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Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.
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The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.
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Since the onset of the COVID-19 pandemic, counselors have had to adapt and evolve to meet the needs of clients and the growing need for mental health services. In addition to a lack of experience providing telemental health (TMH) services, many counselors had received little or no TMH training or continuing education prior to the onset of the COVID-19 pandemic. Counselor self-efficacy (CSE) may be an important factor in determining how counselors have been impacted by the increase in provision of TMH services, and the areas where they are needing more support. The purpose of this quantitative study was to explore how the amount TMH training and continuing education received, the amount of time spent providing TMH services, and the amount of time spent providing counseling services predict CSE. Participants (n=84) completed an online survey containing items from the Counseling Self-Estimate Inventory (COSE). Results of a bivariate regression and one-way ANOVA indicated that TMH training and continuing education did not predict CSE;however, differences between groups revealed an interesting phenomenon which prompted further discussion. Results also showed that both the amount of time spent providing TMH services and the amount of time spent providing counseling services predicted CSE. Counselors and counselor educators can use results from this study to advocate for more resources and support for counseling students and counselors who are providing TMH services. Furthermore, results from this study indicate a need for more research on CSE and TMH to improve counselor education and support. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Súhrn Úvod: Zdravotnícki pracovníci, predovšetkým sestry, môžu byť v exponovanom období počas pandémie covidu-19 vystavení zvýšenej psychickej záťaži. Cieľ: Zistiť, aký je dopad zvýšených nárokov na poskytovanie zdravotnej starostlivosti spojený s koronakrízou, na úroveň psychickej záťaže a kvality života sestier na rôznych pracoviskách. Metodika: Prierezová, prieskumná štúdia merania duševného zdravia u 504 sestier. Bol použitý štandardizovaný dotazník SF-36 a Meisterov dotazník miery neuropsychickej záťaže. Výsledky: Škála preťaženia a monotónnosti významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Celková záťaž významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Vek respondentov významne (p < 0,05) a pozitívne (r > 0) koreluje s kvalitou života v doménach vitalita, mentálne zdravie a duševné zdravie a negatívne (r < 0) koreluje s kvalitou života v oblastiach fyzické fungovanie, telesná bolesť, celkové vnímanie zdravia a celkové fyzické zdravie. Záťaž signifikantne lepšie zvládali muži. Signifikantne vyššia bola v skupine respondentov pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti. Záver: Zvýšené nároky na poskytovanie zdravotnej starostlivosti spojené s koronakrízou negatívne pôsobili na úroveň psychickej záťaže a kvalitu života sestier. Horšie výsledky boli zaznamenané u sestier pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti.Alternate :Introduction: Health care workers, especially nurses, may be exposed to increased psychological stress during the COVID-19 pandemic. Objective: To determine how the increased demands on health care delivery associated with the coronavirus crisis affect the level of psychological stress and quality of life of nurses in different workplaces. Methods: A cross-sectional exploratory study of mental health in 504 nurses. The standardized SF-36 questionnaire and Meister's questionnaire for neuropsychological strain were used. Results: The overload and monotony scales are significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The total load is significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The age of respondents is significantly (p < 0.05) and positively (r < 0) correlated with quality of life in the domains of Vitality, Mental Health, and Mental Component Summary, and negatively (r > 0) correlated with quality of life in the domains of Physical Functioning, Bodily Pain, General Health, and Physical Component Summary. Men handled the stress significantly better. Stress levels were significantly higher in the group of respondents working in intensive care units and in primary care. Conclusions: The increased demands on health care delivery associated with the coronavirus crisis had a negative impact on the level of psychological load and the quality of life of nurses. Worse results were found in nurses working in intensive care units and in primary care.
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The article focuses on the future of diagnostic testing in healthcare, highlighting the importance of testing in tracking and treating diseases like COVID-19. It discusses the advancements in diagnostic technology, including combination tests for multiple respiratory diseases and the rise of at-home testing, which will increase access to testing and empower patients to manage their health.
