COVID-19 Pneumonia Virtual Follow-up Service in Greater Glasgow and Clyde: Effectiveness and Outcomes

A COVID-19 pneumonia virtual follow-up service was established within Glasgow Greater and Clyde Health Board in line with national guidance. We aim to evaluate this service and identify patient factors which may predict likelihood of attendance. Using digital clinical systems, we retrospectively collected data on all patients referred to the service between March and August 2020. 802 patients were invited to attend our service. 82.7% of patients were discharged after virtual clinic review;609 patients (75.9%) had radiological resolution and 54 patients (6.7%) failed to attend follow-up chest x-ray. Persistent radiological changes prompted a face to face (13 patients) or telephone (93 patients) clinic review, and patients could self-refer to the service if they had persistent symptoms. Subsequent investigations were organised for 150 patients inclusive of imaging, clinical physiology, blood tests and speciality referrals. Post-COVID19 diagnoses were made in 104 patients (12.9%) of the follow-up population including parenchymal lung disease, pulmonary thromboembolism and long COVID. We identified age, requirement for translator and number of household members as predictors for attending follow up. Patients were more likely to attend with increasing age (p <0.001) and with increased household numbers (p <0.001). The requirement of an interpreter significantly reduced the likelihood to attend (p=0.005). In conclusion, our follow-up service was effective in discharging patients with radiological resolution, identifying complications of COVID-19 and had low non-attendance rate. Developing the service to address language barriers and aid attendance for the elderly would be beneficial.

Does Frequency or Amount Matter? An Exploratory Analysis the Perceptions of Four Universal Basic Income Proposals

Advocates for a Universal Basic Income (UBI) argue that it would provide citizens with a basic foundation for financial security, boost the economy, alleviate poverty, encourage entrepreneurship, reduce crime, and insulate the employment sector against job losses due to automation. Still, the idea lags in popularity in the United States compared to existing cash policies such as the annual Earned Income Tax Credit and one-time COVID-19 relief packages. We hypothesize that this disparity is related to predicted uses of a UBI in comparison to annual or lump sum cash programs. In this survey of 836 Americans, we explore whether predicted behavioral responses to four randomly assigned hypothetical cash transfer scenarios vary across the domains of amount and frequency. Respondents are more likely to associate monthly payments with work disincentives and lump-sum transfers with debt repayment. Implications for UBI advocates include the need to continue educating the public on the empirical associations between UBI, employment, and expenditures. © 2023 by the authors.

Collaboration between Australian peak bodies and governments in the context of the COVID-19 pandemic: New ways of interacting

Peak bodies ("peaks”) are funded by Australian governments to fulfil a multifaceted role, including presenting a collective voice to government on behalf of their nongovernmental service provider members and the vulnerable client populations they serve. However, the relationship between peaks and governments has been fraught, with governments imposing contractual conditions in exchange for funding, thereby constraining advocacy. During the COVID-19 pandemic, the nongovernmental sector provided vital services, including care and support for children and families, and dispensed emergency funding through their service networks. This research investigates engagement between peak bodies and governments during the COVID-19 pandemic in 2020–2021. Nineteen CEOs and senior executives were interviewed from 16 peak bodies. Additionally, 27 surveys were completed by peak and nongovernmental sector representatives. Interview transcripts were coded using NVivo and thematically analysed. Four types of interactions between government and peak bodies were identified: collective leadership;partnership;advocacy to influence;and advocacy designed for public pressure. These four types of interactions formed a public advocacy continuum. In some Australian jurisdictions, the study showed that collective and partnership mechanisms between peaks and government were strengthened or revived, yet sustained work will be needed to entrench these positive developments in a postcrisis environment. © 2023 The Authors. Australian Journal of Social Issues published by John Wiley & Sons Australia, Ltd on behalf of Australian Social Policy Association.

A review of disparities in peripheral artery disease and diabetes-related amputations during the COVID-19 pandemic.

