Australian experiences using a COVID-19 chest radiography reporting template: An implementation study

Introduction: Chest X-rays are an important tool in COVID-19 disease management and progression.1 Several radiology societies have developed structured reporting templates to reduce interpretation variability and measure concordance.2 This study aimed to measure concordance of three international chest X-ray reporting templates in a Sydney hospital. Method(s): 12 radiologists viewed a test set of 50 COVID-19-positive patients' chest X-rays (30 classic appearance, 20 indeterminate) and 20 normal or 'other' diagnoses chest X-rays. Radiologists classified the cases according to the Royal Australian and New Zealand College of Radiology (RANZCR), British Society of Thoracic Imaging (BSTI) and modified Co-RADS (Dutch)3 templates. Intra-reader and inter-reader reliability were calculated plus measures of experiences of using templates. Result(s): Inter-reader agreement between radiologists was highest for the BSTI template (0.46), followed by RANZCR (0.36) and modified Co-RADS (0.31). The intra-reader agreement across the three templates for 'classic/characteristic' COVID-19 cases was 0.61, for 'normal' cases 0.76 and 'alternative' 0.68 with large variations that were not related to experience. Radiologists agreed the templates were easy to use and would consider using them in the future, although some cases had very low concordance (intra- and inter-reader). Conclusion(s): The BSTI template yielded highest agreement for reporting all chest X-ray types. There was a large range of intra-reader agreement for all four types of patient presentations. Further investigation of radiology lexicon is required to seek reasons for variation as well as understanding the perception of utility by referring physicians. Extension of this work should include radiographers using the templates.

Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool.

INTRODUCTION: The multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial disease severity, will have significant rehabilitation needs. METHODS: Cross-sectional study of consecutive patients referred by general practitioners (April-November 2020). Primary outcomes were presence/absence of anticipated sequelae. Binary logistic regression was used to test association between acute presentation and post-COVID-19 symptomatology. RESULTS: 155 patients (n=127 men, n=28 women, median age 39 years, median 13 weeks post-illness) were assessed using the tool. Acute symptoms were most commonly shortness of breath (SOB) (74.2%), fever (73.5%), fatigue (70.3%) and cough (64.5%); and post-acutely, SOB (76.7%), fatigue (70.3%), cough (57.4%) and anxiety/mood disturbance (39.4%). Individuals with a confirmed diagnosis of COVID-19 were 69% and 63% less likely to have anxiety/mood disturbance and pain, respectively, at 3 months. CONCLUSIONS: Rehabilitation assessment should be offered to all patients suffering post-COVID-19 symptoms, not only those with laboratory confirmation and considered independently from acute illness severity. This tool offers a structure for a remote assessment. Post-COVID-19 programmes should include SOB, fatigue and mood disturbance management.

Trans/feminist collaborative autoethnographic storying of gender-based violence, during the COVID-19 pandemic

The COVID-19 crisis has spotlighted particular insidious social problems, including gender-based violence (GBV), and their relationship with movement and confinement. As well as changing configurations of GBV, the experience of the global pandemic and the immobilities of national lockdowns have created space to imagine GBV - to connect with past experiences in the context of our rethinking of current experiences across multiple spaces. In this article we explicate a transdisciplinary feminist collaborative autoethnographic storying of GBV during the COVID-19 pandemic. Based on the 'trans/feminist methodology' of Pryse (2000), we seek to contribute knowledge of GBV through the lens of COVID-19 using our own experiential life storying. In this article we show the potential of this method in understanding lived experiences over time that are situated in a specific context. Our experiences of GBV, as viewed through the pandemic, are presented as fragments, which then make up a collective narrative that illustrates our shared experiences of GBV in all its forms, across multiple spaces and throughout our life histories. In this common story, GBV is considered to im/mobilise - to stagnate our range of mobilities to varying degrees across these spaces and times.