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Introduction: According to the National Academies of Science, Medicine, and Engineering, even before the pandemic, 24% of Americans 65+ were considered socially isolated, and 43% of adults 60+ were lonely. Both experiences are associated with serious physical and mental health problems, including increased risks of dementia, stroke, depression, and suicidal ideation. As older adults engage in stricter social distancing to protect themselves from COVID-19, their risk of social isolation and loneliness is heightened. According to research by the Kaiser Family Foundation, 46% of adults 65+ reported that the worry and stress caused by pandemic has had a negative impact on their mental health. In order to combat this unique challenge, we must employ innovative, flexible solutions that adapt to the shifting circumstances and an uncertain future. Method(s): WH SeniorLink has developed an innovative program for integrating friendly visiting, mutual aid, needs assessment and case management, all delivered remotely by trained volunteers. The program was conceived, developed and executed since the beginning of COVID-19 restrictions and has grown to become a fully fledged 501(c)(3) organization, and is a model of flexible service delivery during this unusual time. The program operates through a volunteerism-mutual aid model. Volunteers are trained using online modules and quizzes and supervised by a licensed social worker, including training on needs and risk assessment. Volunteers are then matched with an older adult with similar interests and language preferences to provide friendly weekly phone calls, care packages and letters. Older adults with higher needs are referred to WH SeniorLink's service navigation program which operates using the online platform, Apricot, and is staffed by masters level social work interns and supervised by licensed social workers. Service navigation involves conducting comprehensive assessments and identifying resources and referrals. Older adults who express interest are also paired with each other to provide social support. Barriers to program development have included identifying consistent funding sources and volunteer attrition. Result(s): Data shows 169% growth in contacts made with older adults between May and October, with 2.5 times more older adults served in November than in May. Initial responses to the Dejong Gierveld Loneliness Scale and qualitative data collection reflect that older adults continue to feel lonely and isolated in the midst of the pandemic, but that WH SeniorLink is helping. By placing emphasis on empowering older adults to form sustained relationships with volunteers and their peers, WH SeniorLink encourages reciprocal relationships through which older adult participants are valued for their experiences and contributions. Conclusion(s): The mission of WH SeniorLink is to strengthen community ties and improve health outcomes among older New Yorkers by providing social-emotional support and connection to essential services. WH SeniorLink was founded during the COVID-19 pandemic, in response to the myriad of new challenges faced by older adults including greater risk of social isolation and increased disconnection from essential services. However, we recognize that the pandemic has only exacerbated a problem that began long before, and older adults are at risk of being left behind in the coming months and beyond. Funding(s): WH SeniorLink is funded by a starter grant from Columbia School of Social Work and subsequent crowdfunded donations.Copyright © 2021
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Background: Stratified care aims at matching the intensity and setting of mental health interventions to the needs of help-seeking Young People. In Australia, a 5-tiered system of mental health services is in operation. To aid patient triage to the most appropriate tier, a Decision Support Tool (DST) has been developed and is being rolled out nationally Methods: We analysed outcome data pre-and post-enrolment of about 1500 Young People (aged 16-25) referred to a Youth Mental Health Service delivering medium- and high intensity psychological treatment programs (tiers 3 and 4). We compared outcomes in both tiers during three 12-month periods: (a) in the inaugural phase of tier 4, prior to service saturation and stringent triaging, and prior to the COVID-19 pandemic (2019);(b) during the COVID-19 pandemic when all services were delivered remotely over phone- and video facilities, and when DST triaging was introduced (2020);(c) following return of face-to-face consultations, in a situation of service saturation and stringent DST triaging (2021) Findings: About 22% of Young People in the tier 3 program experienced reliable improvement according to their Kessler-10 (K-10) scale ratings, regardless of changing circumstances. In contrast, 40% of people in the tier 4 program reliably improved during the inaugural phase When circumstances and service delivery changed (COVID-19 restrictions service saturation, DST triaging), the rate of reliable improvement halved to about 20% Conclusion(s): Access to higher intensity psychological programs improves treatment outcomes for help-seeking Young People. However high-intensity services are more sensitive to external and service factors than less intense treatment models.
