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1.
Eurohealth ; 27(1):41-48, 2021.
Article in English | CAB Abstracts | ID: covidwho-2124712

ABSTRACT

Countries in Europe have rapidly scaled-up, redeployed, repurposed, retrained and retained their workforce during COVID-19 to create surge capacity, protect the health and well-being of the workforce, and ensure effective implementation of vaccination programmes. Doing so has had enormous governance implications, including the need for intra-governmental and cross-organisational governance actions, increased transparency for planning, and delegated leadership to health employers and health workers. It is important that stakeholders continue to learn and share their experiences on the effectiveness of different workforce governance responses to allow the health workforce to recover, rebuild and repurpose.

3.
European journal of public health ; 32(Suppl 3), 2022.
Article in English | EuropePMC | ID: covidwho-2102828

ABSTRACT

Background This study considers some of the effective governance tools that have been utilised to mobilise, redeploy and repurpose the health workforce during the COVID-19 pandemic to create surge capacity, protect workforce health and wellbeing and ensure effective implementation of vaccination programmes. Methods Data were systematically extracted from the Observatory/WHO Europe/European Commission Health System and Response Monitor, covering the period from March 2020 to May 2021 with a focus on four dimensions of health workforce governance: national/regional government policies;legislation;regulation;the role and remit of employers and management. Results A wide-range of governance actions across all levels were required to ensure the health workforce could provide effective pandemic responses. Creating surge capacity, for example, often required adoption of emergency legislation to facilitate exceptional hiring procedures and the changing of (re-)registration requirements, as well as additional training and development of new competencies among other actions. Putting in place physical and mental health support meanwhile required defining infection control policies, monitoring PPE supply and distribution, ensuring access to free mental health support, and implementation of breaks. Some countries also allowed “new” types of workers to vaccinate;online or in person training;adjustments to payment mechanisms;and creating new supervision requirements. Conclusions Pandemic responses have broken up sclerotic governance structures which have hampered past health workforce development and reform, new training programmes have been rapidly developed, leadership roles have been delegated to a wider-range of health professionals than before and monitoring systems that provide more rapid data on staffing levels have been put into place. Learning from and evaluating these changes will be important to help inform future pandemic responses.

4.
Colorectal Disease ; 24(Supplement 2):44, 2022.
Article in English | EMBASE | ID: covidwho-2078388

ABSTRACT

Background: COVID-19 required restructuring of colorectal cancer (CRC) diagnostics. We instituted consultant telephone assessment of all urgent suspected cancer (USC) referrals. CT abdomen and pelvis (CTAP) and Faecal Immunochemical Testing (FIT) were the primary modalities of investigation in patients without rectal bleeding or anaemia. We report on efficacy and safety at 15 months follow up. Method(s): 277 USC CRC referrals were received between 1st April and 30th May 2020. Patients with rectal bleeding (n = 41) were directed to sigmoidoscopy. Consultant surgeons telephoned 236 non-bleeding patients of whom 196 were referred for FIT and CTAP, whilst 40 patients were downgraded from USC. 182 CTAP scans and 136 FIT tests were performed. Not all patients had both tests as positive CT findings prompted endoscopy referral and some patients declined further investigation. Result(s): Over two months, 16 diagnoses of CRC were made;15 from the CTAP/FIT group and one from flexible sigmoidoscopy (detection rate 5.8%). This compares to 524 USC referrals and 19 CRC diagnoses (detection rate 3.6%) over the equivalent period in 2019. Follow up at 15 months showed that no patient discharged from the USC pathway had re-presented with colorectal cancer. Conclusion(s): Combining FIT and CTAP in the USC setting draws on the developing use of FIT in CRC investigation. This was initially a pragmatic response to COVID-19, however our experience of using this pathway for exclusion of CRC will be relevant to maintenance and streamlining of USC services after the pandemic.

