coding process, inter-rater reliability (IRR) quantitatively assessed the coding agreement across researchers until the IRR was higher than 80% for each coding category and the overall IRR across all categories was higher than 90%. The data from the interviews showed students perceived poorer team communication in the virtual environment, limiting team's effectiveness in completing tasks. Students mentioned that the environment had negative effects on the collaboration and relationship formation of the group members. Some students described strategies they adapted for improving communication, including approaches for establishing clear expectations, streamlining meetings, and building trust. Results indicate that designing a meeting structure with thorough planning documentation that designates time for social interactions to foster trust between team members is a powerful method for encouraging effective communication and overall project success. © American Society for Engineering Education, 2021

Earth unbound: Climate change, activism and justice

This experimental writing piece by the Earth Unbound Collective explores the ethical, political and pedagogical challenges in addressing climate change, activism and justice. The provocation Earth Unbound: the struggle to breathe and the creative thoughts that follow are inspired by the contagious energy of what Donna Haraway (2016) calls response-ability or the ability to respond. This energy ripples through monthly reading groups and workshops organised by this interdisciplinary collective that emerged organically in January 2020. © 2021 Philosophy of Education Society of Australasia.