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NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.
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Objectives: The COVID-19 pandemic has disrupted healthcare delivery for patients with cancer. This research assessed the impact of COVID-19 on the delivery of cancer care in the US during the pandemic and evaluated emerging treatment trends in the post-COVID-19 setting. Method(s): A series of Community Oncology Research Evaluations (CORE) meetings were conducted across the US between December 2021 and May 2022. During these meetings, community oncologists undertook a survey focused on the impact of COVID-19 in the community-practice setting. Result(s): 242 community oncologists participated in the survey. Over 80% of the physicians estimated that up to 20% of patients with cancer have gone undiagnosed due to their reluctance to visit a healthcare provider during the pandemic. More than half (51%) of community oncologists reported a decrease of up to 50% in in-office patient visits versus before COVID-19, with most physicians (71%) indicating that some delivery of care changed to a virtual setting in up to 20% of patients. Most physicians (86%) reported no change in their willingness to assess new therapies. Most common strategies to manage cancer during the pandemic included the use of telemedicine for stable patients receiving oral chemotherapy (55%), use of extended dosing schedules (39%), and switching route of chemotherapy administration from intravenous to oral or subcutaneous (38%). Once COVID-19 is under control, these strategies are expected to remain in place. Nearly half of the community oncologists (48%) plan to continue using telemedicine for managing disease in stable patients receiving oral chemotherapy, over a quarter intend to continue using extended dosing schedules, and 19% plan to use oral or subcutaneous chemotherapy when appropriate. Conclusion(s): COVID-19 had a detrimental impact on cancer diagnosis and delivery of therapy. Community oncologists reported a seemingly permanent shift in care patterns including telemedicine, extended dosing schedules, and switching chemotherapy administration route.Copyright © 2023
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The COVID-19 pandemic, emerging/re-emerging infections as well as other non-communicable chronic diseases, highlight the necessity of smart microfluidic point-of-care diagnostic (POC) devices and systems in developing nations as risk factors for infections, severe disease manifestations and poor clinical outcomes are highly represented in these countries. These POC devices are also becoming vital as analytical procedures executable outside of conventional laboratory settings are seen as the future of healthcare delivery. Microfluidics have grown into a revolutionary system to miniaturize chemical and biological experimentation, including disease detection and diagnosis utilizing muPads/paper-based microfluidic devices, polymer-based microfluidic devices and 3-dimensional printed microfluidic devices. Through the development of droplet digital PCR, single-cell RNA sequencing, and next-generation sequencing, microfluidics in their analogous forms have been the leading contributor to the technical advancements in medicine. Microfluidics and machine-learning-based algorithms complement each other with the possibility of scientific exploration, induced by the framework's robustness, as preliminary studies have documented significant achievements in biomedicine, such as sorting, microencapsulation, and automated detection. Despite these milestones and potential applications, the complexity of microfluidic system design, fabrication, and operation has prevented widespread adoption. As previous studies focused on microfluidic devices that can handle molecular diagnostic procedures, researchers must integrate these components with other microsystem processes like data acquisition, data processing, power supply, fluid control, and sample pretreatment to overcome the barriers to smart microfluidic commercialization.Copyright © 2023 by Begell House, Inc.
