ABSTRACT
Introduction: Infection prevention and control (IPC) came to the fore during the COVID-19 pandemic with global expectations in healthcare of compliance with recognised international guidelines. Yet despite 40 years of modern IPC practice, health services around the world struggle to maintain minimal IPC standards even without the pressures of a pandemic, many are in resource-limited settings. Atoifi Adventist Hospital (AAH) in the Solomon Islands is one such hospital. Aim(s): To investigate IPC practice at AAH with the aim of creating a meaningful and sustainable program. In doing this, staff and community knowledge and beliefs about infection transmission was explored, and IPC practice and rationale determined. Method(s): This qualitative study employed a participatory action research methodology using Photovoice followed by semi-structured interviews as the primary data collection method. Participants included staff educated in biomedical principles, and staff with little or no formal education. Result(s): Improving IPC practice is not straightforward. Cultural, spiritual and societal practices and beliefs influence how people view disease causation and transmission and affects healthcare worker's practice. 'Germ theory' does not necessarily inform people's beliefs, even for staff educated via the biomedical model;to implement IPC guidelines based on germ theory principles, and expect staff to practise accordingly, is not plausible. Conclusion(s): IPC programs will only work if they are transformed into a context that is understood by staff and community - one that complements the biomedical model. Governments and hospital leaders need to consider this when implementing IPC programs. It's time for us to challenge the rhetoric.Copyright © 2022
ABSTRACT
Aim: Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability. Material(s) and Method(s): A retrospective review of all patients undergoing AWR in a single NHS trust, multiple surgeons, between 23rd March 2020 and 22rd March 2022, the 2 years following U.K. Government imposed lockdown, was undertaken and compared with the pre-pandemic AWR activity. Procedures were initially undertaken at a cold site and when demonstrated to be safe, main site operating restarted. The primary outcome was 90 day mortality, secondary outcomes of COVID-19 infection within 7 days, length of stay, critical care requirement, and complication rate. Result(s): In the study period, 173 patients underwent AWR, compared with 99 cases in a single year preceding lockdown. 90 day mortality rate was zero. No patients returned positive COVID tests to the trust within 7 days of AWR, and no patients were readmitted for COVID related symptoms. Critical care admission was required in 7 patients, 3 of these were planned admissions pre-operatively. The surgical site occurrence rate was 9.8% (17), infection 5.8% (10), seroma 2.3% (4) and haematoma 1.7% (3). There were no recurrences reported, with follow up ranging between 1 and 18 months. Conclusion(s): Continuing AWR services during the COVID pandemic is feasible and safe. Peri-operative COVID infection rates are low, critical care requirements minimal, and there is no impact on patient morbidity or mortality.
ABSTRACT
The COVID 19 pandemic necessitated a rapid implementation of virtual care within the Canadian healthcare system generating previously unimagined levels of virtual care uptake and accessibility. The transition to virtual care provided benefits for both patients and providers including a reduction in cost, time saved, and greater protection from infection. However, to date, the system in the Canadian province of Ontario has focussed on ‘replacing’ discrete in-person ‘moments’ of care with digital interactions such as phone and video visits. This design research study contributes to the health design community by incorporating a strategic futures approach to existing discussions surrounding virtual care. Collecting, analyzing and adding patient and primary care provider voices through this design research study provides new insights into virtual care experiential gaps and highlights opportunities for virtual care within primary care modalities. As a result of this new data, and through consultation with stakeholders, a roadmap for future virtual care possibilities in Ontario was developed answering noted needs of patients and providers by extending digital health interactions across a broader spectrum of synchronous and asynchronous care modalities and folding in an amalgam of digital, virtual, and in person connection for patient care experiences. [ FROM AUTHOR]
ABSTRACT
Background: Venous thromboembolism (VTE) is a prevalent disease with high morbidity and mortality. VTE has well-documented physical sequelae, however the psychological and emotional experience of patients is seldom evaluated in randomized controlled trials. Aim(s): We conducted a scoping review of published qualitative studies aiming to understand the physical, psychological, and emotional impact of VTE as reflected from patients' perspectives. This scoping review is part of a larger initiative to develop a core outcome set for VTE treatment studies. This research is funded by the Canadian Institutes of Health Research and CanVECTOR. Method(s): A systematic literature search was conducted to identify qualitative studies assessing patient experience of VTE. Two authors independently screened titles and s using Covidence systematic review software. Full text reviews were conducted independently by two study team members. QSR International NVivo 12 software was used to perform systematic line-by- line coding of the Results and Discussion from all included articles. A modified method of thematic synthesis was used to collate themes upon reading and re-reading of the publications. Result(s): Our search strategy returned a total of 4944 citations;28 were ultimately included in the analysis. The studies were conducted across 13 countries and representative of 436 participants including a spectrum of VTE sub-populations. There were seven major themes identified;Acute Impacts: An Unforeseen Blow, Sustained Psychological Distress, Loss of Self: Life is Changed, Challenges of Thrombosis Management, Balancing Coping and Control, Negative Experience with the Medical System, and VTE in the Context of Other Conditions. Each major theme was comprised of additional subthemes (Figure 1). Conclusion(s): The physical, psychological, and emotional impacts of VTE extend beyond the quantitative outcomes typically evaluated in clinical trials. An improved understanding of the outcomes most important to patients will improve patient-centered research and care in VTE.
