A Review of COVID-19 Deaths among Law Enforcement Officers in the United States

The purpose of this study is to investigate the characteristics of law enforcement officers in the United States who died from COVID-19 in 2020–2021. Data were drawn from the Officer Down Memorial Page (ODMP) website. Results reveal that 729 law enforcement officers died from COVID-19 between 2020 and 2021, with the majority of these deaths occurring in the southern region of the United States. Additionally, a larger percentage of COVD-19 deaths were reported for officers who were male, White, and older compared to officers of color, younger officers, and female officers. © The Author(s) 2023.

Was Icu Right for You? An Exploratory Qualitative Study of Patients >=65 Yrs and Next of Kin in Covid-19: The Escalate Study

Introduction The decision to admit an older patient to the intensive care unit (ICU) should reflect shared goals of care. Resource limitations during the Covid-19 pandemic highlighted challenges in selecting candidates for escalation. Patients and next of kin (NoK) who have experienced ICU are well-placed to reflect on whether the admission was right for them. Objective To explore older patients' (>65 years) and their loved ones' views on escalation decision making. Methods Qualitative study involving semi-structured interviews with patients, NoK of survivors and NoK of deceased who experienced UK ICU admission with Covid-19 respiratory failure between March 2020 and February 2021. A preliminary questionnaire was used to maximise sample diversity of age, sex, ethnicity, survival, decision regret and impact of event scores. Interview data were collected via video conferencing or telephone. Transcripts were analysed using framework analysis. Results 30 participants were interviewed. Results Five themes were identified: 'Inevitability' - a sense that the illness and its management are out of the control of the patient or their loved one;'Disconnect' - differences between hospital and lay person narratives;challenges to bridging that gap included effective communication aided by technology;'Acceptance' - of the consequences, good or bad, of an intensive care admission as unalterable;'Beyond comprehension' - participants had not contemplated ill health or ICU prior to admission and even with the benefit of hindsight struggled to describe which potential outcomes would be acceptable or unacceptable if they needed to be involved in similar decision-making around escalation in the future;'Covid-19' - unique impact of a pandemic. Conclusion This study, which includes bereaved NoK as well as patients and NoK of survivors, adds perspective to inform decision making regarding treatment escalation of older people.

Beyond chart review: using NLP as a performance improvement tool to track aspirin utilization

Objective: As quality metrics increase, chart review to capture this data will not be feasible. Natural language processing (NLP) may offer solutions especially for lower resourced systems. ACOG and USPSTF recommend aspirin (ASA) to reduce the probability of developing preeclampsia. ASA is commonly only charted in free text in the electronic health record (EHR), rather than in the discrete field medication list. The aim of this study was to evaluate whether NLP could correctly identify patients for whom aspirin was indicated and who received it. Study Design: A retrospective cohort study of patients with clinic visits who delivered in two time periods: Oct 2019-Feb 2020 and Jan-Jun 2021. These were chosen to sample both pre- and post-COVID clinical documentation practices. To establish whether aspirin was received and indicated, chart review was performed for medications and risk factors/indications. We trained two Bidirectional Encoder Representations from Transformers (BERT)-based NLP models: first, a model to identify patients for whom aspirin had been given (Model 1: ASA Received);second, a model to identify patients for whom aspirin was indicated based on ACOG/USPSTF criteria (Model 2: ASA Indicated). Each model was then applied on the holdout data from the initial cohorts. Each model was also then applied on new, unseen data to evaluate its use for ongoing predictive performance (Mar-Jul 2022). Result(s): The models were trained on 824 patients, of whom 314 (38%) were positive per the ASA Indicated model and 92 (11%) were positive by the ASA Received model. Both models had excellent discriminatory abilities: ASA Received ROC AUC 0.87, ASA Indicated ROC AUC 0.91 (Figure 1). When applied to new data (Mar-Jul 2022), the models predicted frequencies of ASA indication and treatment which were stable and consistent with our performance trend (Figure 2). Conclusion(s): NLP represents a potential tool to monitor quality improvement processes without chart review. Since these models were developed on real-world EHR data, clinical dashboards could be created allowing more efficient and widespread system monitoring. [Formula presented] [Formula presented] Copyright © 2022

Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial.

