Immersive Technologies - The future for tracheostomy education?

Introduction: The need for standardised education on tracheostomy care is well recognised.1 Staff frequently report a lack of confidence in caring for those with tracheostomies, as well as the management of adverse events as they occur.2 Over the past decade, healthcare providers have developed strategies to educate staff, however, the covid-19 pandemic has severely hampered the ability to provide this necessary training due to restrictions on access to training rooms, the need for social distancing and the significant clinical demands placed on both trainers and trainees.3 The potential for immersive technologies to augment healthcare training is gaining interest exponentially.4 However, its effectiveness is yet to be clearly understood and as such it is not yet common within healthcare education.5 Based on the above, we aimed to explore the potential of these immersive technologies to overcome the current challenges of tracheostomy education, and to develop future strategies to use immersive technology in healthcare education. Method(s): We received a 400,000 grant from Cardiff Capital Region (CCR) to undertake a rapid innovation project overseen by the SBRI centre of excellence. The project consisted of 3 main phases: 1) feasibility;2) development;and 3) testing. The project was officially launched in April 2021 and lasted 12 months. Project governance was provided via the SBRI for clinical excellence, a project board with representation from Welsh Government, Cardiff University and Cardiff and Vale UHB, and a project team with clinical expertise in both the delivery of tracheostomy education and the provision of simulation training in healthcare. Result(s): Phase 1: During phase one 4 industries were successful and received up to 30,000 to explore the feasibility of immersive technology to support tracheostomy education. The industries were Rescape, TruCorp, Aspire2Be and Nudge Reality. During the feasibility phase all industries focused on the emergency management process utilising existing NHS Wales tracheostomy education resources and the national tracheostomy safety programme. Phase 2: For phase 2, Rescape and Nudge Reality were chosen to develop the technology. These industries continued to work in conjunction with the project team to capture the core elements of tracheostomy care, including multi-user emergency management scenarios. Additional content was also added for bronchoscopy and insertion of intercostal drains. Phase 3: Testing of both solutions was undertaken over an 8-week period, across 6 Health Boards in NHS Wales. The results of the testing will be analysed and available for presentation in due course. Provision findings demonstrate good face and content validity with high levels of user satisfaction. Discussion / Conclusion(s): The provision of essential tracheostomy education has been severely affected by the covid-19 pandemic. Evolving immersive technologies have the potential to overcome these challenges and improve the effectiveness and efficiency of education packages in tracheostomy care and wider. Through this CCR grant, in conjunction with industry, we have developed two solutions with the potential for widescale procurement and future research on the use of immersive technologies within healthcare.

Improving Outcomes in Oesophagectomy Patients

Introduction: Aberdeen Royal Infirmary is a low volume centre carrying out approximately 13 oesophagectomies per annum. Due to minimal exposure to post-operative oesophagectomy patients, staff had low perceived confidence in their management within the Intensive Care Unit (ICU). After an initial pause due to the COVID-19 pandemic, oesophagectomy service provision restarted in June 2020. Prior to this project, no standardised care pathway existed for post-operative oesophagectomy patients. A protocol driven management pathway was implemented within the ICU setting in October 2020. Objective(s): 1. Standardise the first 5 days of post-operative care for oesophagectamies 2. Improve 30 day mortality rate 3. Reduce opiate use on step down to High Dependency Unit (HDU) 4. Improve ICU Medical and Nursing staff perceived confidence in the management of oesophagectomy patients. Method(s): A multi-disciplinary approach was taken, with input from ICU, Surgical, Anaesthetic, Physiotherapy, Nursing, Pain and HDU teams. Standards of care for post-operative oesophagectomy patients were identified and a protocol was subsequently produced for use within ICU with reference to current Enhanced Recovery After Surgery (ERAS) guidelines.1 The protocol covered the first 5 days of post-operative care. It identified tasks to be completed each day and highlighted which staff group was responsible for performing each task. Additionally, an information sheet was distributed to Medical and Nursing ICU staff to educate them on oesophagectomy patients and recognition of potential complications that arise when caring for this patient group. Data on 30 day mortality and opiate use at step down to HDU was collected from electronic notes. This was collected retrospectively prior to implementation of the protocol from January 2019 - July 2020 and prospectively following its implementation, from October 2020 - December 2021. ICU staff perceived confidence in managing post-operative oesophagectomy patients was measured using a combined quiz and survey. It was completed by staff prior to introduction of the protocol. Following implementation of the protocol and distribution of the information sheet, the quiz and survey was repeated to evaluate improvement in staff confidence. Result(s): A total of 38 oesophagectomy cases were identified. 21 cases were reviewed prior to implementation of the protocol, with 1 mortality at 30 days. 17 cases were reviewed following implementation of the protocol, with 0 mortalities at 30 days. Qualitative scoring showed a 20% increase in staff confidence to manage this patient group. Review of drug prescription charts revealed a reduction in dose of modified release opiates at step down to HDU. Conclusion(s): Oesophagectomy is major surgery and causes significant staff anxiety in low volume centres. This protocol has successfully standardised care for this patient group and allowed continuation of this essential service provision during the COVID-19 pandemic. This protocol improved 30 day mortality, reduced opiate use at step down to HDU and improved ICU staff perceived confidence in caring for post-operative oseophagectomy patients.