The COVID-19 pandemic has profoundly affected health care delivery. In addition to the significant morbidity and mortality associated with acute illness from COVID-19, the indirect impact has been far-reaching, including substantial disruptions in chronic disease care. As a result of pandemic disruptions in health care, vulnerable and minority populations have faced health inequalities. The aim of this review was to investigate how the COVID-19 pandemic has impacted vulnerable populations with limb-threatening peripheral artery disease and diabetic foot infections.

CHANGES IN HEART RATE, SLEEP, AND PHYSICAL ACTIVITY BEHAVIOR FROM PRE- TO POST-COVID

Background: When the WHO declared COVID-19 a global pandemic on March 11, 2020, stay-at-home orders and business closures were imposed to contain viral spread. Accumulating evidence suggests that these societal disruptions caused abrupt changes in important health behaviors such as physical activity, but most work to date has used self-report measures. Longitudinal studies collecting objective measures of activity and sleep behavior and heart rate before and after the pandemic could shed light on potential health implications of the ongoing pandemic and associated social distancing measures. Objective: To determine whether significant within-person changes in objective heart rate, sleep, and physical activity occurred from pre- to post-COVID pandemic. Methods: Adult smartphone users were recruited from an online registry. 22 participants (M 47 years old, range 20-72;76% female;91% White;55% with at least one chronic medical condition) provided access to their Fitbit data and had at least one week of pre-COVID (March 11, 2019 to March 10, 2020;M = 256 days of data, range 25-366 days) and post-COVID (March 11, 2020 to December 31, 2020;M = 231 days of data, range 107-294 days) Fitbit data. Results: Paired t-tests revealed significant decreases in mean heart rate (77 to 75 bpm;t(18) = 2.91, p < .01), step counts (7946 to 6969 steps/day;t(21) = 2.72, p = .01), and total active time (185 to 165 minutes/day;t(21) = 3.02, p < .001) and significant increases in total sedentary time (766 to 781 minutes/day;t(21) =-2.88, p < .01) from pre- to post-COVID but no significant changes in Fitbit-assessed sleep time, latency, or efficiency. Conclusions: These prospective sensor data captured before and after the pandemic contribute to our understanding of how COVID-19 has affected physical activity and heart rate. Findings suggest that adults became less physically active and more sedentary after the pandemic relative to the year prior to COVID-19 but that sleep behaviors remained relatively stable. Although this is a small nonrepresentative sample, these longitudinal objective behavioral data corroborate larger self-report studies. Future analyses will examine trajectories of activity change over the course of the pandemic and characteristics of participants who maintained or increased activity levels despite social distancing mandates.

EFFECTS OF COGNITIVE LOAD, MOTIVATIONAL BELIEFS, ACHIEVEMENT EMOTIONS ON IMPOSTOR SYNDROME IN CLINICAL SKILLS TRAINING FOR FIRST-YEAR MEDICAL STUDENTS

BACKGROUND: Teaching methods can impact achievement emotions and cognitive load in learners. Due to COVID19, the University of Central Florida College of Medicine (UCF) adopted some online clinical-skills training for their first-year medical students (M1s) while the University of Florida College of Medicine (UF) was able to continue with limited in-person instruction. We hypothesized online learning could increase cognitive load, negatively impact self efficacy, and lead to increased levels of imposter syndrome associated with learning clinical skills. METHODS: M1s from UCF and UF from the 20-21 academic year were given an online survey during the Summer of 2021measuring Medical Student Wellbeing Index (WBI), Clance Imposter Phenomenon Scale (CIPS). Cognitive load and achievement emotions were measured using previously validated instruments on a 5-point Likert scale. Demographic data was collected, and IRB approval obtained. Descriptive statistics were obtained with SPSS 27 and reported as frequencies and percent response. Spearman correlation analysis was performed on all variables. T-tests were conducted to compare variables between UF and UCF. Overall response rate was 54% (44% and 61% for UCF and UF, respectively). RESULTS: Analyzing combined data from both schools for history and physical exam components, several statistically significant correlations were found (see Table 1). For both history and physical exam components UF learners had higher task value (4.66, 4.26 p<.001;4.70, 4.52 p=.042), enjoyment (4.34, 3.70 p<.001;4.28, 3.86 p=.001) and self-efficacy (4.43, 4.10 p=.004;4.36, 4.02 p=.007) and lower anxiety (2.32, 2.84, p=.003;2.32, 3.03 p<.001) and extrinsic load (1.88, 3.14 p<.001;2.07, 3.35 p=.001) compared to UCF learners, respectively. UF learners had lower WBI scores than UCF learners (250.74, 279.90 p=.024), but no differences in CIPS scores were found. Higher scores on CIPS and WBI scores indicate greater severity of imposter syndrome and reduced well-being, respectively. CONCLUSIONS: Teaching methods appear to have an impact on learners' achievement emotions, cognitive load, and well-being. Increased task value may mitigate a learners' extrinsic load with implications on how educators apply teaching methods. Further studies are needed to identify long-term impacts of online teaching methods.