ABSTRACT
Background: Estrogen receptor positive breast cancer (BC) is the most common type of breast cancer in postmenopausal women and aromatase inhibitors (AI) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop Arthralgia often resulting in poor adherence and decreased quality of life. Methods: This is a single arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability and potential efficacy of TaiChi4Joint, a remotelydelivered 12-week Tai Chi intervention designed for the relief of AI-induced joint pain. Women diagnosed with stage 0-III BC who have been receiving an AI for at least 2 months and reporting arthralgia with a ≥ 4 score on a 0-10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join Tai Chi classes delivered over ZOOM three times a week for 12 weeks. Program engagement strategies include the use of a private Facebook study group and box.com cloud for archiving live class recordings. The program utilizes Text messaging and emails with periodic positive quotes and evidence based information on Tai Chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments online at baseline, 1, 2 and 3 months intervals from study enrollment: Brief Pain Inventory (BPI), Western Ontario and McMaster University Osteoarthritis index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory (FSI), Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Studies Depression (CES-D). Results: 55 eligible patients were invited to participate and 39 consented and completed the baseline assessments. 61% (median) Participants attended the classes, with no Tai Chi related adverse events reported. 22 of the 39 participants completed the 3-month follow up assessments with a 56% retention rate. Study participants reported improvement from baseline compared to 3 month as follows: For BPI (P = .000), AUSCAN pain subscale (P =.000), AUSCAN function subscale for 35 patients (P = .000), WOMAC (P = .000), CES-D (P = 0.001), FSI (P = 0.00) and PSQI (P = .000). However HFRDIS improved in 11 patients (P = 0.00) for the other 22 patients (P = 0.154). Conclusions: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a Telehealth based Tai Chi intervention for reducing AI-induced arthralgia. The intervention decreased patient reported pain, stiffness and improved sleep quality and depressive symptoms. With our promising findings, larger telehealth based trials of Tai Chi for AI-associated arthralgia are needed.
ABSTRACT
Background: The number of young people with mental health (MH) problems presenting in general practice and the prescribing of psychotropic medicines, particularly antidepressants have been steadily increasing over the last decade. This trend has accelerated since the onset of the COVID-19 pandemic. Objectives: To identify key issues relating to management of psychological distress, depression and anxiety disorders in people aged between 16 and 24 years. Mapping issues to behavioural change techniques and appropriate interventions to form an education programme for health professionals and young people. Methods: Desktop research, environmental scanning and interviews with consumers, health professionals, stakeholder organisations and experts in youth MH were conducted to identify issues and education themes. Interventions were informed by the Theoretical Domains Framework (Cane et al., 2012;Michie S et al., 2005) and Behaviour Change Techniques (Michie et al., 2008, 2013). Feasibility, relevance and acceptability of interventions were reviewed by health professionals, young people and other stakeholders alongside the programme scope, focus and key messages. Findings: Education themes identified for the programme include communication to empower young people to manage their MH, comprehensive assessment for young people in distress, engagement of health professionals and young people in consideration of management options, and careful review of treatment effects over time. Interventions selected include educational outreach in general practices, general practice data feedback, online articles, videos, podcasts and webinars. Conclusion: The proposed programme focuses on building young peoples' health literacy and general practitioners' knowledge, skills and confidence. It will aim to improve young peoples' experience of MH care, connections with health professionals and engagement with treatment options.