Roots and resiliency for native American young people

Aim: The presentation shares traditional Native American knowledge about wellbeing and caring for a person's body, heart, connection to the Creator, ancestors, and the land Methods: Drawing upon community narratives and traditional ancestral knowledge themes pertinent to the topic will be presented. Narrative Review Results: Ancestral knowledge is essential to access and practice in? community care and healing. This knowledge is sacred to the lives wellbeing, and continuation of traditional ways for Confederated Tribes of Warm Springs (CTWS) people. CTWS young people play an important role in these practices for their community and elders. The practice of taking CTWS children from families was a pivotal moment that pushed forward the concept of mental health for the CTWS. The threat of climate change, and the COVID-19 pandemic's activation of memories of imposed isolation between our people and from traditional ways continues to impact our young people. The process of healing from historical and present-day traumas includes grieving those losses and healing from addictions, as well as physical and sexual abuse Conclusion(s): Rebuilding and strengthening connections to the land Chuush (water in Sahaptin language), food gathering, and being with each other, is central to our young people's, and community's, healing The path of returning to our traditional understanding of the knowledge of what the Creator has provided for the CTWS people will be shared. This knowledge is useful for the care of young people Native and non-Native alike.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. All rights reserved.

The 'Life after ICU' mobile application- a process in creating an accessible patient-centred platform for Intensive Care rehabilitation resources

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.

Exploring the scope of nursing practices in the care of ECMO supported patients in Israel

Objectives: The growing implementation of extracorporeal membrane oxygenation (ECMO) for patients with COVID19 has led to increased involvement of nurses in treating ECMO-supported patients (ECMO-SP). In June 2021, the Israeli Ministry of Health;s Nursing Administration published the first director;s circular in the world to detail the nursing scope of practice in caring for ECMO-SP. This study aimed to examine how often nurses perform various activities while caring for adult ECMO-SP. Method(s): A cross-sectional study. A convenience sample consisted of 76 registered ICU nurses (mean age 41.3+/-8.7 years;71% female). A 20-item Nursing Activities in the Care of ECMO-SP instrument was developed based on the Israeli Ministry of Health;s procedure on Nursing Practice in the Care of ECMO-SP and a literature review. The instrument examined how often nurses perform various activities on a Likert scale ranging from 1 (Never) to 5 (Always). Exploratory and confirmatory factor analyses (EFA and CFA), as well as descriptive statistics and Pierson;s correlations were performed. Result(s): When examined in EFA and CFA, the instrument yielded acceptable fit indices. The instrument contains four subscales with the following mean +/- SD scores: Factor 1. Nursing care of ECMO-SP not related to the ECMO device (7 items, a=0.90), M+/-SD=4.66+/-0.61;Factor 2. Activities on the ECMO device during emergencies (5 items, a=0.82), M+/-SD=2.1+/-0.91;Factor 3. ECMO device calibrating and monitoring (4 items, a=0.72), M+/-SD=3.26+/-1.0;and Factor 4. Medication and blood administration through the ECMO device (4 items, a=0.73), M+/-SD=1.52+/-0.60. Of the 20 nursing activities, 10 (50%) were reported as "never" or "rarely" performed. Nine out of 20 items (45%) were reported as "very often" or "always" performed. Conclusion(s): Ten out of 20 (50%) activities while caring for ECMO-SP listed in the scope of practice as permissible for nurses to perform were reported as not performed at all or performed rarely. Policymakers need to act so that the activities listed in the nursing scope of practice are carried out by nurses in practice.