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Introduction: InS:PIRE (Intensive Care Syndrome: Promoting Independence and REcovery) is a multidisciplinary programme whose role is to assist patients in the identification of, and subsequent rehabilitation from the sequelae of an admission to the Intensive Care Unit (ICU). In NHS Aryshire and Arran (NHSAA) InS:PIRE has traditionally consisted of in-person rehabilitation and support meetings to help manage common post-ICU issues. COVID-19 forced all InS:PIRE activities online, and has required services to redesign their delivery of supporting resources to be readily accessible remotely. Thus, the 'Life after ICU' app was created. Objective(s): The role of this application was to help better-provide accessible information to former ICU patients and their relatives, as well as, improve connectivity between medical professionals and patients. Method(s): The app platform was developed by Piota. Resources were chosen for inclusion through surveying InS:PIRE attendees, who identified their main areas of concern. These areas included: physical problems, emotional issues, social issues, family support, COVID specific support, and physiotherapy. The multidisciplinary InS:PIRE team co-ordinated the identification and collation of the appropriate resources. Additionally, the app serves as a platform for InS:PIRE to disseminate information about the on-going programmes as well as allowing attendees to contact the InS:PIRE team. Result(s): A trial version of the 'Life After ICU' app has now been launched. This app will allow patients and their families to readily access the resources they require. Following a trial period, feedback from app users will be collected and further adaptations made. Conclusion(s): Launching the app recognises the wider view of the importance of eHealth, and its role in modernising service-delivery. Indeed, the Scottish National Clinical Strategy recognises this as an area for future development. The efficacy of eHealth interventions for rehabilitation have been acknowledged,1-2 and thus translating them to the ICU context can be considered as a means of improving the holistic rehabilitation of this complex patient group. Furthermore, through providing services easily accessible by patients, this app allows InS:PIRE to realise NHSAA's 'Caring for Ayshire' strategy, whose aim is to provide care closer to home.
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Objectives: Self-perceptions of aging (SPA) have been shown to influence healthcare-seeking behaviors among middle-aged and older adults. Negative SPA may intensify the COVID-19 pandemic-related healthcare disruptions in this population. Therefore, this study seeks to evaluate the association between SPA and care deferrals among community-dwelling adults aged >=50 years in the US during the COVID-19 pandemic. Method(s): A cross-sectional study of the eligible sample was conducted using data from the 2020 wave of the Health and Retirement Study. SPA score was measured using a validated eight-item instrument with higher scores indicating negative SPA. The association between SPA and care deferrals during the COVID-19 pandemic was assessed using multivariable logistic regression adjusted for respondents' sociodemographic and clinical characteristics, past COVID-19-related experiences, and COVID-19 worry. Result(s): The final sample consisted of 4,153 community-dwelling adults aged >=50 years. 30% reported care deferrals during the COVID-19 pandemic. Among respondents who deferred care, the majority were aged 50-64 years (46.6%), females (65.4%), and White (64.5%). Most commonly reported care deferrals were dental appointments (74.5%) and physician visits (56.5%). Care deferrals were mainly due to clinic/office rescheduling or cancelling appointments (57.5%), respondent deciding the care could wait (33.8%), and COVID-19 fear (21.8%). Respondents reporting care deferrals reported higher mean SPA scores, indicating negative aging attitudes, compared those who did not defer care (Mean (SD): 3.24 (1.02) vs. 3.05 (1.04), p<0.001). After accounting for covariates, higher SPA scores were associated with significantly higher odds of care deferrals (aOR: 1.20, 95% CI: 1.11 - 1.30, p<0.001). Conclusion(s): This study found that negative SPA were associated with care deferrals during the COVID-19 pandemic among community-dwelling adults aged >=50 years. As healthcare delivery rebounds to pre-pandemic levels, the role of SPA in healthcare-seeking behaviors should be recognized. Health promotion efforts may target positive aging attitudes to encourage timely and proactive use of healthcare.Copyright © 2023
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In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The process of collaborating on research was mutually beneficial for a network of independent practices and a group of academic researchers. * The process benefited the practices by facilitating more precise thinking about quality improvement, motivating the staff, and enabling readiness for health system change. * The process benefited the researchers by illuminating nuances of clinical and organizational workflow and revealing the practices' in-depth understanding of the communities they serve. * If practices have more federally funded opportunities to consistently participate in research, it could help speed greater adoption of payment reform models to promote health equity at the state and national levels. _____ A 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care, has called out the persistent "neglect of basic primary care research" in the United States.1 A 2020 study by the RAND Corporation found that primary care research represents only 1% of all federally funded projects (including projects funded by the National Institutes of Health, the Agency for Healthcare Research and Quality [AHRQ], and the Veterans Health Administration).2 However, innovation in primary care is central to advancing health care delivery. Leaders in health care innovation recently called for CMS to test a proposal for primary care payment reform in accountable care organizations (ACOs) composed of independent practices (ie, practices not owned by hospitals).3 By innovating in independent practices, these leaders argued that CMS would provide incentives for those practices to stay independent, thereby potentially decreasing the vertical market consolidation that contributes to rising health care costs.3 Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers.1 AHRQ's practice-based research networks have not fully addressed this gap, as they have struggled to find infrastructure and maintain funding.1 In this commentary, we report on the lessons we learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. [...]ACPNY found that experience with research facilitates innovation and readiness for health system change (lesson 1C).