Services to Mobile Users

Libraries are adapting to the changing times by providing mobile services. One hundred fifty-one libraries were chosen based on circulation, with at least one library or library system from each state, to explore the diverse services provided to mobile users across the United States. According to the data, mobile apps, mobile reference services, mobile library catalogs, and mobile printing are among public libraries' most-frequently offered services, as determined by mobile visits, content analysis, and librarian survey responses. Every library examined had at least one mobile website, mobile catalog, mobile app, or webpage adapted for a mobile device. Following the COVID-19 outbreak, services such as mobile renewal, subscriber database access, mobile reservations, and the ability to interact with a librarian were expanded to allow better communication with customers—all from the comfort and safety of their own homes. Libraries are continually looking for innovative methods to assist their mobile customers as the world changes. © 2023 American Library Association. All rights reserved.

Globalization and education

This chapter seeks to explore some of the major theoretical traditions that have informed thinking about globalization and its implication for education research. I particularly situate an understanding of globalization within broader developments in the social sciences around spatial issues, as well as the various theoretical frameworks that have been mobilized to better understand where and to whom education policy is spatially and relationally located. These include (i) scalar approaches, or an understanding of space as nested multi-levelled scales;and (ii) topological approaches, or an understanding of space as constituted through relations between social actors. © 2023 Elsevier Ltd. All rights reserved.

Diagnosis, treatment, and outcome of patients with oesophagogastric cancer during the COVID-19 pandemic: national study.

BACKGROUND: The national response to COVID-19 has had a significant impact on cancer services. This study investigated the effect of national lockdown on diagnosis, management, and outcomes of patients with oesophagogastric cancers in Scotland. METHODS: This retrospective cohort study included consecutive new patients presenting to regional oesophagogastric cancer multidisciplinary teams in National Health Service Scotland between October 2019 and September 2020. The study interval was divided into before and after lockdown, based on the first UK national lockdown. Electronic health records were reviewed and results compared. RESULTS: Some 958 patients with biopsy-proven oesophagogastric cancer in 3 cancer networks were included: 506 (52.8 per cent) before and 452 (47.2 per cent) after lockdown. Median age was 72 (range 25-95) years and 630 patients (65.7 per cent) were men. There were 693 oesophageal (72.3 per cent) and 265 gastric (27.7 per cent) cancers. Median time to gastroscopy was 15 (range 0-337) days before versus 19 (0-261) days after lockdown (P < 0.001). Patients were more likely to present as an emergency after lockdown (8.5 per cent before versus 12.4 per cent after lockdown; P = 0.005), had poorer Eastern Cooperative Oncology group performance status, were more symptomatic, and presented with a higher stage of disease (stage IV: 49.8 per cent before versus 58.8 per cent after lockdown; P = 0.04). There was a shift to treatment with non-curative intent (64.6 per cent before versus 77.4 per cent after lockdown; P < 0.001). Median overall survival was 9.9 (95 per cent c.i. 8.7 to 11.4) months before and 6.9 (5.9 to 8.3) months after lockdown (HR 1.26, 95 per cent c.i. 1.09 to 1.46; P = 0.002). CONCLUSION: This national study has highlighted the adverse impact of COVID-19 on oesophagogastric cancer outcomes in Scotland. Patients presented with more advanced disease and a shift towards treatment with non-curative intent was observed, with a subsequent negative impact on overall survival.

An understanding of discordant SARS-CoV-2 test results: An examination of the data from a central Auckland laboratory

AIM: The diagnostic sensitivity of the SARS-CoV-2 real time reverse transcription polymerase chain reaction (RT-PCR) test has not been determined. This has led to a degree of uncertainty in the interpretation of results, particularly in patients tested repeatedly. The aim of this study was to explore the characteristics of patients who initially tested negative, and subsequently tested positive for SARS-CoV-2. METHOD(S): This retrospective observational study utilised data from the LabPlus Virology laboratory, Auckland City Hospital, to identify cases (hospital and community) with initial negative and subsequent positive SARS-CoV-2 RT-PCR results. Their clinical and laboratory characteristics were summarised. RESULT(S): From 1 February to 13 April a total of 20,089 samples were received for SARS-CoV-2 testing. Of 2,011 samples from patients with multiple tests, 25 samples were positive. Nine samples were from patients who initially tested negative then tested positive. Reasons for the initial negative test results, which were all from upper respiratory tract samples, included pre-symptomatic presentation or late presentation. All patients had significant risk factors and ongoing or evolving symptoms, which warranted repeat testing. CONCLUSION(S): Few patients had discordant test results for SARS-CoV-2 RT-PCR. For patients who have a significant risk factor and a negative test result, repeat testing should be performed. Copyright © 2020 New Zealand Medical Association. All rights reserved.