Planning for a potential paediatric bronchiolitis surge: How Inter-Professional Education (IPE) was used to build a practice-ready clinical team

Introduction: Bronchiolitis is the most common cause for paediatric respiratory hospital admissions in young children in the UK.1 Following the relaxation of international SARS-Cov-2 lockdown measures a potential national surge in cases was predicted, highlighting a need for more collaborative working across core specialities.2 This prompted the use of the principles of Inter-Professional Education (IPE) to prepare and deliver an intervention to improve outcomes for these patients.3 Objectives: * To plan, deliver and evaluate an educational intervention focussed on improving the knowledge, skills and attitudes needed to care for a sick child with bronchiolitis * To utilise the principles of IPE to improve competence and confidence across core specialities involved in the care of a sick child with bronchiolitis Methods: A team from the Adult Intensive Care Unit (AICU) and the Paediatric High Dependency Unit (PHDU) from the Royal Berkshire Hospital in Reading delivered an inter-professional teaching session focussed on caring for the sick child with bronchiolitis. The patient journey was utilised as a framework to teach the core knowledge, skills and attitudes needed to clinically manage a child from the Emergency Department (ED) to the Intensive Care Unit (ICU). Each session included a lecture about bronchiolitis - describing pathophysiology and how to recognise the deteriorating child;a skills and drills tutorial - highlighting the need for weight-based calculations for high flow nasal oxygen, intravenous fluids and drugs;and a practical simulation scenario - focussing on the stabilisation and management of a sick child awaiting retrieval to the Paediatric Intensive Care Unit (PICU). Result(s): 135 healthcare professionals from a range of adult and paediatric disciplines involved in the care of children across the patient journey attended one of fourteen teaching sessions delivered between September to December 2021. Attendees completed a feedback questionnaire. One hundred and twenty-two (90%) reported an extremely high degree of satisfaction overall, with many saying they would recommend the teaching sessions to others. Areas of personal and professional development were highlighted across the following main themes: gaining theoretical knowledge;understanding key equipment;performing drug calculations;preparing for intubation and ventilation;assessing the need for chest physiotherapy techniques;and more collaborative team-working. Free text comments demonstrated that the attendees felt the teaching sessions: built confidence through the sharing of new or improved knowledge and skills;facilitated a safe space to practice using simulation;and provided the opportunity to learn about and from each other. Many of the attendees also commented on areas they wanted to reinforce and further develop in daily clinical practice as a direct result of the sessions. Conclusion(s): On-going evaluation is taking place as the teaching sessions continue throughout the year, facilitating the inclusion of additional inter-professional groups from across core specialities. These sessions have been used as a template for the development of further planned IPE with a more varied range of paediatric clinical cases and presentations. These will continue to build on the transferable knowledge and skills that increase competence and confidence in caring for the sick child whilst developing a more collaborative practice-ready workforce.

