ABSTRACT
This is a story of six researchers who came together to make sense of the tumult triggered by the COVID-19 pandemic. The team centered emotion and affectivity, letting it guide research design, team meetings, and the ways we related with interviewees and each other. The project also prompted us to critically examine our habits and realize the relatively privileged ways our own strategies of self-soothing could have problematic repercussions on the collective. As such, centering compassion and emotion not only served as a method of individual coping but also served to critically reveal how we as academics are enmeshed in systems that bring trauma to bear. This chapter closes with several ideas about how we might engage in research methods during and about times of collective suffering that move beyond individual emotional release and may prompt relational work toward communal catharsis and systematic change. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.
ABSTRACT
The article deals with teachers and teacher education from the perspective of broad policy frames, of how these frames are enacted in specific policies, including teacher career systems as well as pre-service and continuing teacher education, and how they appear in a diversity of international contexts. New Public Management and Accountability teacher policies are critically discussed in the light of their contemporary prevalence, using recent relevant research. Social justice and inclusion as a broad policy frame is examined in the light of immediate challenges posed by the COVID-19 pandemic, migrant people, as well as by the 2030 Sustainable Development Goals. © 2023 Elsevier Ltd. All rights reserved.
ABSTRACT
The article presents results of studies in Chile and Portugal during COVID-19 lockdowns and remote teaching conditions. In each of both countries, over two thousand teachers of all school levels and types were surveyed during a two-month period on their professional experiences in the first year of remote teaching. The article discusses teacher accounts of how their work changed, their difficulties, impact on well-being, as well as new professional learning brought about by the challenges involved. Conceptually, the study relied on notions of occupational professionalism, self-efficacy perceptionsand collegial support in challenging circumstances. Results in both countries highlighted an impact on teacher occupational professionalism and self-efficacy perceptions, mainly brought about by intermittent levels of engagement of students during remote teaching sessions, and difficulties in carrying out proper assessments of student learning. Student well-being was of greater concern to teachers than their own problems, despite feeling the stressful effect of much longer daily working hours, more so among Chilean than Portuguese teachers. The study also brought out teachers' imaginative efforts and the use of unaccustomed pedagogic strategies to reach out to students and insure some level of learning, especially among those without internet connectivity.
ABSTRACT
Background: Patients (pts) with malignancies are at increased risk of morbidity and mortality from COVID-19. Among these pts, some of the higher case fatality ratios (CFR) reported are among pts with myeloid malignancies, ranging from 37 to 50% (Mehta V, Cancer Discov 2020;Ferrara F, Leukemia 2020). Levine Cancer Institute (LCI) has a robust hematologic malignancy and cellular therapy program that serves many pts with myeloid malignancies, seeing nearly 100 new diagnoses of acute myeloid leukemia per year. A strategy to mitigate risks associated with COVID-19 was established at LCI in partnership with Atrium Health's (AH) Hospital at Home (HAH). HAH was a system wide platform using telemedicine and home health services to assess and monitor COVID-19 + pts at high risk of complications. To augment HAH for our medically complex cancer pts, a virtual health navigation process involving expertise from across LCI, including a specialized nurse navigation team, was developed to rapidly identify LCI pts + for SARS-CoV-2, monitor them under physician supervision, and escalate care as needed with AH HAH. Along with the navigation platform, data-driven guidelines for detecting, monitoring, and managing LCI pts + for SARS-CoV-2 were swiftly employed across the extensive LCI network. Herein we report on the outcomes for LCI pts with myeloid malignancies + for SARS-CoV-2 and outline the employed risk mitigation strategies and their potential impact on these outcomes. Methods: An automated daily list of LCI pts + for SARS-CoV-2 was provided by AH Information Services. Each pt's chart was reviewed by a nurse navigator for hematologic or oncologic diagnosis, outpatient or inpatient status, and COVID-19 