AIMS: Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. MATERIALS AND METHODS: Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. RESULTS: Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up - lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence - and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. CONCLUSIONS: Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.

Qualitative Research in a Technological Age: Friend or Foe

Introduction: Familiarity with information technology is increasingly widespread. COVID-19 has increased the use of video conferencing social media within the UK population, including by older people1 This evolving scene has the potential to change how research is conducted.2 Social media has been employed for recruitment to qualitative research,3,4 but mostly in a young cohort. Recruitment through interfaces such as Twitter has the potential to access a larger number of participants, but may not reach all groups, such as older people. Video conferencing (VC) is increasingly used for qualitative interviewing.5 It simulates in-person communication while avoiding the need to travel but requires access to costly equipment and confidence in engaging with the technology. Objective: To explore the experience of using technology in a critical care-based qualitative research study. Methods: The ESCAlation of the eLderly (Age-65years) to criTical carE with COVID-19 (ESCALATE) study uses semi-structured interviews with patients and loved ones to explore views on escalation of older people to critical care during the COVID-19 pandemic. Recruitment took place using two routes: UK-wide social media advertising;and postal invitations via local databases with telephone follow up. For the former, the study was advertised directly via the social media platform Twitter using a specifically created study account (@covidescalate), showing a brief advert and link to a questionnaire and contact form. Relevant charities were invited to disseminate the advertisement. In-person interviews were avoided to maximise participant and interviewer safety in the context of the COVID-19 pandemic. Participant preference for mode of interview (VC or telephone) was established. If participants stated in advance that they were not familiar with video technology or found during the interview that they were unable to manage a VC, interviews were conducted by telephone. Results: There was partial uptake by charities and limited 'retweeting' overall. Only one responder meeting eligibility criteria responded via social media advertising, compared with 44 from local postal/telephone recruitment. Ten interviews were conducted via VC and 12 via telephone, where participants were not familiar with VC. There was no difference in interview duration with VC lasting around 45 minutes and telephone calls lasting around 42 minutes. The researchers found that it was more difficult to pick up on social and non-verbal cues without visual contact but all questions in the topic guide were covered using both media. There was no difference between choice of VC vs. telephone according to participant ethnicity (BAME vs Caucasian) or sex. In one case, several participants from one family joined the VC from different locations. Conclusion: In the ESCALATE study, video conferencing and telephone interviews were both valuable interviewing methods. Social media recruitment was of limited use but this may reflect the participant demographic and research team experience and could still be useful for recruiting certain groups in other studies. Information technology has the potential to increase engagement with research but our experience demonstrates that it must be used flexibly and with consideration.

The end is just the beginning: Involving bereaved next of kin in qualitative research