Depression and burden in caregivers of onco-hematologic patients during SARS-Cov-2 pandemic

Aims: Onco-hematologic diseases (lymphomas, myeloma, leukemia) require intensive treatment regimens and represent a burden at the affective and instrumental level for their caregivers. The aim of this study was to investigate the link between caregiving burden and depressive symptoms in caregivers of onco-hematologic patients during the SARS-CoV-2 pandemic. Method(s): A convenience sample of 101 caregivers of onco-hematologic patients were recruited at the Hematology Unit of the Holy Spirit Hospital, Pescara, Italy. Most of the caregivers were female (80%) with an average age of 41 years old (SD = 14.01). Participants were administered the Caregiver Burden Inventory (CBI), the Patient Health Questionnaire-9 (PHQ-9) for depression, and the Fear of Covid-19 Scale (FCV-19S) during two months of the COVID-19-related stay-at-home period (April-May 2021). Result(s): Moderate-to-severe depression (PHQ-9 > 10) were reported by 36% of caregivers. Depressive symptoms were associated with caregivers' time-dependence (r = 0.43), developmental (r = 0.61), physical (r = 0.72), social (r = 0.60), and emotional burden (r = 0.43) (all ps < 0.001). CBI explained 53% of the PHQ-9 variance, particularly the physical (beta = 0.54, p < 0.001) and the social (beta = 0.30, p < 0.01) dimensions of burden. Unexpectedly, COVID-19 was not associated with caregiver burden and depressive symptoms. Conclusion(s): Caregivers of onco-hematologic patients may experience depression due to the burden of caregiving, which is related mostly to the patients' disease rather than extraordinary, even dramatic events such as the pandemic. Psychological interventions are needed for them.Copyright © 2023

Assessment of the challenges and adaptation strategies of pediatric nurses in charge of caring for children with COVID-19

Background: Coronavirus Disease 2019 (COVID-19) is a pandemic cause severe acute respiratory syndrome. It is a major public health crisis threatening humanity since world war two. Aim(s): This study aimed to assess challenges and adaptation strategies of pediatric nurses in charge of caring for children with COVID-19. Methodology: A descriptive research design was used to conduct this study. Setting(s): This study was carried out at pediatric hospital affiliated to Fayoum university hospitals. A purposive sample of 100 nurses who providing care for children with COVID-19 in the previous mentioned setting. A structured interview questionnaire sheet consisted of four parts were used for data collection: Part (1): Assess characteristics of studied sample;Part (2): Assess pediatric nurses' knowledge regarding caring for children with COVID-19;Part (3): Challenges that faced pediatric nurses in caring of children with COVID-19;Part (4): Adaptation strategies used by pediatric nurses to face of COVID-19 of children. Result(s): The results showed that 55% of the studied nurses had unsatisfactory knowledge level of caring for children with COVID-19. Regarding total challenges 75% of studied nurses had psychological challenges and 65% of the studied nurses had high working pressure. Also, regard adaptation strategy 60%, 55% and 51% of the studied nurses not used cognitive and educational adaptation, psychological and emotional adaptation and physical adaptation respectively. Conclusion(s): The present study concluded that, there was highly statistically significant between total challenges of COVID-19 and total adaptation strategies among pediatric nurses in charge of caring for children with COVID-19. Recommendations: Continuous training program for pediatric nurses to improve using of the adaptation strategies of caring for children during the COVID-19.Copyright © 2023 Scientific Publishers of India. All rights reserved.

Explanation of Factors Affecting Self-care and Diabetes Management During the COVID-19 Pandemic: A Qualitative Study