VRCT: Randomized Controlled Trial Evaluating the Impact of Virtual Reality Therapy on BPSD and QoL of Acute Care In-Patients With Dementia

Background: Virtual Reality (VR) is increasingly considered a valuable therapy tool for managing behavioural and psychological symptoms (BPSDs) and quality of life (QoL) in dementia (Parsons, 2013). However, rigorous studies are still needed to evaluate its impact in acute care settings (Appel, 2021). This study evaluated the impact of VR-therapy on managing BPSDs, falls, and length of stay (LoS) and QoL for inpatients with dementia admitted to an acute care hospital. Method(s): An open longitudinal interventional randomized controlled trial was conducted between April 2019 and March 2020 (ClinicalTrials.gov, ID:NCT03941119). A total of 69 participants (age >=65, diagnosis of dementia, did not meet exclusion criteria) (Figure 1) who were randomly assigned either followed standard of care (Control Arm, n = 35 or received VR-therapy every 1-3 days (Intervention Arm, n = 34) (Figure 2). VR-therapy entailed watching 360-degree-VR-films on a HMD for up to 20 minutes (Figures 3 and 4). Instances of daily BPSDs documented in EMR nursing notes were categorized based on the Neuropsychiatric Inventory (NPI). QoL measures included the Quality of Life in Late-Stage Dementia scale (QUALID) and semi-structured interviews conducted at scheduled visits. Structured observations (including the standardized "ObsRVR" tool) and interviews were used to measure treatment feasibility (Figure 5). Result(s): VR-therapy had a statistically significant effect (p =.014) in reducing aggressivity (i.e., physical aggression and loud vociferation). A sentiment analysis of patient responses to the semi-structured interviews on QoL revealed a statistically significant impact of VR therapy (p =.013). No statistically significant impact of VR therapy was found for other BPSDs (e.g., apathy), falls, or LoS or QoL as measured by the QUALID. VR-therapy was overall an acceptable and enjoyable experience for participants and no adverse events occurred as a result of VR-therapy. Conclusion(s): Immersive VR-therapy appears to have an effect on aggressive behaviours and QoL in acute care patients with dementia. Although the RCT was stopped before reaching the intended sample size due to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. Copyright © 2022 the Alzheimer's Association.

Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action

Background. Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI. Methods. We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheterassociated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression. Results. Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (< 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative toWhite patients in both study periods (pre-pandemic, 49% vs 38%;during pandemic, 47% vs 31%;respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30;95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51;95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3). Conclusion. We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes. (Figure Presented).

Comparison of Trends in Hospital-Onset Bloodstream Infections (HOBSIs) and Central Line Associated Bloodstream Infections (CLABSIs) across a Three-Hospital Health System in the COVID Era