ABSTRACT
Over the last decade, course-based undergraduate research experiences (CUREs) have been recognized as a way to improve undergraduate science, technology, engineering, and mathematics education by engaging students in authentic discovery. CUREs have been shown to have positive benefits similar to traditional undergraduate research experiences;however, they can reach a larger number of students and are open to all students who enroll in the course. Motivated by the need to redesign the large introductory physics lab at The University of Colorado-Boulder to be fully remote in response to the COVID-19 pandemic, we designed and implemented the first remote, large-enrollment, physics CURE. Here, we detail the motivations and the challenges when designing the course, and provide detailed descriptions of the course components. Throughout the course, we collected course artifacts and administered surveys to the students. Based on these data sources, we find that this course helped students gain research skills and coding confidence, engage in productive and enjoyable teamwork experiences, and feel motivated and interested in experimental physics research. © 2022 authors. Published by the American Physical Society.
ABSTRACT
Background: Adolescents with overweight (OW) and obesity (OB) report profound psychological stressors. Yet, traditional adolescent behavioral weight control interventions have not focally targeted stress reduction. Mindfulness skills may benefit adolescents with OW/OB and enhance treatment outcomes by providing strategies to manage stress. The goal of this study was to integrate mindfulness and behavioral weight control for adolescents with OW/OB by obtaining feedback from a Youth Advisory Board (YAB) and conducting an open trial of a novel Mindfulness-Based Weight Control (MBWC) intervention. A secondary goal was to describe intervention adaptation intervention in response to the COVID-19 pandemic. Methods: Feedback on the intervention was obtained during 6 group meetings of the YAB (N = 9;M = 15.22 yrs, SD = 1.20;66.6% male;zBMI M = 1.97, SD = .34). The open trial included 2 cohorts (N = 14;M = 15.14 yrs, SD = 1.56;71.4% female;zBMI M = 2.08, SD = .26) both of which received 8 sessions of the group MBWC intervention. Cohort 1 was conducted in-person. Due to COVID-19, cohort 2 was adapted for virtual, synchronous delivery. Results: The YAB provided feedback on developmental and cultural fit of MBWC for adolescents with OW/OB. For the open trial, a small effect (Hedge's g = .16) was found in zBMI decrease from pre-( M = 2.02, SD = .26) to post-( M = 1.97, SD = .30) treatment. However, the pre-post change in zBMI failed to reach significance, t = 1.68(10), p >.05. Post-treatment, participants in both groups rated on a 10-point scale (0 = strongly disagree to 10 = strongly agree) that they were 'satisfied with the HEARTS program' (M = 7.92, SD = 1.38) and would 'recommend the HEARTS program to a friend' (M = 8.50;SD = 1.78). Conclusions: Open trial findings provide preliminary support for this novel adolescent mindfulness-enhanced group behavioral weight control intervention, with adaptation for real-time online delivery. Specifically, results support the acceptability of this MBWC intervention, run both in-person and virtually with adaptation due to COVID-19. Further evaluation of the full 16-week MBWC intervention with a larger sample is needed to examine the impact on adolescent zBMI change.