Introduction: Adopting diabetes self-care behaviors to control blood glucose is essential, but adherence to them has been challenged due to restrictions related to Covid-19. These restrictions have negatively impacted the psychosocial condition of individuals with diabetes, which could lead to poor self-care. Accordingly, this study aimed to explore the experiences of individuals with type 2 diabetes regarding self-care behaviors and diabetes management during the COVID-19 pandemic. Material(s) and Method(s): This qualitative study was conducted using conventional content analysis, the data of which were collected through interviews with people over 18 years of age with type 2 diabetes who were selected from the Endocrinology Clinic of Erfan Hospital in Tehran. Using telephone and WhatsApp, semi-structured interviews were conducted with 20 participants (15 women). Content analysis was done using the constant comparative method, and the open and axial coding method was applied. The data were manually coded, and the main themes and categories emerged from data. Result(s): Two main themes emerged from the data: 1) challenges and limitations toward diabetes self-care and 2) facilitators of efficient self-care. Challenges and limitations included 4 sub-themes: Inevitable lifestyle changes, psychosocial problems, limited/lack of access to health care services and medication, and adverse physical effects. Facilitators had 2 sub-themes: improved individual capability and maintaining social interaction. Conclusion(s): Our findings indicated that inevitable lifestyle changes, limited access to health care, and adverse psychosocial consequences were the most critical challenges for diabetes management during the COVID-19 pandemic. Improving stress management skills and effective coping strategies can facilitate the adoption of self-care behaviors.Copyright © 2022, Research Institute for Endocrine Sciences. All rights reserved.

'Forgotten issue': Living and caring for people with chronic breathlessness

Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.

Integrating Bioethics and Neonatal Palliative Care in a Pandemic: The Scope of Advocacy and Online Collaboration for Exceptional Life-Sustaining Medical and Surgical Interventions in a Regional Neonatal Intensive Care Unit

Purpose of Study: The regional NICU is an essential healthcare resource for families of newborns with serious life-threatening illnesses. Mechanical ventilation, cardiovascular therapies, therapeutic hypothermia, and neonatal surgeries are common life-sustaining interventions. Our NICU serves an underprivileged population in a resource poor environment and several ethical questions frequently emerge when facing extremes of innovative therapies. The pandemic and rapidly changing institutional protocols accentuated challenges faced by frontline NICU teams caring for newborns at risk for devastating illnesses and death. Concurrently, evolving paradigms in neonatal ethics required urgent and high quality palliative care in a background of racial and socioeconomic inequities, restrictive visitation policies, and limited healthcare resources. The purpose of this study was to ensure that neonates and their families receive ethically sound care, timely referrals for innovative therapies, and specialized palliative care in the strained and uncertain environment of the COVID-19 pandemic. Methods Used: The key steps consisted of structured and impromptu discussion forums for specialized palliative care and medical ethics, perinatal case conferences and pediatrics grand rounds on virtual platforms, educational webinars for interdisciplinary teams, and improved electronic communication. Online collaboration and innovative combinations of in-person and virtual meetings were utilized for urgently Incorporating clinical updates. Summary of Results: 1. A neonate with severe HIE and postnatally diagnosed congenital diaphragmatic hernia required emergent ECMO center referral. NICU providers utilized a structured bioethics and palliative care framework for providing family support and discussing the prognostication challenges of acute illnesses. 2. Many important bioethical questions emerged while caring for infants with life-threatening chromosomal abnormalities. Ethical tension was addressed by teaching tools, quality of life and pediatrics ethics conversations, mitigation of moral distress, contemporary clinical and surgical experience, community engagement, and family perspectives. 3. Ethical conflicts are central in the decision to resuscitate neonates born between 22 and 23 weeks of gestation. To provide urgent prenatal consultations and attend high risk deliveries, we collaborated across geographically distant healthcare systems, unified management strategies and analyzed outcomes data. 4. NEC in several extremely preterm babies had devastating outcomes and the team respected each family's voice with compassionate, shared decision-making for both curative care surgeries and palliative care. Conclusion(s): The new workflows, telephone and video conferences, and redirection to telehealth based family meetings did not change important outcomes during the pandemic. Advocacy and education for integrating bioethics and palliative care were vital facets of neonatal critical care in a resource poor and ever-changing pandemic environment.