Background. Hospital-onset bloodstream infection (HOBSI) incidence has been proposed as a complementary quality metric to central line-associated bloodstream infection (CLABSI) surveillance. Several recent studies have detailed increases in median HOBSI and CLABSI rates during the COVID-19 pandemic. We sought to understand trends in HOBSI and CLABSI rates at a single health system in the context of COVID-19. Methods. We conducted a retrospective analysis of HOBSIs and CLABSIs at a three-hospital health system from 2017 to 2021 (Figure 1). We compared counts, denominators, and demographic data for HOBSIs and CLABSIs between the prepandemic (1/1/2017-3/30/2020) and pandemic period (4/1/2020-12/31/2021) (Table 1). We applied Poisson or negative binomial regression models to estimate the monthly change in incidence of HO-BSI and CLABSI rates over the study period. Figure 1: Definitions applied for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs). Potentially contaminated blood cultures were identified by microbiology laboratory technicians as any set of blood culture in which a single bottle was positive for organisms typically considered as skin contaminants. Uncertain cases undergo secondary review by senior lab technicians. Table 1: Count, denominator, and device utilization ratio data for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs) Note that central line utilization increased upon regression analysis (p<0.001). Results. The median monthly HOBSI rate per 1,000 patient days increased from 1.0 in the pre-pandemic to 1.3 (p< 0.01) in the pandemic period, whereas the median monthly CLABSI rate per central line days was stable (1.01 to 0.88;p=0.1;Table 2). Our regression analysis found that monthly rates of HO-BSIs increased throughout the study, but the increase was not associated with the onset of the COVID-19 pandemic based on comparisons of model fit (Figure 2;Table 3). Despite an increase in central line utilization, regression modelling found no changes in monthly CLABSIs rates with respect to time and the COVID-19 pandemic. Incidence of HOBSIs and CLABSIs by common nosocomial organisms generally increased over this time period, though time to infection onset remained unchanged in our studied population (Table 2). Conclusion. HOBSIs rates did not correlate with CLABSI incidence across a three-hospital health system from 2017 and 2021, as rates of HOBSI increased but CLABSI rates remained flat. Our observed increase in HOBSI rates did not correlate with the onset of the COVID-19 pandemic, and caution should be used in modeling the effects of COVID-19 without time-trended analysis. Further evaluation is needed to understand the etiology, epidemiology, and preventability of HO-BSI.

Modeling Diagnostic Testing Strategies for SARS-CoV-2 to Minimize Societal Costs and Return People to Work

Background. The shift to more transmissible but less virulent strains of SARS-CoV-2 has altered the risk calculation for infection. Particularly among young adults, the economic burden of lost work due to isolation exceeds the economic burden of morbidity due to infection. Testing strategies must adapt to these changing circumstances. Methods. We modeled six testing strategies to estimate total societal costs for symptomatic people 18-49 years old: isolation of all individuals with no testing, rapid antigen test (RAg), RAg followed by a second RAg 48h later if first negative, RAg followed by a polymerase chain reaction (PCR) if negative, RAg followed by a PCR if positive, and PCR alone. We calculated costs for hypothetical cohorts of 100 symptomatic healthcare workers tested with each strategy;we included testing costs, lost wages, and hospitalization costs for the index, secondary, and tertiary cases. Key assumptions were 5% prevalence of infection, sensitivity of first/second RAg 40/80% with 97% specificity, PCR sensitivity/specificity 95/99%, all individuals isolate at symptom onset, are tested the same day, and isolate for 5 days if positive. RAg results were available the same day, PCR results were available the next day (Figure 1). One-way sensitivity analyses were performed for RAg sensitivity (20-80%) and positivity rate (1-80%). Results. The least expensive strategy was RAg alone (Figure 2). This was primarily driven by its low sensitivity, which reduced lost wages at the expense of missing cases. At a threshold for RAg sensitivity lower than 29%, PCR testing alone became the cheapest strategy. When the positivity rate was > 6% confirming a negative RAg with a PCR became the cheapest strategy, closely followed by PCR alone. At a positivity rate of > 29%, isolation without testing was cheapest followed by confirming a negative RAg with a PCR and by the serial RAg test strategies (Figure 3). Conclusion. In relatively young, healthy populations, a single rapid test was the least expensive strategy when the positivity rate was < 6%, testing that included PCR became cheapest at intermediate positivity, and empiric isolation was cheapest at positivity > 29%. Calibrating SARS-CoV-2 test strategies based on epidemiology may save societal costs.