symptoms. Pts without a cancer diagnosis were not assigned a navigator. If hospitalized, a pt was not assigned a navigator;following discharge, if enrolled in HAH, a navigator was assigned. In collaboration with HAH, an algorithm for directing care was utilized (Figure 1). A diagnosis-specific navigator contacted and screened the pt with an assessment tool, which scored pts for surveillance and treatment needs (Table 1). Documentation was forwarded to the primary hematologist/oncologist. Comprehensive guidelines for testing, scheduling, management of + pts, research, and process changes were created, disseminated, and actively updated through LCI's EAPathways. For outcome analysis for pts with myeloid malignancies, pt vital status was updated through data cutoff (7/3/21). Results: From inception on 3/20/20 to 12/2/20, 974 LCI patients were identified as SARS-CoV-2 + and reviewed for nurse navigation. Of the 974 pts, including pts with benign and malignant diagnoses, 488 were navigated. Among all SARS-CoV-2 + LCI pts, 145 (15%) had a hematologic malignancy, including 37 (4%) pts with myeloid malignancies. Characteristics are shown in Table 2. Of the 37 pts, 18 (49%) were navigated. 70% with myeloid malignancies were on active treatment at the time of + test. Nearly 50% of those on active treatment were navigated. 46% were hospitalized with COVID-19, with this being the main reason for no assigned navigator. 24% of hospitalized pts were eventually assigned a navigator. Only 3 pts had undergone allogeneic stem cell transplantation (allo-SCT) with a median time from transplant to detection of SARS-CoV-2 of 9 months (range, 7-23). 2 out of 3 cases post allo-SCT were asymptomatic. No pt died from COVID-19 following allo-SCT. Among the navigated pts with myeloid malignancies, there was no death related to COVID-19. 4 pts, all of whom were hospitalized, died from COVID-19 (N=2, myelodysplastic syndrome with 1 on azacitidine;N=2, myeloproliferative neoplasm, both on hydrea). A CFR of 11% was demonstrated for LCI pts with myeloid malignancies. Conclusions: A multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted cancer pts + for SARS-CoV-2. With our embedded nurse navigation team's specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities f r care escalation or adjustments in cancer-focused care were promptly identified. In this setting, among the high-risk population of pts with myeloid malignancies, a lower CFR than has been reported was observed. A virtual navigation platform with HAH capabilities is a feasible, safe, and effective way to monitor and care for this high-risk population. [Formula presented] Disclosures: Moyo: Seattle Genetics: Consultancy. Chai: Cardinal Health: Membership on an entity's Board of Directors or advisory committees. Avalos: JUNO: Membership on an entity's Board of Directors or advisory committees. Grunwald: Amgen: Consultancy;Agios: Consultancy;Astellas: Consultancy;Daiichi Sankyo: Consultancy;Stemline: Consultancy;Bristol Myers Squibb: Consultancy;PRIME: Other;Trovagene: Consultancy;Blueprint Medicines: Consultancy;AbbVie: Consultancy;Med Learning Group: Other;Pfizer: Consultancy;Sierra Oncology: Consultancy;Janssen: Research Funding;Incyte: Consultancy, Research Funding;Gilead: Consultancy;MDEdge: Other;PER: Other;Cardinal Health: Consultancy;Karius: Consultancy. Copelan: Amgen: Consultancy.
ABSTRACT
Background: MF patients (pts) can have significant disease-associated symptoms. Guidelines recommend evaluation of pts' symptom burdens and prognostic risk scores at clinic visits. The myeloproliferative neoplasm symptom assessment form total symptom score (MPN-SAF TSS) is a standardized system that evaluates 10 specific MPN-related symptoms on a scale of 1-10. Furthermore, the dynamic prognostic scoring system plus (DIPSS plus) has been validated as a risk stratification tool for MF pts at any point during the disease course. At our institution, leukemia physicians have created an MF pathway to guide practitioners throughout a large healthcare system with many locations. The pathway recommends MPN-SAF TSS and DIPSS plus risk score with clinic visits occurring every 3-6 months. Unfortunately, the traditional approach to obtaining the MPN-SAF TSS and DIPSS plus score is burdensome for many providers and pts. Moreover, a recent analysis (Verstovsek Ann Hematol 2020) demonstrates that risk prognostication is very often performed incorrectly. We designed a study to streamline workflow by incorporating our specialty pharmacy to assist in the completion of the MPN-SAF TSS and DIPSS plus score via telephone prior to clinic visits. We hypothesized that partnership between our physicians and the specialty pharmacy may benefit pts by increasing adherence to the MF pathway. Methods: This study is conducted