TIMELY FOLLOW-UP OF ABNORMAL CANCER SCREENING TEST RESULTS IN TWO LARGE PRIMARY CARE PRACTICE NETWORKS

BACKGROUND: Timely follow-up of abnormal cancer screening test results (“abnormal screens”) is critical but often not achieved. As part of an NCI funded intervention trial (mFOCUS: multilevel Follow-up of Cancer Screening, ClinicalTrials.gov NCT03979495), we report on abnormal screens that were identified and tracked to identify eligible patients overdue for study inclusion. While not anticipated when this study was conceived, the COVID-19 pandemic resulted in a larger than anticipated backlog of patients in need of follow-up of abnormal screens. METHODS: Patients in two primary care practice networks affiliated with Mass General Brigham who had an abnormal screen for breast, cervical or lung cancer were identified using computerized algorithms and then tracked for completion of appropriate follow-up based upon the cancer type and the severity of the abnormal result. Since the intervention was designed as a “fail safe” system, additional time (2-6 months depending on the severity of the abnormal screen) was added after the recommended follow-up interval. We report the number of abnormal screens by cancer type and severity of the abnormality and the number of patients who completed follow-up based upon guideline and expert recommendations. RESULTS: Patient tracking and enrollment started with abnormal screens for breast and lung on 8/24/2020 and cervical cancer on 10/16/2020. Enrollment ended for all abnormal screens on December 15, 2021. Over the study period, 4003 abnormal breast, 5214 abnormal cervical, and 478 abnormal lung screens were identified. High risk abnormalities were most common for cervical (51.7%, recommended colposcopy or endometrial biopsy), lung (22.6%, LRADS 4B, 4X or 5), and lowest for breast (0.4%, BIRADS 5). Rates of completing recommended follow-up of abnormal screens by cancer type and severity of the result are shown in the table. CONCLUSIONS: Maximizing the benefits of cancer screening requires the timely follow-up of abnormal screening results. Though likely exacerbated by the COVID-19 pandemic, we identified that timely completion of abnormal screens is often not achieved. Rates of completion varied by cancer type and the severity of the abnormal result but highlight the need for systems based, multi-level interventions to identify, report and track abnormal results.

Digital Relationality, Rights, Resilience: Conceptualising a Digital Social Ecology for Children's Birth Family Relationships When in Care or Adopted

