ABSTRACT
During late spring 2020, when states were issuing stay-at-home orders, the majority of congregations and Americans followed protocols and avoided in-person worship. Yet a vocal minority of Americans defied protocols and gathered in worship. The authors use national panel data collected in mid-May and August 2020 to assess whether Americans who attended worship more frequently during lockdown restrictions were more likely to report testing positive for coronavirus disease 2019 (COVID-19) three months later. Accounting for relevant correlates including mask use, general attendance at large gatherings, and knowing others who had tested positive, the likelihood that Americans tested positive for COVID-19 between May and August 2020 grew almost linearly as Americans attended in-person worship more frequently during lockdown. However, interactions indicate that this increase was limited primarily to those who were not regular attenders previously. The results suggest that worship attendance during lockdown substantially increased COVID-19 infections for the minority who attended possibly as a form of protest.
ABSTRACT
In the UK, approximately 3 million people are malnourished or at risk of malnutrition. Malnutrition is a major public health issue with costs the NHS over £19 billion per year in England alone. We know 93% of malnutrition happens in peoples own homes, 5% in care homes and 2% in hospital. It is also understood that 30% of inpatients are at higher risk of becoming malnourished in hospital. 1 As many departments, demand for dietetic services has outweighed capacity, in part due to improved rates of nutritional risk screening across the organisation. The Trust uses an internal validated nutritional screening tool but community partners largely use MUST (Malnutrition Universal Screening Tool). Within our Dietetic team, we identified a number of treatment strategies needed to ensure timely care, patient empowerment and patient safety with a focus on improved nutrition to help recovery across organisational boundaries from the acute admission and into primary care. Patients who are identified as malnourished or at very high risk of malnutrition, have specialist requirements should have immediate referral to a dietitian. Oral nutritional supplements are now prescribed appropriately whilst in hospital and post discharge in line with national and local guidelines. 4 Communication between different healthcare professionals and settings is essential for the seamless delivery of care2 and hospital teams discharging patients with an identified risk of malnutrition should communicate this in writing to primary care teams3. As a team, we decided to encompass nutrition and dysphagia scores as an inpatient on discharge letters. This was be achieved by working closely with the pharmacy, Speech and Language, catering, nursing and medical teams to develop and implement a clear process for all adult inpatients to improve ward based nutritional care and appropriate prescribing, based on their individual risk of malnutrition. We have developed and implemented a discharge process that provides patients with a nutrition pack (malnutrition pathway leaflets, cover letter +/- Care Homes information) +/- nutritional supplements on discharge. The process was developed with local CCGs, GPs, PCN Pharmacists and community dietetic services. Outcomes measured include;appropriate prescribing, access to snacks and supplements, clinical outcomes including length of stay (LOS), readmission rates and timely access to first line advice. Baseline audit information revealed only 8% of inpatients received the a first line nutrition leaflet, this has increased to 13% just 6 weeks post implementation, patient first line snacks has increased to 5 different categories as choice available has increased. Oral nutritional support (ONS) is now solely prescribed using the agreed ONS pathway. Early indications suggest a direct improvement in patient care and choice. References 1. Brothern A, Simmonds N, Stroud M.2010. Malnutrition Matters: Meeting Quality Standards in Nutritional Care. A report on behalf BAPEN Quality Group 2. ‘A Guide to Managing Adult Malnutrition in the Community’ Last accessed from: on 02.07.2021 3. ‘Pathway for using ONS in the Management of Malnutrition’ Last accessed from:https://www.malnutritionpathway.co.uk/library/ons_pathway.pdf on 29.06.2021 4. ‘Nutritional considerations for primary care teams managing patients with or recovering from COVID-19’ BDA and optimising nutritional prescribing last accessed :. 02.07.21
ABSTRACT