Adopting a Telemedicine Model of Asthma Care during the Covid-19 Pandemic

Purpose of study The IMPACT DC Asthma Clinic is an intervention program designed to transition children who are heavily dependent on the emergency department for episodic care to more effective longitudinal asthma care in their primary medical homes. We sought to study the implementation of a telemedicine model for IMPACT DC during the COVID-19 pandemic in order to address barriers to care. Methods used A telemedicine model of IMPACT DC was implemented using rapid-cycle improvements and process mapping. Measures for adoption of services including visit completion, show rates, primary language, and patient satisfaction were collected for six months. Healthcare utilization data for the six months prior to the IMPACT DC clinical intervention was collected. This data was compared to in- person clinic visits over the same six-month period the previous year. Summary of results 360 patients successfully completed a telemedicine visit between April 2020 and September 2020 with an average visit show rate of 52%. Primary language was English in 89%. These patients were most frequently classified as having mild-persistent asthma and were assessed as well-controlled. Satisfaction survey response rate was 33%;overall average satisfaction was high. In the comparison group, 701 patients successfully completed an in-person clinic visit between April 2019 and September 2019 with a visit show rate of 39%. Primary language was English in 84%. These patients were most frequently classified as having mild-persistent asthma, not well-controlled. Healthcare utilization data for both groups six months prior to their visit are displayed Conclusions The use of telemedicine provides IMPACT DC a feasible and adoptable model to continue caring for children with asthma, with overall high patient satisfaction. This model addresses access barriers during the pandemic, and promises to be an adjunctive tool for reaching families with low show rates and high healthcare utilization. (Table Presented).

Emotional challenges in our work with laboratory animals: tools that support caring for others and yourself

Inevitably, most of us who work with laboratory animals will sometimes form bonds with the animals we are caring for. These relationships will positively enhance the care and wellbeing of the animals' but they also pose important emotional challenges, as was clearly exposed with some contingency managements associated with the COVID-19 pandemic. It is important that the industry acknowledge the existence of these bonds and provide institutional support mechanisms to help Animal Technologists to deal with the emotional challenges of their profession. Current COVID-19 associated working logistics pose further challenges such as delegation of responsibilities, separation of working teams and contingency management of stock to name but a few, along with the individual health and social, economic and personal relationship challenges. This article provides some tools and ideas to support a more open, communicative and emotionally-supportive working environment. The importance of 'self-care' is also discussed. There is a growing commitment to nurture a Culture of Care, and supporting our colleagues by raising awareness of our emotional challenges may support this.Copyright © 2021 Institute of Animal Technology. All rights reserved.

The Live Experiences of Nurses Caring for Patients Diagnosed with COVID-19 Infection in the North West Province

Background: Nurses are the frontline healthcare workers and continue to play a vital role in caring for patients diagnosed with COVID-19 infection. Exploring and describing the experiences of nurses caring for COVID-19 patients are significant to determine what nurses are experiencing physically, psychologically, and socially, in order to help them in improving the quality of patient care. Objective(s): The study aimed to explore and describe the live experiences of the nurses caring for patients diagnosed with COVID-19 infection in the North West Province. Method(s): A qualitative, descriptive, phenomenological and contextual design was used to collect data. The study used a non-probability sampling approach and purposive sampling technique to select four focus group discussions (FGDs) in this study. Data were collected through semi-structured interviews, and analysis was done using descriptive phenomenological data analysis to develop themes and categories. Measures to ensure the trustworthiness of the study were considered throughout the study. Result(s): The results indicated nurses' conceptualisation of COVID-19, nurses' physical experiences of caring for patients diagnosed with COVID-19 infection, nurses' psychological experiences of caring for patients diagnosed with COVID-19 infection, nurses' social experiences of caring for patients diagnosed with COVID-19 infection, nurses' positive experiences of caring for patients diagnosed with COVID-19 infection, and nurses' experiences of coping when caring for patients diagnosed with COVID-19 infection. Conclusion(s): The study showed nurses caring for COVID-19 patients to be physically, psychologically, and socially affected by the disease. Therefore, they needed support from the managers, colleagues, family members, and the community.Copyright © 2023 Dikobe et al.