ABSTRACT
The ongoing COVID-19 pandemic has affected all aspects of life, including interreligious engagement. This article offers one interpretation of the key markers that should underpin a distinctively Christian engagement with other religious traditions in the current climate. It develops suggestions around the three “theological virtues” – namely, faith, hope, and love – as it is argued that these make the Christian way of being in the world distinctive and attractive. Each virtue is defined first in a broad way, and then in specifically Christian terms, before it is explored in its various applications to interreligious engagement. The article focuses on the opportunities and challenges of engagement in pandemic times throughout, indicating areas for future development in the process. Its conclusion highlights the challenges associated with interreligious engagement in the digital context. © 2021 World Council of Churches
ABSTRACT
Aim: Surgical training has been significantly impacted by COVID-19. Social distancing requirements mandated a change in face-to-face teaching with many deaneries adopting 'virtual' sessions. Surgical training does not immediately lend itself to e-learning owing to its hands-on nature. We describe our experiences in developing a virtual teaching program for Core Surgical Trainees within the Wessex Deanery. We provide tips, tricks, and pitfalls for educators to establish or improve similar programs. Method: From June 2020 monthly, in-person teaching was replaced with virtual sessions. Quantitative and qualitative feedback directed improvements in the program. In addition to knowledge-based lectures we integrated on-line learning tools (LapPass) and utilised surgical videos to ensure continued development of surgical skills. Mock MRCS and ST3 interviews were conducted remotely using 'break-out rooms. Where face-to-face teaching was essential (Boot Camp, Field Camp) safety was ensured with reduced numbers (split sessions), social distancing and appropriate PPE. Results: All trainees strongly agreed (67%) or agreed (33%) that virtual teaching works well. There were no significant differences in feedback scores compared with face-to-face teaching. Attendance increased by 42%. Interactivity was maintained with 'cameras on, mics off', polling apps and chat box function. Advantages include uploading webinars for future review, ability for educators to present from multiple locations, increased availability and breadth of speakers and reduced burden on clinical commitments. Conclusions: The COVID-19 pandemic has dictated an evolution of surgical teaching. Virtual teaching has many advantages over face-to-face and should continue to play a part in postgraduate medical education, even after social distancing restrictions are lifted.
ABSTRACT
Consumer countries and blocs, including the UK and the EU, are defining legal measures to tackle deforestation linked to commodity imports, potentially requiring imported goods to comply with the relevant producer countries' land-use laws. Nonetheless, this measure is insufficient to address global deforestation. Using Brazil's example of a key exporter of forest-risk commodities, here we show that it has similar to 3.25 Mha of natural habitat (storing similar to 152.8 million tons of potential CO2 emissions) at a high risk of legal deforestation until 2025. Additionally, the country's legal framework is going through modifications to legalize agricultural production in illegally deforested areas. What was illegal may become legal shortly. Hence, a legality criterion adopted by consumer countries is insufficient to protect forests and other ecosystems and may worsen deforestation and conversion risks by incentivizing the weakening of social-environmental protection by producer countries.
ABSTRACT
Background: Virtual Reality (VR) provides a way to transport someone to a different place and time. Harlington Hospice has explored using VR with inpatients, including the oldest old. It has taken patients back to the street where they grew up or to visit tropical places on their bucket list. These experiences have been uplifting and the feedback has provoked further exploration of the use of VR during the pandemic. Goals: The primary goal is to provide personalised VR content to inpatients. COVID-19 has meant that patients, even in a hospice, have had to endure visiting restrictions - the antithesis of palliative care and often heartbreaking. The use of VR cannot replace a loved one sitting at the bedside, but the VR experience might provide spiritual comfort. A secondary goal is to provide family with a means to stay connected with the patient. Empowering people to attend virtually may reduce guilt and grief caused by separation. Design and Proposal: A 360 (GoPro) camera is provided to family or friends of inpatients. They take the camera home and the recorded content of home life is then played in VR to the patient, immersing the patient back into family life. This is very different from just watching a video. Family and friends can tell stories and say their goodbyes, and the patient will feel fully part of the conversation when they use the headset. Discussion: After publishing 'How Virtual Reality helped Pam (aged 86) travel to the Galapagos Islands!' in the Hospice newsletter, 2 VR headsets have been donated plus a grant to buy the GoPro camera. Policies covering data collection, consent, confidentiality and headset care are in place. Written instructions are provided with the camera and a number for phone assistance. Once the personalised VR content has been created, it is transferred onto the VR headset. Qualitative experience and impact themes will be collected. We are not aware of VR being used in this way by any other provider.
ABSTRACT
At the time of writing, coronavirus disease-2019 (COVID-19) has affected 6.42 million people globally and over 380,000 deaths, with the United Kingdom now having the highest death rate in Europe. The plastic surgery department at Leeds Teaching Hospitals put necessary steps in place to maintain an excellent urgent elective and acute service whilst also managing COVID-positive medical patients in the ward. We describe the structures and pathways implemented together with complex decision-making, which has allowed us to respond early and effectively. We hope these lessons will prove a useful tool as we look to open conversations around the recovery of normal activity.