In April 2020, with the realisation that dietetic practice had to change when covering critical care units, a group of specialist dietitians led the development of a hand held digital dietetic record that could be safely use within the critical care unit avoiding the use of paper and it being transferred off the COVID critical care unit. Being digital enabled remote working, decreased footfall and increased safety for patients and staff. This was the first step in a journey that saw the transformation from a paper based system to one that is entirely digital across all dietetic areas within inpatient and outpatient settings and in both in adults and paediatrics by the end of 2020. Together with the introduction of video patient consultations, video conferencing applications and electronic prescribing, our approach to provide dietetic intervention has changed dramatically. It has enabled a dietetic service to embrace remote working which has been helpful during periods of self-isolation e.g. virtual;ward rounds, group sessions, 1:1 education, interviews, training and development. Collaborative working included the newly developed “digital dietetic group” and the “H Digital” trust group and DXC technologies to develop a clinical data capture (CDC) form. The clinical basis followed the layout as advised in the Model and Process for Nutrition and Dietetic Practice1 to ensure that data capture was relevant and followed a standard process. The purpose of the Model and Process is to describe, through six steps, the consistent process dietitians follow in any dietetic intervention. It articulates the specific skills, knowledge and critical reasoning that dietitians deploy, and the environmental factors that influence the practice of dietetics. This does not take away dietitians’ autonomy. Instead, it enables a consistent approach to dietetic care, with the service user at the centre. This completed form was available as a complete ‘dietetic’ digital record. A key objective within the Organisation’s Digital Strategy and it will reduce risks by enhancing clinical effectiveness and patient safety. The wider multi-professional team found dietetic digital records invaluable, to be able to access 24/7 allowing for continuity of care when unable to speak directly to the dietetic team this included alternative feeding regimens and clinical reasoning that subsequently influenced treatment decisions and allowed for patient care out of hours. This led onto working with trust digital team on electronic prescriptions for oral nutritional support and enteral feeds, digital patient lists (for caseloads), digital design of food and fluid charts for the organisation. The enhancement in clinical safety and patient care where is it required has been phenomenal and an exciting journey we are keen to share. The design will enable dietetic outcomes to be collected directly from digital record. References 1. BDA Model and Process 2020 last accessed;https://www.bda.uk.com/uploads/assets/1aa9b067-a1c1-4eec-a1318fdc258e0ebb/2020-Model-and-Process-for-Nutrition-and-Dietetic-Practice.pdf on 2.7.2021
ABSTRACT
OBJECTIVE: The WHO declared a global pandemic on 11th March 2020 for Coronavirus (COVID-19). During this time, fertility clinics around the world had to adapt very quickly in order to care for patients in a changing landscape with many clinics reducing or halting in-person clinical care during national lockdowns. This provided a unique opportunity for fertility nurses to increase engagement with patients via digital approaches. The purpose of this study was to examine the shift in fertility nursing clinical care pathways from face to face to virtual including the use of electronic patient information/ education delivery, electronic consenting platforms, and telehealth visits. understand the experience of fertility nursing care during the pandemic from a cohort of nursing professionals based in the UK and US. MATERIALSANDMETHODS: Baseline data was collected from the EngagedMD electronic patient information and consenting platform taken (March 2019 to March 2020), and then during the first year of the pandemic (March 11th 2020 [the declaration from the WHO] to April 11th 2021), and via a survey about virtual patient engagement conducted via interviews with nursing staff currently based in fertility clinics in both the US and UK. Descriptive statistics were analysed for all the data. RESULTS: There was an increase from baseline of 105.32% in the use of electronic consent forms during the pandemic, an increase of 60.016% of patients who had been educated with electronic patient information modules and an increase of 102.33% of fertility nurses implementing an electronic consenting or electronic patient education tool into their clinical patient pathway. All respondents (n=28) reported that the use of electronic consenting, electronic patient information and telehealth services changed the way in which they care for fertility patients. 62% (n=17) reported that as a direct result of implementing virtual care pathways, they had saved nursing time. CONCLUSIONS: Evidence collected from both data sources shows that there has been a significant shift in the way that fertility nurses are caring for their patients during the pandemic. There has been a change in the way that fertility nurses provide patient care due to the need to adapt during this global pandemic. The use of electronic and virtual platforms to educate, consult and consent fertility patients has increased at a much higher level than previous years. The results suggest that the role of the fertility nurse practitioner has changed to include the implementation of virtual care pathways and that care may continue to be provided this way in the future. IMPACT STATEMENT: Patient care can be delivered at a high level in a virtual way and the use of electronic platforms should be considered to save nursing administration time and to provide patients with better access to resources and information.