5.
CORONAVIRUS POLITICS: The Comparative Politics and Policy of COVID-19 ; : 215-234, 2021.
Article in English | Web of Science | ID: covidwho-2068458
6.
International Journal of Stroke ; 17(2 Supplement):11, 2022.
Article in English | EMBASE | ID: covidwho-2064674

ABSTRACT

Background: Cardiac Rehabilitation (CR) is a multidisciplinary approach involving exercise training and health-related education routinely available to cardiac patients, but rarely offered to people with stroke. We have shown people with stroke can be integrated into centre-based CR, but due to access difficulties, opportunities for people with stroke to participate in centre-based CR are limited. Home-based CR is well-established for people with heart disease and offers an alternative for people with stroke who are unable to access centre-based rehabilitation. Aim(s): Investigate the safety and feasibility of home-based, telehealthdelivered, stroke-adapted CR. Method(s): A single-site, prospective-cohort safety and feasibility trial. People with ischaemic stroke were screened for eligibility and invited to participate in a six-week program of exercise and education delivered via telehealth to the participant in their own home following discharge from inpatient rehabilitation (i.e. <6-weeks post-stroke). Safety and feasibility were assessed by incidence of adverse events and measures of participant recruitment, retention, and adherence. Result(s): Ninety-five people with stroke were screened, 67 (70%) were eligible to participate, and 19 (28%) consented. Of the 28 that were ineligible to participate, the main reasons for exclusion were haemorrhagic stroke (53%), nil medical clearance (18%), and nil acute stroke (14%). Of the 48 eligible participants that did not consent, 45% were not included due to the impact of COVID-19, 20% were discharged prior to being approached to participate, and 12% did not consent due to a lack of time. Three participants dropped out of the study prior to commencing the outpatient intervention. The remaining 16 participants completed the six-week intervention. Positive written and verbal feedback was received from participants on the appropriateness of the intervention. Conclusion(s): COVID-19 significantly impacted our capacity to recruit participants to this trial. Preliminary data suggests home-based, telehealthdelivered, stroke-adapted CR is safe and potentially feasible in early subacute stroke.

7.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032046

ABSTRACT

Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

8.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032039

ABSTRACT

Background: The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1-4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims: We aim to report our single-centre experience with complications arising from DPBSR. Methods: This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results: 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16-91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30-332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94-441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions: Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications.

9.
INTERNET JOURNAL OF ALLIED HEALTH SCIENCES AND PRACTICE ; 20(2), 2022.
Article in English | Web of Science | ID: covidwho-1935354

ABSTRACT

Context: When authentic clinical experiences are unavailable, instructors may need to consider alternatives for evaluating clinical reasoning. Objective: Describe an educational technique that simulates clinical experiences to allow students to demonstrate clinical reasoning. Background: The COVID-19 pandemic created a situation where providing clinical experiences became impossible. Yet, students still needed to exercise clinical judgement as part of their athletic training education program. The unfolding case study technique aligns well with Kolb's Theory of Experiential Learning and can be used to help students improve clinical reasoning and critical thinking skills. Description: An unfolding case study was used to simulate a clinical experience for students when clinical sites became unavailable to students due to COVID-19. The technique involves using a case study over time where the student receives information, evaluates the information, makes a clinical decision in response to the information, and receives further information and feedback based on their decision. This repeats until the student reaches the conclusion of the case. Clinical Advantages: Students found this assignment to be beneficial as it allowed them to practice clinical reasoning and critical thinking in a realistic, yet low risk environment. Students were able to learn new skills in documentation and billing for services. The assignment allows for critical feedback to be given to the students at multiple points. Conclusions: The unfolding case study can be an effective substitute for a clinical experience in extreme situations. The unfolding case study allows students to exercise clinical judgement in a safe environment.

11.
European Observatory on Health Systems and Policies. European Observatory Policy Briefs ; 2021.
Article in English | MEDLINE | ID: covidwho-1668445

ABSTRACT

Digital health tools hold the potential to improve the efficiency, accessibility and quality of care. Before the pandemic, efforts had been made to support implementation across Europe over many years, but widespread adoption in practice had been difficult and slow. The greatest barriers to adoption of digital health tools were not primarily technical in nature, but instead lay in successfully facilitating the required individual, organizational and system changes. During the COVID-19 pandemic many digital health tools moved from being viewed as a potential opportunity to becoming an immediate necessity, and their use increased substantially. Digital health tools have been used during the pandemic to support four main areas: communication and information, including tackling misinformation;surveillance and monitoring;the continuing provision of health care such as through remote consultations;and the rollout and monitoring of vaccination programmes. Greater use of digital health tools during the pandemic has been facilitated by: policy changes to regulation and reimbursement;investment in technical infrastructure;and training for health professionals. As the pandemic comes under control, if health systems are to retain added value from greater use of digital health tools, active strategies are needed now to build on the current momentum around their use. Areas to consider while developing such strategies include: Ensuring clear system-level frameworks and reimbursement regimes for the use of digital health tools, while allowing scope for co-design of digital health solutions by patients and health professionals for specific uses. Combining local flexibility with monitoring and evaluation to learn lessons and ensure that digital health tools help to meet wider health system goals.