Impact of Covid-19 Pandemic on a British Columbia Children's Hospital Youth Advisory Committee

Purpose of Study: Between September 2020 and November 2021, a survey was developed in partnership with children, youth, and community members experiencing vulnerabilities in a Vancouver Inner City Neighbourhood (ICN) to explore challenges encountered during the COVID-19 pandemic. In the survey, participants were asked questions about their financial status, housing security, food accessibility, and other social determinants of health. Other equity-seeking groups in Vancouver, including youth experiencing developmental and/or other medical diversity, wished to adapt the ICN COVID-19 survey to explore the impact of the pandemic in their community. These youth are active members of the province's pediatric tertiary care teaching hospital's Youth Advisory Committee (YAC), and in sharing their lived experience as patients, they strive to improve the quality of healthcare for children and youth throughout British Columbia. The objectives of this study were to: 1) adapt the COVID-19 survey to capture the views and needs of youth experiencing developmental and/or other medical diversity;and 2) identify how the COVID-19 pandemic impacted this group's social determinants of health. Methods Used: Ethics board approval was obtained for this observational, cross-sectional study (H20-00987). The research team and YAC co-constructed an adapted COVID-19 survey via Zoom dialogues. YAC members completed the survey online via Qualtrics from May 2022-August 2022. Demographic information and survey results were analyzed using descriptive statistics. Summary of Results: In total, 12 participants completed the survey, including 11 youth and 1 staff member. The median age of the youth participants was 23 years (n=11, min=14, max=29). During the COVID-19 pandemic, 82% (9/11) of youth reported changes in their ability to attend work or school, 36% (4/11) reported concern around reliable and affordable access to medications/medical treatment, and 46% (5/11) reported difficulty in caring for themselves. 46% (5/11) of youth also reported difficulty in caring for older adults or people in their families with disabilities. Many youth (6/11;55%) reported they had less than five people to turn to for support in times of stress, and 46% (5/11) of youth reported the pandemic changed their ability to connect with these people. Furthermore, 82% (9/11) of youth reported experiencing some level of distress related to the pandemic. 73% (8/11) of youth reported heightened anxiety, 82% (9/11) reported worsened mood, 55% (6/11) reported difficulty sleeping, and 64% (7/11) reported difficulty exercising. Conclusion(s): Youth with developmental and/or other complex medical diversity experienced difficulties accessing work and education, reliable and affordable medical care, and social support due to the COVID-19 pandemic. The pandemic negatively impacted the social, emotional, and physical wellbeing of these youth, indicating a need for future dialogue and advocacy to ensure the views and voices on rights of children and youth are honoured.

Medicines optimisation for residents with dementia during the COVID-19 pandemic: a qualitative study of the views and experiences of care home managers

Introduction: The COVID-19 pandemic has disproportionately affected people with dementia, especially those in care homes (1). The pandemic may have exacerbated existing medication challenges that care home residents with dementia may experience, such as issues with adherence and administration. Aim(s): To explore the views experiences of care home managers in Northern Ireland (NI) about optimising medicines use and accessing primary healthcare services for residents with dementia during the COVID-19 pandemic and identify key lessons for supporting care home staff with medicines optimisation for residents with dementia both now and during future health crises. Method(s): Care home managers were recruited using several approaches which utilised purposive and snowball sampling. Participant sampling and recruitment commenced in January 2022 and finished in July 2022. The interview topic guide was developed based on published literature, current COVID-19 guidelines for care homes, and following discussion within the research team;it was piloted with two nurses with experience of working in care homes. Semi-structured interviews were conducted either using an online video-conferencing platform or via the telephone after obtaining written informed consent from participants. All interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis (2). Analysis of data is ongoing. Result(s): Fourteen interviews were conducted, lasting between 25 and 56 minutes. Findings to date have highlighted the challenges care homes have faced whilst caring for residents with dementia during the pandemic. Participants described changes to the way in which primary healthcare services were provided. In particular, provision of services from general practice (e.g. prescribing, consultations) were mostly conducted over the telephone and/or online and some participants reported that this had an impact on medication review: ''it's only the review of medication that has not been done during the pandemic'' [CHM-07]. Restrictions on visiting to care homes during the initial and middle phases of the pandemic affected aspects of medicines optimisation for residents with dementia and an already stretched care sector: There was a lot of problems prior to COVID. COVID just made those problems monumental'' [CHM-14]. Most participants perceived that community pharmacy services were not affected by the pandemic and medication supply continued: We haven't had an issue with community pharmacy to be honest with you'' [CHM-03]. Participants identified lessons for future health crises including the need for improved communication with general practitioners, the importance of a multidisciplinary team effort to optimise medicines for residents with dementia, along with input from residents' family members, and greater support for care homes. Conclusion(s): This study has highlighted the difficulties that care home managers have faced in accessing general practice services during the pandemic and the impact this has had on residents with dementia receiving medication review. Whilst these findings add to a limited evidence base, they may not be generalisable to other parts of the UK. Future work will focus on development of a questionnaire study with care home managers.