The use of digital communication technology by children residing in out-of-home care or adopted from foster care has mainly been approached hesitantly and from a risk paradigm. The Covid-19 pandemic catalysed many digital and social work intersections, including practices used for birth family contact where in-person visits were supplemented or replaced with 'virtual' contact via digital devices. Whilst technology-mediated contact is characterised as 'virtual', the relationships it facilitates and emotions it generates are very real within children's social ecology. Digital ubiquity in social life and the rapid pace of technological change presents significant ethical and practical tensions. To help social workers navigate this complexity of 'contact-in-reality' and facilitate safe, ethical use of digital communication technology for birth family contact, we connect an understanding of the dynamics of birth family contact with literature on children's use of digital technology and ecological concepts of person-in-environment to offer a digital social ecology heuristic for social work practice. Three key aspects cut across all systems and levels, referred to here as the three Digital R's: digital relationality;digital rights;and digital resilience. Future research is needed to understand how these dynamics play out. Conversations about use of social media, mobile Internet and other digital communication technology by children in care or adopted from care often focus on risk. The Covid-19 pandemic meant that social workers had to rethink digital technology and consider how it might be used for birth family contact. When contact happens using technology, it is often thought of as 'virtual', however, these relationships and emotions are very real for children. Technological progress is happening quickly, and digital technology is everywhere. Social workers must think about how this will affect their practice. We bring together work on birth family contact, children's digital technology use and theoretical literature on the influence of environments on individuals. We offer a way of looking at these issues to help social workers consider how to use digital communication technology for birth family contact in safe and ethical ways. We propose consideration of the three Digital R's: digital relationality (digital technology and relationships);digital rights (legal protection of children's safety and opportunities whilst using digital technology);and digital resilience (digital skills and ability to cope with negative experiences). Future research is needed to strengthen empirical evidence on how these factors manifest and interact.

Health service COVID-19 wellbeing and support initiatives: a mixed-methods evaluation.

BACKGROUND: Health services implemented a range of initiatives during the COVID-19 pandemic to support employee wellbeing and assist employees to manage the professional and personal challenges they experienced. However, it is not known if such initiatives were acceptable to employees or met their needs. AIMS: To evaluate the wellbeing and support initiatives implemented at an Australian health service during the COVID-19 pandemic from the perspectives of employees (both users and non-users) and key stakeholders. METHODS: A mixed-methods design (survey, interviews and data audit) to investigate employees' and key stakeholders' perceptions, experiences and use of the wellbeing and support initiatives implemented at a large tertiary metropolitan health service in Melbourne, Australia. RESULTS: Ten employees participated in an interview and 907 completed a survey. The initiatives were well used and appreciated by staff. There was no significant difference in the proportion of clinical staff who had used the initiatives compared to non-clinical staff (44% versus 39%; P=0.223). Survey respondents reported the initiatives improved their mental health (n = 223, 8%), ability to cope with COVID-19 related stress and anxiety (n = 206, 79%), do their work (n = 200, 77%) and relationships with colleagues (n = 174, 67%). Staff would like many of the initiatives (with some modifications) to continue after the COVID-19 pandemic. CONCLUSIONS: The findings suggest a high level of staff satisfaction with the implemented wellbeing and support initiatives, and confirm the need for, and importance of, developing and implementing initiatives to support health service staff during outbreaks of infectious diseases such as the COVID-19 pandemic.

Diagnostic accuracy of the Abbott ID NOW SARS-CoV-2 rapid test for the triage of acute medical admissions.

BACKGROUND: Decisions to isolate patients at risk of having coronavirus disease 2019 (COVID-19) in the emergency department (ED) must be rapid and accurate to ensure prompt treatment and maintain patient flow whilst minimising nosocomial spread. Reverse transcription polymerase chain reaction (RT-PCR) assays are too slow to achieve this, and near-patient testing is being used increasingly to facilitate triage. The ID NOW severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) assay is an isothermal nucleic acid amplification near-patient test which targets the RNA-dependent RNA-polymerase gene. AIM: To assess the diagnostic performance of ID NOW as a COVID-19 triage tool for medical admissions from the ED of a large acute hospital. METHODS: All adult acute medical admissions from the ED between 31st March and 31st July 2021 with valid ID NOW and RT-PCR results were included. The diagnostic accuracy of ID NOW [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] was calculated against the laboratory reference standard. Discrepant results were explored further using cycle threshold values and clinical data. FINDINGS: Two percent (124/6050) of medical admissions were SARS-CoV-2 positive on RT-PCR. Compared with PCR, ID NOW had sensitivity and specificity of 83.1% [95% confidence interval (CI) 75.4-88.7] and 99.5% (95% CI 99.3-99.6), respectively. PPV and NPV were 76.9% (95% CI 69.0-83.2) and 99.6% (95% CI 99.5-99.8), respectively. The median time from arrival in the ED to ID NOW result was 59 min. CONCLUSION: ID NOW provides a rapid and reliable adjunct for the safe triage of patients with COVID-19, and can work effectively when integrated into an ED triage algorithm.