13.
European Journal of Public Health ; 31:2, 2021.
Article in English | Web of Science | ID: covidwho-1610559
14.
British Journal of Surgery ; 108(SUPPL 7):vii51, 2021.
Article in English | EMBASE | ID: covidwho-1585068

ABSTRACT

Aim: The ongoing Covid-19 pandemic has interrupted surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS). Methods: A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Patients over 18 with a diagnosis of colon or rectal cancer who received elective surgery as primary treatment were included. Delay was defined as the period between CRC diagnosis and day of surgery. Metanalyses of the outcomes OS and DFS were conducted. Forest plots, funnel plots, tests of heterogeneity, and estimated Number Needed to Harm (NNHs) were produced. Results: Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed a delay to elective resection was associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p=0.020) and at three months the HR for three datasets was 1.57 (95%CI 1.16-2.12, p=0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was nonsignificantly negatively associated with DFS on metanalysis. Conclusions: This review recommends elective surgery for CRC patients is not postponed longer than four weeks, as evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk-factors for future pandemics.

15.
European Journal of Heart Failure ; 23:116-116, 2021.
Article in English | Web of Science | ID: covidwho-1548030
17.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514812

ABSTRACT

At the onset of the COVID-19 pandemic, health care providers had to abruptly change their way of providing care in order to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Even the most well-resourced health systems faced pressures from new challenges brought on by COVID-19, and every country had to make difficult choices about how to maintain access to essential care while treating a novel communicable disease. Using the information available on the HSRM platform from the early phases of the pandemic, we analyze how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and outpatient settings. Many country responses displayed striking similarities despite very real differences in the organization of health and care services. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and non-COVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Many countries expect to operate at lower capacity for routinely provided care, which will impact patient access and waiting times. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision.

18.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514641

ABSTRACT

The COVID-19 pandemic has confronted health systems with extraordinary changes in demand for health services, which magnified underlying disparities in the health workforce. Initial health workforce capacities were critical, as health systems only have two options to increase workforce level: increasing capacity among the existing workforce or mobilising/recruiting additional personnel. Workforce capacity became a limiting factor in an effective pandemic response, particularly in countries with acute workforce shortages. Countries in Europe have pursued various strategies to rapidly surge the numbers of health workers and using their existing human resources differently, including by introducing or expanding on alternative and flexible approaches such as task shifting and other skill-mix changes. The pressure to provide services across the continuum of care, from prevention and vaccination to specialist and inpatient care, led several countries to re-evaluate the distribution of tasks among the health workforce. In the best cases, multidisciplinary team-based staffing models combined the skills of multiple health professionals, enabling provision of the right care at the right time. This presentation will provide an overview of strategies to increase capacity for surges in human resources requirements, as well as supporting measures that help recognise the key role of health workers in the pandemic response. A brief overview of key metrics to assess resilience in the area of human resources will also be provided.

19.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514528

ABSTRACT

Background Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job. Methods We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods. Results We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently. Conclusions While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development.

20.
Archives of Disease in Childhood ; 106(SUPPL 1):A263-A264, 2021.
Article in English | EMBASE | ID: covidwho-1495080

ABSTRACT

Background The COVID-19 pandemic led to changes in patterns of presentation to Emergency Departments. Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Objectives Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions. Methods We collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres between January-June 2020 and T1DM in four centres between January-July 2020. We compared these to the corresponding period in 2019. The impact of lockdown on total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity were evaluated. Results Children with new diagnosis of CC (n=253) and T1DM (n=187) were included in the analysis. Overall there was a 17% reduction (138 vs 115) in number of incident CC cases and 9% reduction (98 vs 89) in T1DM cases between 2019 and 2020, with some regional variation. No significant differences in gender, ethnic background or age at diagnosis between study periods were observed. The route to diagnosis and severity of illness at presentation were unchanged across all time periods. Median diagnostic interval for CCs during lockdown was comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI during pre-lockdown period Jan-Mar 2020 (2.7 weeks) (table 1). Median diagnostic interval for T1DM during lockdown was similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in pre-lockdown period Jan-Mar 2020 (21 days) (table 2). Conclusions There is no evidence of diagnostic delay or increased illness severity for CC or T1DM during the first lockdown in the participating centres. This provides reassuring data for children and families with these life-changing conditions. Data collection at a more comprehensive national level would provide greater clarity on diagnostic intervals.

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