in two parts, a retrospective and a prospective phase. A review 12 months prior to start of study was completed to gain historical insight on provider adherence to the MF pathway, with attention to MPN-SAF TSS and DIPSS plus. Then, a prospective study was designed to include new or established MF pts. Pts would be followed for 12 months after start of study. The pilot study was open only at our largest site, home to a subspecialty leukemia clinic where disease-specific physicians practice. For pts who enroll in the prospective study, specialty pharmacists complete both the MPN-SAF TSS and the DIPSS plus score ~3 months via phone prior to clinic visits. Calls for each pt are completed within 10 days of the pt's next visit. If the pharmacist is unable to reach the pt, the physician is notified via EMR message. Completed assessments are documented in the EMR. All enrolled pts are evaluated for MF pathway adherence during the study period. Results: We reviewed system-wide charts for 12 months prior to March 1, 2020 to assess if DIPSS and/or MPN SAF forms were documented for MF patients. 79 MF pts, treated by 32 physicians, were identified. Patients in remission after allogeneic stem cell transplantation were excluded. 36 pts (46%) had the MPN-SAF TSS completed and 53 pts (67%) had DIPSS plus performed at least once in the preceding 12 months. 45 pts, treated by 8 physicians, were followed primarily at the pilot site. 27 pts (60%) had MPN-SAF TSS documented and 38 (84%) had DIPSS Plus performed at least once in the preceding 12 months. The prospective study was initiated on March 1, 2020. As of July 15, 2020, 32 patients have been screened for enrollment by treating physicians. This includes 3 newly diagnosed patients not included in the retrospective analysis. 22 pts have had their initial assessments completed. 2 pts could not be reached, 1 of which died prior to the next clinic visit, 2 pts declined the study, and 6 pts had not yet had clinic visits. Of the 22 pts consented and contacted for the study, 100% had the MPN-SAF TSS and DIPSS Plus score documented with their first visit during the study period. To date 11 pts (of the initial 22) have undergone reevaluation;100% had the MPN-SAF TSS and DIPSS Plus score documented with their 3-month follow-up visit. Conclusion: Many practicing clinicians perform MPN-SAF TSS and DIPSS plus scores for MF pts. However, there are lapses in the uptake of both. At our institution, the DIPSS plus score is performed more commonly than the MPN-SAF TSS. This early analysis suggests that a telemedicine approach and partnership between specialty pharmacy and physicians can optimize clinical wor flow. With the initial success of this pilot, our program is expanding study enrollment to include regional clinics. Due to the COVID19 pandemic, there is now heightened interest in telemedicine practices. Preliminary data from this study suggest that a multidisciplinary approach incorporating telemedicine for MF pts provides an effective approach to measuring patient symptom burdens and assigning prognostic categories. [Formula presented] Disclosures: Chojecki: Novartis: Other: Investigator Meeting Attendance;Incyte: Research Funding. Shah: Incyte: Speakers Bureau;Pharmacyclics: Speakers Bureau. Knight: Foundation for Financial Planning: Research Funding. Ai: Celgene: Speakers Bureau;Incyte: Speakers Bureau. Avalos: Best Practice-Br Med J: Patents & Royalties: receives royalties from a coauthored article on evaluation of neutropenia;Juno: Membership on an entity's Board of Directors or advisory committees. Copelan: Amgen: Membership on an entity's Board of Directors or advisory committees. Grunwald: Janssen: Research Funding;Genentech/Roche: Research Funding;Abbvie: Consultancy;Daiichi Sankyo: Consultancy;Abbvie: Consultancy;Abbvie: Consultancy;Trovagene: Consultancy;Incyte: Consultancy, Research Funding;Celgene: Consultancy;Incyte: Consultancy, Research Funding;Agios: Consultancy;Janssen: Research Funding;Astellas: Consultancy;Daiichi Sankyo: Consultancy;Trovagene: Consultancy;Premier: Consultancy;Merck: Consultancy;Genentech/Roche: Research Funding;Forma Therapeutics: Research Funding;Agios: Consultancy;Celgene: Consultancy;Celgene: Consultancy;Cardinal Health: Consultancy;Pfizer: Consultancy;Trovagene: Consultancy;Premier: Consultancy;Astellas: Consultancy;Premier: Consultancy;Merck: Research Funding;Astellas: Consultancy;Merck: Consultancy;Genentech/Roche: Research Funding;Daiichi Sankyo: Consultancy;Agios: Consultancy;Amgen: Consultancy;Amgen: Consultancy;Cardinal Health: Consultancy;Merck: Consultancy;Cardinal Health: Consultancy;Pfizer: Consultancy;Amgen: Consultancy;Pfizer: Consultancy;Incyte: Consultancy, Research Funding;Forma Therapeutics: Research Funding;Forma Therapeutics: Research Funding.