Introduction: Almost half the UK population die in hospital and more than two thirds of these are aged 75 years or more.1 Older people make up an increasing proportion of patients admitted to critical care and often have poorer outcomes, especially in the context of COVID-19.2 Loved ones are an essential support network for older patients but their ability to provide support was compromised by visiting restrictions during COVID-19. Little is known about the experiences of older patients in ICU and there is limited literature on the experiences of bereaved relatives.3 Bereaved relatives may be the only way to access the experiences of patients who do not survive, but there are a number of barriers to including bereaved relatives in research. Researchers may feel inhibited from imposing what might be seen as an additional burden on families during the aftermath of a bereavement. The ongoing ESCAlation of the eLderly (age >65years) to criTical carE with COVID-19) (ESCALATE) study includes semi-structured interviews with bereaved loved ones as well as patients and NoK of survivors in the UK. Objectives: To describe successful involvement of bereaved next of kin in critical care-based research Methods: This qualitative research uses semi-structured interviews and thematic analysis. Patient and public involvement from an intensive-care focused charity and local palliative care team advice was sought in order to develop recruitment strategies such as detailed, sympathetically worded participant information packs.4 In keeping with the literature,5 the window for recruitment and interview was approximately one year following bereavement. Following ethical approval, participants were recruited via postal invitations with follow up telephone calls if no response after a minimum of one week. Results: Recruitment was limited by only 40% of bereaved NoK (next of kin) having postal addresses recorded on the hospital systems. 9 /40 bereaved NoK contacted by letter responded and as well as completing a questionnaire, consented to be interview. A further 5/11 contacted by follow-up telephone call agreed to participate (consistent with response rates for patients and NoK of survivors). All of the interviewed bereaved participants completed the interview according to the interview topic guide, with each interview lasting around 45 minutes. More than half were female, and three quarters were Black, Asian or Minority Ethnic. Bereaved relatives were keen to share their experience and some even volunteered additional information with the interviewers, such as resources they had created for their local community and personal diaries. Participants reported that they were happy to be interviewed if it would help others in a similar position. Conclusion: Bereaved relatives of critical care patients are willing to engage in qualitative research. Recruitment is challenging due to practical constraints, but we suggest could be improved through meticulous documentation of contact details and involvement of bereavement services in research. By seeking the views of bereaved loved ones, we can improve care for critically unwell patients at end of life.

Upper Extremity Wounds Treated with Biodegradable Temporizing Matrix versus Collagen-Chondroitin Silicone Bilayer

Objective This study aims to compare outcomes between Novosorb Biodegradable Temporizing Matrix (BTM) and Integra collagen-chondroitin silicone for upper-extremity wound reconstruction. Methods This retrospective study analyzed adult patients who underwent wound reconstruction with either BTM or Integra at our institution between 2015 and 2020. Results Forty-eight patients were included: 31 (64.6%) BTM and 17 (35.4%) Integra. Mean age was 44.0 (range: 18-68) years. Age, race, sex, smoking, comorbidities, and defect size were similar between groups. Wound etiologies included 12 (25.0%) burn, 22 (45.8%) trauma, and others. Median template size was 133 cm 2for BTM and 104 cm 2for Integra (p = 0.526). Skin grafting was performed after 14 (45.2%) and 14 (82.4%) wounds treated with BTM and Integra, respectively (p = 0.028). Template complications of infection and dehiscence were comparable. Skin-graft complications occurred in five (35.7%) and three (21.4%) wounds in BTM and Integra, respectively (p = 0.031). Skin-graft failure rates were comparable (p = 0.121). Mean number of secondary procedures required after template placement was higher in the Integra group (BTM, 1.0;Integra, 1.9;p = 0.090). Final healing was achieved in 17 (54.8%) BTM and 11 (64.7%) Integra wounds (p = 0.694). Median time to healing was 4.1 months after BTM and 2.6 months after Integra placement (p = 0.014). Conclusion Compared with Integra, BTM achieved comparable wound healing and complication rates. Fewer secondary procedures and skin grafts were observed in BTM wounds, likely as a result of the coronavirus disease 2019 pandemic. At our institution, 100 cm 2of product costs $850 for BTM and $3,150 for Integra, suggesting BTM as an economical alternative to fulfill the high functional and aesthetic requirements of upper-extremity wounds. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Urban Park Use During the COVID-19 Pandemic: Are Socially Vulnerable Communities Disproportionately Impacted?