The utility of COVID-19 reporting templates for chest radiography (CXR): an Australian single centre study

Purpose: Chest radiographs (CXRs) are an important tool for COVID-19 disease management and progression.1 A number of international thoracic/radiology societies have developed structured reporting templates to reduce interpretation variability and measure concordance.2 Recent research into COVID-19 templates have used small data sets, small numbers of radiologists and focused on predictive disease progression. The aim of this study is to evaluate the utility of three (Australian, British, Dutch) CXR qualitative reporting templates in a large Sydney teaching hospital. Methods and Materials: Twelve staff specialist radiologists were recruited to participate in the study. Retrospective CXRs between 2020-21 were collected and organized into test sets, containing the CXRs of 50 PCR-positive COVID-19 patients and classified as 'classic/ characteristic' for radiology signs of COVID-19 disease (30 cases) or 'indeterminate' for radiological signs (20 cases) by two expert radiologists. A further 10 CXRs of patients who were imaged for an 'alternative' diagnosis and 10 CXRs that had been reported 'normal' were included. Radiologists were assigned to one of three image sets, with the 70 images randomized and instructed to report the cases using three templates: the Royal Australian and New Zealand College of Radiology (RANZCR), British Society of Thoracic Imaging (BSTI) and modified Co-RADS (Dutch)3. Fleiss' Kappa Coefficient was used for agreement between radiologists on each template (inter-reader), and for radiologist's agreement within themselves using the three templates (intra-reader). Result(s): Inter-reader agreement between radiologists was highest for the BSTI template at 0.46 (moderate agreement), followed by RANZCR (0.36) and modified CO-RADS (0.31) (fair agreement). For all templates, agreement was highest for 'normal CXRs" and lowest for 'indeterminate', with moderate or fair agreement for the 'classic' COVID-19 cases (BSTI 0.44;RANZCR 0.31;mod-CO-RADS 0.31). The intra-reader agreement across the 3 templates for 'classic/characteristic' COVID cases was 0.61, for 'normal' cases 0.76 and 'alternative' 0.68 (all at substantial agreement), indicating that radiologists largely were consistent with classification of cases. Conclusion(s): The BSTI template yielded the highest agreement among radiologists for reporting COVID-19 CXRs as well as for 'normal' and 'alternative'. There was a large range of intra-reader agreement for all 4 types of patient presentations, however the level of agreement equal to or higher than 'moderate'. Structured reporting templates have yielded promising results for concordance between radiologists and reliability within radiologist's reporting of CXRs. Further investigation of radiology lexicon within templates is required to seek reasons for variation in concordance, as well as the demographics of readers.

Impact of a Comprehensive SARS-CoV-2 Infection Prevention Bundle on Rates of Hospital-Acquired Respiratory Viral Infections

Background: We evaluated the impact of a comprehensive SARS-CoV-2 (COVID-19) infection prevention (IP) bundle on rates of non–COVID-19 healthcare-acquired respiratory viral infection (HA-RVI). Methods: We performed a retrospective analysis of prospectively collected respiratory viral data using an infection prevention database from April 2017 to January 2021. We defined HA-RVI as identification of a respiratory virus via nasal or nasopharyngeal swabs collected on or after hospital day 7 for COVID-19 and non–COVID-19 RVI. We compared incident rate ratios (IRRs) of HA-RVI for each of the 3 years (April 2017 to March 2020) prior to and 10 months (April 2020 to January 2021) following full implementation of a comprehensive COVID-19 IP bundle at Duke University Health System. The COVID-19 IP bundle consists of the following elements: universal masking;eye protection;employee, patient, and visitor symptom screening;contact tracing;admission and preprocedure testing;visitor restrictions;discouraging presenteeism;population density control and/or physical distancing;and ongoing attention to basic horizontal IP strategies including hand hygiene, PPE compliance, and environmental cleaning. Results: During the study period, we identified 715 HA-RVIs over 1,899,700 inpatient days, for an overall incidence rate of 0.38 HA-RVI per 1,000 inpatient days. The HA-RVI IRR was significantly higher during each of the 3 years prior to implementing the COVID-19 IP bundle (Table 1). The incidence rate of HA-RVI decreased by 60% after bundle implementation. COVID-19 became the dominant HA-RVI, and no cases of HA-influenza occurred in the postimplementation period (Figure 1). Conclusions: Implementation of a comprehensive COVID-19 IP bundle likely contributed to a reduction in HA-RVI for hospitalized patients in our healthcare system. Augmenting traditional IP interventions in place during the annual respiratory virus season may be a future strategy to reduce rates of HA-RVI for inpatients.Table 1.Figure 1.

