Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings.

Introduction: We explored priorities and perspectives on health policy and payer strategies for improving HPV vaccination rates in safety-net settings in the United States. Methods: We conducted qualitative interviews with policy and payer representatives in the greater Los Angeles region and state of New Jersey between December 2020 and January 2022. Practice Change Model domains guided data collection, thematic analysis, and interpretation. Results: Five themes emerged from interviews with 11 policy and 8 payer participants, including: (1) payer representatives not prioritizing HPV vaccination specifically in incentive-driven clinic metrics; (2) policy representatives noting region-specific HPV vaccine policy options; (3) inconsistent motivation across policy/payer groups to improve HPV vaccination; (4) targeting of HPV vaccination in quality improvement initiatives suggested across policy/payer groups; and (5) COVID-19 pandemic viewed as both barrier and opportunity for HPV vaccination improvement across policy/payer groups. Discussion: Our findings indicate opportunities for incorporating policy and payer perspectives into HPV vaccine improvement processes. We identified a need to translate effective policy and payer strategies, such as pay-for-performance programs, to improve HPV vaccination within safety-net settings. COVID-19 vaccination strategies and community efforts create potential policy windows for expanding HPV vaccine awareness and access.

Enhanced-youth transition planning: An innovative practice change with transition-age youth involved with child welfare in a rural setting

This article presents Enhanced-Youth Transition Planning (E-YTP), an innovative child welfare workforce practice change for transition-age youth (TAY) involved with child welfare services from five rural jurisdictions in the State of Maryland. We describe the practice change from services as usual for TAY, including training and coaching needs for the child welfare workforce. This study presents quantitative and qualitative data assessing the impact of the E-YTP practice change on the workforce. A total of 36 supervisors and foster care workers participated in the study. The Professional Quality of Life and Maslach Burnout Inventory-Human Services Survey were given to the workforce at four time over a four year period. Findings suggest an increase in burnout and secondary traumatic stress (for the PQL) and an increase in emotional exhaustion and personal accomplishment (for the MBI-HS). Focus group and interview findings suggest that the workforce endorses E-YTP. The workforce felt that the practice change made their work with TAY feel more meaningful, was a necessary practice change for TAY, and that E-YTP worked well in preparing youth for a successful exit from child welfare. We discuss implications for workforce practice changes with TAY in a rural setting, adaptations for the COVID-19 pandemic, and the need for ongoing supervision and coaching for the workforce. © 2023

How crisis reveals the structures of practices

The speed, scope and scale of changes wreaked by the Covid-19 crisis of 2020 onwards raise challenging questions for practice theorists. After all, practice theory has generally emphasized continuity. According to Reckwitz, practices are 'routinized types of behaviour'. For Nicolini practices are 'very resilient and often difficult to change because, qua practices, they are taken for granted and often considered as part of the natural order of things'. Where practice theorists have explored change, they have often focused on slow-cooked transformations, for instance the spread of showering from the 1870s onwards, the emergence of the Kentucky bourbon industry in the mid-19th Century, or the decades-long shifts in the practices of strategy in modern Western businesses. The Covid-19 changes have an intensity that is quite other to these leisurely evolutions. Our argument here is that the Covid-19 crisis, challenging as it is, in fact provides an opportunity for practice theorists. As a set of extreme events, it exposes for further investigation structural features of practices along two dimensions, external and internal. These structural features help us address two particularly tough questions raised by initial observations of the crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Pandemic Detours or New Sustainable Pathways? Post-pandemic Mobility Futures in Danish Cities

When mobility normality breaks down, new futures can emerge. This paper explores COVID-19 disruptions of everyday mobility in Danish cities and new emerging pathways toward less carbon-intensive mobility futures in the light of the mobile risk society and practice theory. It uses a stakeholder workshop with public transport providers as empirical outset to start conceptualizing new discussions that have emerged in the wake of COVID-19. Through four inquiries into pandemic-induced changes–including reducing, remoding, rescheduling and replacing mobility practices–it discusses how a new critical view on “business as usual” has emerged from the pandemic, especially in relation to public transport and linkage to other transport modes. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

The Influence of COVID-19 on Ultrasound Practice

Introduction COVID-19 had a major impact on ultrasound practice. The recommended “safe distance” of 2 meters (to limit COVID-19 infection) cannot be maintained during standard ultrasound procedures. Thus, special precautions, proper infection prevention, and control measures were implemented to limit the spread. The purpose of this study was to assess the impact of the pandemic on ultrasound technologists and their work practices and to suggest future changes that may be implemented. Methods This Research Ethics Board (REB) approved study included a quantitative survey which was designed based on a literature review. The survey used questions with a 5-point Likert scale along with multiple-choice questions. For the statistical analyses, the Wilcoxon signed-rank test, the Kruskall-Wallis test and Spearman's coefficient correlation test were used. Results There were 40/100 respondents. All but five questions produced significant results. Enhanced cleaning (p < 0.02) and increased wait time (p < 0.02) were found to be dependent on specific institutions. Additionally, the majority of case types performed by a sonographer (p < 0.02) and the years of experience (p = 0.006) influenced perception of a permanent change of practice. Although procedures have taken longer during the pandemic, sonographers do not anticipate an increase in procedure time for future scheduling. Sonographers experienced an increase in stress levels, causing it to be less manageable than before the pandemic (p = 0.0003). Wearing PPE was identified as a permanent change in practice whereas increasing the use of mobile ultrasound was not highlighted as future practice. Conclusion Respondents reported challenges getting support for initiatives to relieve sonographer stress. If factors such as adequate communication and workload are not properly addressed, there can be negative psychological effects for sonographers. Many changes were suggested to be implemented to ensure sonographers feel supported so that their workload is manageable.

Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic.

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

Postscript: Women's Health and the Era After COVID-19.

As the world clamored to respond to the rapidly evolving coronavirus 2019 (COVID-19) pandemic, health care systems reacted swiftly to provide uninterrupted care for patients. Within obstetrics and gynecology, nearly every facet of care was influenced. Rescheduling of office visits, safety of labor and delivery and in the operating room, and implementation of telemedicine are examples. Social distancing has impacted academic centers in the education of trainees. COVID-19 vaccine trials have increased awareness of including pregnant and lactating women. Last, the pandemic has reminded us of issues related to ethics, diversity and inclusiveness, marginalized communities, and the women's health workforce.

Changes to medication abortion clinical practices in response to the COVID-19 pandemic.

OBJECTIVES: To document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. STUDY DESIGN: Longitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. RESULTS: Seventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. CONCLUSIONS: Sites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. IMPLICATIONS STATEMENT: Medication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.

Maintaining Maternal-Newborn Safety During the COVID-19 Pandemic.

COVID-19, the disease caused by the SARS-CoV-2 virus, was declared a global pandemic by the World Health Organization on March 11, 2020. In addition to older individuals and those with underlying chronic health conditions, maternal and newborn populations were also identified as being at greater risk. It became critical for hospitals and clinicians to maintain the safety of individuals in the facility and minimize the transmission of COVID-19 while continuing to strive for optimized outcomes by providing family-centered care. Rapid change during the pandemic made it appropriate to use the plan-do-study-act (PDSA) cycle to continually evaluate proposed and standard practices. Our team established an obstetric COVID-19 unit for women and newborns, developed guidelines for visitation and for the use of personal protective equipment, initiated universal COVID-19 testing, and provided health education to emphasize shared decision making.