The COVID-19 pandemic altered human behavior around the world. To maintain mental and physical health during periods of lockdown and quarantine, people often engaged in outdoor, physically distanced activities such as visits to parks and greenspace. However, research tracking outdoor recreation patterns during the pandemic has yielded inconsistent results, and few studies have explored the impacts of COVID-19 on park use across diverse neighborhoods. We used a mixed methods approach to examine changes in park use patterns in cities across North Carolina, USA, during the COVID-19 pandemic, with an emphasis on impacts in socially vulnerable communities (based on racial/ethnic composition and socioeconomic status). First, we surveyed a demographically representative sample of 611 urban residents during August 2020 to assess their use of outdoor park spaces before and during the pandemic. Second, we used cell phone location (i.e., geo-tracking) data to document changes in park visits within 605 socioeconomically diverse urban census tracts before (July 2019) and during (July 2020) the pandemic. Data from both methods revealed urban park use declined during the pandemic;56% of survey respondents said they stopped or reduced park use, and geo-tracked park visits dropped by 15%. Park users also became more homogenous, with visits increasing the most for past park visitors and declining the most in socially vulnerable communities and among individuals who were BIPOC or lower-income. Our results raise concerns about urban park use during the COVID-19 pandemic and suggest pre-existing health disparities in socially vulnerable communities might be exacerbated by inequitable access and utilization of parks and greenspace.

Capable: Comparing the patient generated index to standard quality of life measures in patients and caregivers affected by high-grade brain tumours-preliminary analysis

AIMS: High grade gliomas are rare but have the highest number of cancer deaths in the under-40s. Treatment options are limited, resulting in a clinical focus on maintaining quality of life (QoL). However standard QoL assessment tools are time consuming, may not reflect an individual's priorities, and are rarely used in clinical practice. Moreover, the impact of caring for someone with a high grade glioma is seldom assessed. An alternative approach to assessing quality of life is to use a patient-or carer-generated index (PGI/CaGI), which asks patients &carers to raise, rank and number their concerns. This may offer a route to individualised QoL assessments within clinical and research settings. The CaPaBLE study tests the feasibility and acceptability of the PGI and CaGI methodology in patients with high-grade glioma and their caregivers. This paper highlights key similarities and differences of the PGI/CaGI to standard QoL questionnaires. METHOD: CaPABLE is an observational phase 2 non-randomised study following patients and their caregivers over 6 months starting at either first diagnosis or recurrence (https://www.isrctn.com/ISRCTN45555598). Patients and caregivers complete both standard questionnaires (EORTC QLQ C30 &BN20 and CargoQOL) and PGI/CAGI at 5 timepoints over the 6 month period. Each time the patients/caregivers complete the PGI/CAGI they are asked to identify up to 5 main topics of concern for their QoL, to score these, and rank their importance. For this analysis, we grouped topics into themes, compared the stability of themes over time and to EORTC domains. Analyses of EORTC measures are conducted using standard scoring approaches. Here we present an initial analysis of occurrence of PGI/CaGI themes compared to EORTC domains, but do not consider scores or ranking. RESULTS: 6 patients (4 male) and 5 caregivers (3 female;4 paired with patients;one unpaired) have completed both standard questionnaire and PGI/CaGI at three or more time points, with a total of 19 (patient) and 18 (caregiver) assessments. On average people reported 3 topics at each assessment. The PGI generated 59 topics (32 themes);the CaGI, 50 topics (23 themes) and themes were consistent over time. The most common domain raised by patients was "social life" (13). Caregivers raised "personal life and family" (12 and "planning ahead" (7) more commonly. Of the 32 PGI themes, 23 align with EORTC domains. 9 PGI themes were not represented in the EORTC questionnaires, and 14 EORTC domains did not appear in the PGI. Of the 23 CaGI themes, 17 align with 7 CarGOQOL domains. 6 CaGI themes were not represented in the CarGOQOL and 3 CarGOQOL domains did not appear in the CaGI. CONCLUSION: PGI and CaGI themes coincide with the main domains of EORTC (i.e., cognitive, social, role, physical, emotional functioning, future uncertainty). However, there were significant discrepancies: PGI (e.g., intimacy, ability to drive, and COVID related restrictions) and CaGI (e.g. personal life &family) highlighted themes that are not in the standard questionnaires. Both PGI/CaGI and standard questionnaires agree that symptom-related issues such as pain and seizures are not the main priority when it comes to QoL. In addition, CarGOQOL reports positive aspects of care, whereas CaGI only raised negative areas. This study is the first to show the feasibility of PGI/CaGI in a brain tumour patient &caregiver population. PGI/CaGI are notably quicker to complete and provide insights not captured by standard questionnaires. We are continuing to recruit patients and caregivers, and have submitted a protocol amendment to carry out qualitative interviews with patients and caregivers, to explore their views further.