High-flow nasal cannulae for respiratory support in adult intensive care patient

Background High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. Objectives To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. Selection criteria We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask;or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. Data collection and analysis We used standard methodological procedures as expected by Cochrane.

Perioperative exercise programmes to promote physical activity in the medium to long term: systematic review and qualitative research

BACKGROUND: In England, more than 4 million hospital admissions lead to surgery each year. The perioperative encounter (from initial presentation in primary care to postoperative return to function) offers potential for substantial health gains in the wider sense and over the longer term. OBJECTIVES: The aim was to identify, examine and set in context a range of interventions applied perioperatively to facilitate physical activity in the medium to long term. DATA SOURCES: The following databases were searched - Cochrane Central Register of Controlled Trials, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO and SPORTDiscus in October 2020. Clinical trials databases were also searched, and backward and forward citation searches were conducted. REVIEW METHODS: We undertook a systematic review;ran database searches in October 2020;extracted data;conducted risk-of-bias assessments of studies;and used Grading of Recommendations Assessment, Development and Evaluation assessments. We conducted focus groups and interviews with people running services designed to promote physical activity, to understand the practical and contextual factors that make such interventions 'work'. Although the two streams of work were conducted independently, we considered overlapping themes from their findings. RESULTS: In the review, we found 51 randomised controlled trials and two quasi-randomised trials;nine non-randomised studies formed a supplementary data set. Studies included 8604 adults who had undergone (or were undergoing) surgery, and compared 67 interventions facilitating physical activity. Most interventions were started postoperatively and included multiple components, grouped as follows: education and advice, behavioural mechanisms and physical activity instruction. Outcomes were often measured using different tools;pooling of data was not always feasible. Compared with usual care, interventions may have slightly increased the amount of physical activity, engagement in physical activity and health-related quality of life at the study's end (moderate-certainty evidence). We found low-certainty evidence of an increase in physical fitness and a reduction in pain, although effects generally favoured interventions. Few studies reported adherence and adverse events;certainty of these findings was very low. Although infrequently reported, participants generally provided positive feedback. For the case studies, we conducted two online focus groups and two individual interviews between November 2020 and January 2021, with nine participants from eight services of physical activity programmes. Conceptual and practical aspects included how the promotion of physical activity can be framed around the individual to recruit and retain patients;how services benefit from committed and compassionate staff;how enthusiasts, data collection and evidence play key roles;and how digital delivery could work as part of a blended approach, but inequalities in access must be considered. LIMITATIONS: Outcome measures in the review varied and, despite a large data set, not all studies could be pooled. This also limited the exploration of differences between interventions;components of interventions often overlapped between studies, and we could not always determine what 'usual care' involved. The case study exploration was limited by COVID-19 restrictions;we were unable to visit sites and observe practice, and the range of services in the focus groups was also limited. CONCLUSIONS: Evidence from the review indicates that interventions delivered in the perioperative setting, aimed at enhancing physical activity in the longer term, may have overall benefit. The qualitative analysis complemented these findings and indicated that interventions should be focused around the individual, delivered locally and compassionately, and promoted by a patient's full clinical team. There is a need to develop a core outcome set for similar studies to allow quantitative synthesis. Future work should also investigate the experiences of patients in different contexts, such as different communities, and with different surgical indications. STUDY REGISTRATION: This study is registered as PROSPERO CRD42019139008. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research;Vol. 10, No. 21. See the NIHR Journals Library website for further project information.

An Apple for teacher (education)? Reconstituting teacher professional learning and expertise via the Apple Teacher digital platform

Although COVID-19 has intensified clear global trends towards the digitalisation of schooling and the increasing role of information technology in education, a less obvious consequence has been the shift to online professional learning for teachers themselves. Informed by an emerging critical literature of digital education platforms, this paper will explore how Apple Teacher – the digital learning platform of the US technology giant, Apple Inc. – forges new marketised and platformed relations between schooling spaces and actors. I argue that Apple Teacher helps Apple to maximise its policy relevance, allowing it to leverage its global brand recognition to compellingly promote a particular vision of teacher knowledge and expertise. © 2022 Elsevier Ltd