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Background/Objectives: Telemedicine is a service delivery model in which credentialed specialists provide care remotely to clients. Data regarding patient satisfaction with telemedicine consultations in the field of clinical genetics, and specifically paediatric genetics is lacking. We aimed to compare patient satisfaction rates from telemedicine versus traditional, face-to-face genetics consultations during the COVID-19 pandemic. Method(s): A cross-sectional survey, sent to 1672 parents of minors (patients<18years), or adult patients, who received counselling through the Tel-Aviv Souraski Medical Center Genetics Institute between 1/1/2020-1/6/2020. Data were collected through REDCap and converted to Microsoft EXCEL Database Program( v16.0) and STATA(v14.1). Result(s): Full responses were collected from 457 patients (27.3%). Of them, 330 patients (72.2%) had face-to-face consultations, 80 (17.5%) were counselled through telemedicine, and 47 had both (10.3%). Satisfaction or high satisfaction were reported in 82.1% in the face-to-face consultation group, while 6.3% were unsatisfied or unsatisfied at all, compared with 82.5% and 11.2% in the telemedicine group, respectively. Differences were insignificant statistically between the two groups. Data were further stratified according to subspecialties. Of total consults, 58 (12.7%) were in paediatric genetics. None of the patients who received paediatric genetics counselling solely through telemedicine were unsatisfied. Seventy-six percent of all patients who were counselled through telemedicine would want to use telemedicine services in the future, while 18.7% are undecided, and 5% do not. Conclusion(s): Telemedicine consultations in the genetics clinic during the COVID-19 pandemic, and specifically in paediatric genetics, were associated with high satisfaction rates, non-inferior to traditional consultations satisfaction rates.
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Radiographers function in a niche environment, blending advanced technical skills with patient-focussed care in a multi-disciplinary environment. The past decade has brought significant change to the profession with further change projected into the future. Education programs are dynamic, responsive to emerging technologies and improve from each iteration. The education experience of current students is significantly different to that of experienced radiographers. This presentation provides a snapshot of contemporary education approaches in a medical imaging undergraduate program, preparing radiographers for the future. A significant component of skill development in medical imaging degrees is achieved through clinical placement across a range of settings. Education providers work with clinical departments to maximise learning opportunities, scaffolding structured progression of learning. Lack of availability of suitable resources or placement opportunities, and the priority that must be given to patient service delivery can be challenging for clinical experiences. COVID-19 pandemic restrictions have exacerbated issues, particularly for already time poor clinical environments. The education program showcased draws on contemporary best imaging practice, curriculum design and learning and teaching approaches. For example, the teaching team have applied simulation as a purposeful technique to add safe and procedural steps as part of a cohesive whole-of-curriculum student learning. Simulation prior to clinical placement is widely recognised as an effective response to the challenges of assuring safe and skilled practice.1 In turn, students can reflect on this experiential learning providing robust feedback and discussion using Kolb's reflective practice - exploring the impact of their learning on their future practice.2.