What place does nurse-led research have in the COVID-19 pandemic?

AIM: Reflect upon the visibility of nursing-led research during the COVID-19 pandemic. BACKGROUND: The emerging SARS-CoV-2 infection has galvanized collaborative and multidisciplinary efforts in clinical and research practice worldwide. The scarce evidence-base to manage patients with COVID-19 has included limited nurse-led research. INTRODUCTION: Clinical research nurses have greatly contributed to the delivery of COVID-19 research, yet the number of COVID-19 nursing-led research papers appears to be limited, with even fewer nurse-led research projects funded. METHODS: Authors' views and PubMed search on 'COVID-19 and nursing'. FINDINGS: There is a dearth of nursing-led research. Most papers describe the nursing contribution to COVID-19 care, changes in nursing working arrangements and emotional burden. There are opportunities to explore the consequences to vulnerable population groups of public health measures implemented to stop the progress of the COVID-19 pandemic. DISCUSSION: Workforce gaps, limited integration in research structures and clinical redeployment may have hampered nurse-led research. COVID-19 may exacerbate staffing deficits by disrupting the education pipeline, obstructing the transition from clinical to academic practice, particularly in areas where clinical academic roles are yet to emerge. CONCLUSION: The absence of nurse-led research in COVID-19 can be explained by chronic, underlying factors and the features of the pandemic response. Emerging models of care, effective staffing and inequalities related to COVID-19 appear obvious research areas. Nursing leadership needs to strengthen its political voice and lobbying skills to secure nurse-led research funding. IMPLICATIONS FOR NURSING POLICY: Embracing international nursing research, strengthening collaborations and lobbying policymakers for investment in nurse-sensitive research would enhance the response to COVID-19.

Let's get physical: A prospective pedometer study of doctors working in a South African emergency department.

BACKGROUND: The positive impact of physical activity and exercise on health is well known. Individuals who walk at least 10 000 steps per day are likely to meet recommended physical activity guidelines. Very little is known about the physical activity levels of doctors at work, in particular those working in emergency departments (EDs). OBJECTIVES: To determine how many steps per shift were taken by doctors in a South African (SA) ED. Secondary objectives were to assess what factors influenced the number of steps taken. METHODS: This was a prospective observational cohort study in a tertiary academic teaching hospital ED in Johannesburg over a 1-month period. Doctors wore pedometers during their day shifts in the ED and the number of steps taken during their shifts was measured, as well as the number and triage category of patients seen and whether cardiopulmonary resuscitation (CPR) was performed. RESULTS: The median (interquartile range) number of steps taken per shift was 6 328 (4 646 - 8 409). The number of steps taken exceeded the 10 000-step target in only 11.7% of shifts. The overall mean (standard deviation (SD)) number of steps per hour was 744 (490). Factors that significantly increased the number of steps taken included shift duration, number of patients seen who were triaged yellow, and performance of CPR in a shift. Each additional hour of shift led to a mean (SD) increase of 575 (115) steps. Each additional yellow patient seen led to a mean (SD) increase of 118 (108) steps. The mean (SD) number of steps for a shift with CPR was significantly higher (8 309 (850) steps) than for a shift without CPR (6 496 (384) steps). CONCLUSIONS: Doctors working in an SA ED are not achieving the daily recommended number of steps while at work. The increased risk of ill health and burnout in an already high-risk specialty heightens the importance of exercise and physical activity that needs to be achieved outside the workplace.

COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.