Optical Coherence Tomography (OCT) for Diabetic Maculopathy in a Digital Surveillance Clinic the Value of OCT in Digital Surveillance within Diabetic Eye Screening

DESIGN. Retrospective Audit PURPOSE. To assess the impact of the recent introduction of OCT in one more of the digital surveillance clinics within the Birmingham, Solihull and Black Country Diabetic Eye Screening Programme. METHODS. Between April 2019 and September 2019 an audit was undertaken retrospectively of patients attending Digital Surveillance. All had M1 grading on digital photography and OCT (Heidelberg Spectralis) Images were graded as maculopathy with or without oedema. Other lesions such as age-related macular degeneration (ARMD) and epiretinal membrane (ERM) were documented. Outcomes for those with maculopathy were either referral to Hospital Eye Service (HES) or followed up in the Digital Surveillance (DS) clinic with OCT. RESULTS. 670 patients were included (M 374 F 300 U 23;mean age 60yrs). Ethnicity was not recorded reliably but was predominantly White, Afro/Caribbean, Asian. OCT images were adequate and gradable in 654 patients (97.6%). 139 (20.7%) reverted to annual recall. 433 (64%) were kept within DS. 5 (0.75%) patients were excluded as they were unsuitable for screening. 83 (12.4%) patients were referred to HES, 48 with macular oedema (mean 400μm range 319 to 625, SD 54.8) who remained in HES for treatment and review. 6 (0.9%) patients were referred to HES/GP for other eye pathology (wet ARMD/glaucoma). 4 (0.60%) patients were referred to slit-lamp because images were unassessable. CONCLUSIONS. OCT is effective in DS clinics, providing a definitive diagnosis and measure of macular oedema. This study showed that only a small proportion of patients with maculopathy needed HES referral. All referrals to HES were deemed appropriate and stayed in HES for management. Identification of false positive M1 can continue annual recall safely. OCT allows appropriate prioritising of patients needing treatment more urgently. It has helped ease the pressure in HES with major capacity issues especially during the recent Covid pandemic.

Vulnerable and Forgotten: The Impact of the COVID-19 Pandemic on Autism Special Schools in England

The COVID-19 pandemic has caused, and continues to cause, unprecedented disruption in England. The impact of the pandemic on the English education system has been significant, especially for children and young people with special educational needs and disabilities (SEND). While it was encouraging that the educational rights of children and young people with SEND were highlighted during the COVID-19 pandemic, Government decision-making appeared to be centered around the needs of pupils in mainstream schools. In this article, co-authored by an academic researcher and senior leaders from the Pan London Autism Schools Network (PLASN;a collective of special schools in London and the South East of England, catering for pupils on the autistic spectrum), we reflect on the impact of the COVID-19 pandemic on special schools in England. We document and discuss a range of challenges experienced by PLASN schools, including the educational inequalities that were exposed and perpetuated by the COVID-19 pandemic, as well as the manner in which the needs and realities of special schools were overlooked by the Government. We also detail the creative and innovative solutions implemented by PLASN schools to overcome barriers that they encountered. These solutions centered on facilitating holistic approaches to support, ensuring clear and regular communication with families, providing effective support for home learning, and promoting collaborative ways of working;all of which align with good practice principles in autism education more generally, and are essential elements of practice to maintain post-pandemic. We additionally reflect on how the COVID-19 pandemic could be a catalyst for much-needed change to the SEND system: leading to better educational provision, and therefore better outcomes, for pupils with SEND. © Copyright © 2021 Crane, Adu, Arocas, Carli, Eccles, Harris, Jardine, Phillips, Piper, Santi, Sartin, Shepherd, Sternstein, Taylor and Wright.