ABSTRACT
Background Detection of circulating tumour DNA (ctDNA) in patients (pts) who have completed treatment for early-stage triple negative breast cancer (TNBC) is associated with a very high risk of future relapse. Identifiying those at high risk of subsequent relapse may allow tailoring of further therapy to delay or prevent recurrence. The c-TRAK TN trial assessed the utility of prospective ctDNA surveillance in pts treated for TNBC and the activity of pembrolizumab (P) in pts with ctDNA detected. Methods c-TRAK TN, a multi-centre phase II trial with integrated prospective screening component, enrolled pts with early-stage TNBC and either residual disease following neoadjuvant chemotherapy, or tumour size >20mm and/or axillary lymph node involvement if adjuvant chemotherapy was given. Tumour tissue was sequenced to identify somatic mutations suitable for tracking using personalised digital PCR ctDNA assays (BioRad QX200). Pts had "active" ctDNA surveillance via blood sample testing every 3 months to 12 months (potential up to 18 months if S samples missed due to COVID) during which time if ctDNA was detected (ctDNA+) pts could be randomised 2:1 to P (200mg i.v. q 3 weeks for 1 year) or observation (Obs). Pts and clinicians were blinded to ctDNA+ results unless they were allocated P, when staging scans were done and those free of clinical recurrence started treatment. Following advice from the Independent Data Monitoring Committee, the Obs arm closed on 16/06/2020 with all subsequent ctDNA+ pts allocated P. Following the completion of active ctDNA surveillance, 3-monthly visits continued to 24 months to be analysed retrospectively. The aim was to recruit 150 pts to ctDNA surveillance, assuming 30% would be ctDNA+ within 12 months, allowing ctDNA+ rate to be estimated with a 2-sided 95%CI of +/-7.3%. Co-primary endpoints are i) rates of ctDNA detection by 12 and 24 months from start of ctDNA surveillance;ii) rates of sustained ctDNA clearance on P defined as absence of detectable ctDNA, or disease recurrence 6 months after starting P. Results 208 pts were registered between 30/01/18 and 06/12/19, 185 had tumour sequenced, 171 (92.4%) had trackable mutations, and 161 entered ctDNA surveillance. The rate of ctDNA detection by 12 months after start of surveillance was 27.3% (44/161, 95% CI 20.6-34.9). ctDNA+ rates from baseline, 3, 6, 9 and 12 month ctDNA samples were 23/161 (14.3%), 6/115 (5.2%), 6/99 (5.1%), 7/84 (8.3%), and 2/84 (2.4%) respectively. An additional 2 pts were ctDNA+ on COVID extended active surveillance at 15 (1/51, 2%) or 18 months (1/11, 9%). 7 pts relapsed without prior ctDNA detection. 45 pts entered the therapeutic component of the trial (initially 31 to P and 14 to Obs). 1 Obs pt was re-allocated to P. Of pts allocated to P, 72% (23/32) had metastatic disease at time of ctDNA detection on staging scans (75% (12/16) who were ctDNA+ at baseline and 69% (11/16) at other timepoints). 4 pts declined to start P, largely due to COVID concerns. Of the 5 pts who commenced P, at the time of analysis none achieved sustained ctDNA clearance and 4 had recurred. In pts allocated to Obs, median time to recurrence was 4.1 months (95% CI: 3.2-not-defined). Conclusion The c-TRAK TN trial is to our knowledge the first study to assess the proof-of-principle of whether ctDNA assays have clinical utility in guiding further therapy in TNBC. Relatively few pts commenced P treatment precluding assessment of potential activity. At enrollment, patients had a relatively high of rate of undiagnosed metastatic disease when imaged. Our findings have implications for future trial design, emphasizing the importance of early start of ctDNA testing, and more sensitive and/or more frequent ctDNA testing regimes.
ABSTRACT
Teaching a field experience course during a pandemic resulted in unique challenges because preservice teachers could not visit classrooms like they would in a traditional field experience. This article is a self-study exploration of the tensions experienced by a doctoral student teaching an elementary math and science field experience in a fully online setting during the height of the COVID - 19 pandemic. To substitute for a lack of available elementary school children, preservice teacher acted as substitutes for children during lesson rehearsals. Preservice teachers were usually poor substitutes for actual children when evaluating the extent to which the pandemic field experience mimicked traditional field experience. Instructional videos were frequently used in an attempt to provide meaningful opportunities for preservice teachers to engage in classroom practices. The perceived usefulness of instructional videos by preservice videos varied based on the type of video that was used.
ABSTRACT
Diving into a virtual field in response to COVID-19, my orientation to ethnographic inquiry and writing changed as I joined the ranks of thousands of editors worldwide in contributing to the free online encyclopedia, Wikipedia. Honing practices for participating in this dynamic virtual field attuned me to felt senses of flow and more-than-human connections that I relate to posthuman concepts of affect and immanence. The essay concludes with potential implications for embracing wholehearted participation as a method. © 2022 by the American Anthropological Association. All rights reserved.
ABSTRACT
Prior research demonstrates that a number of cultural factors—including politics and religion—are significantly associated with anti-vaccine attitudes. This is consequential because herd immunity is compromised when large portions of a population resist vaccination. Using a nationally representative sample of American adults that contains a battery of questions exploring views about vaccines, the authors demonstrate how a pervasive ideology that rejects scientific authority and promotes allegiance to conservative political leaders—what we and others call Christian nationalism—is consistently one of the two strongest predictors of anti-vaccine attitudes, stronger than political or religious characteristics considered separately. Results suggest that as Americans evaluate decisions to vaccinate themselves or their children, those who strongly embrace Christian nationalism—close to a quarter of the population—will be much more likely to abstain, potentially prolonging the threat of certain illnesses. The authors conclude by discussing the immediate implications of these findings for a possible coronavirus disease 2019 (COVID-19) vaccine. © The Author(s) 2020.