Understanding Barriers and Facilitators to Compliance with UK Social Distancing Guidelines during the COVID-19 Pandemic: A Qualitative Interview Study

When followed, there is evidence that social distancing measures play a major role in reducing the transmission of viruses such as COVID-19. However, not all individuals follow the guidance. We explored barriers and facilitators to compliance with UK social distancing guidelines during the COVID-19 pandemic through semi-structured interviews with 116 adults. Data were analysed using reflexive thematic analysis and themes mapped to the Capability, Opportunity and Motivation Model of Behaviour (COM-B). Barriers to compliance included inconsistent rules, caring responsibilities, fatigue, unintended consequences of control measures, and the need for emotional support. Facilitators were informational support and social responsibility. Six themes were both a barrier and a facilitator: lived environment, beliefs about consequences of non-compliance, influence of others, practical support, and trust in government. Reflective motivation, psychological capability, and social opportunity were important drivers for compliance. Measures that enable social support alongside strategies to maintain motivation to comply, provide clear guidance and optimise social cohesion should be promoted. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy.

Self-care Neglect Of Heart Failure Caregivers Before And Early After The Pandemic Began

Behavioral benefits of the COVID lockdown have been suggested for patients with heart failure (HF) but little is known about the effects of the pandemic on the family and loved ones who care for these patients. The purpose of this study was to compare self-reported self-care neglect among HF caregivers in the months preceding the pandemic (August 2019 through March 2020) to the self-care neglect reported by HF caregivers in the early months of the pandemic (May 2020 through December 2020). Method(s): Baseline data from an ongoing study with HF caregivers were used for this analysis. All potentially eligible caregivers are screened for self-care neglect;those who score >=2 on the 10-item Health Self-Care Neglect scale (construct validity, alpha reliability.90) are eligible for study enrollment. Possible scores range from 0-10;lower is better. Baseline data before randomization were used for this analysis. Before the pandemic, 40 caregivers were enrolled. In the early months after the pandemic began, we enrolled another 55 caregivers. Participants' demographic and clinical characteristics were compared between groups. Regression analysis was used to identify group differences in self-care neglect, adjusting for group differences at baseline. Result(s): The sample of 95 HF caregivers was predominately White (64%), female (89.5%), spouses (66%), age 54.7 +/- 13.5 years, and caregiving 9.2 +/- 8 hours/day. Only sex differed significantly between the groups;pre-pandemic the sample was 97.5% female but during the early months of the pandemic it was 83.6% female. Health Self-Care Neglect scores were higher (worse) pre-pandemic compared to the early months of the pandemic after accounting for sex (5.3 +/- 0.5 vs. 4.3 +/- 0.4, p=0.04). When individual items on the scale were analyzed, only the proportion of caregivers who put off going to the doctor significantly differed between pre-pandemic (62.5%) and early-pandemic (40%, p=0.03) groups. Conclusion(s): Health Self-care Neglect was higher in HF caregivers before the pandemic began. It may be that the pandemic encouraged caregivers to focus on their health.Copyright © 2022

Effect of COVID-19 on Type 2 Diabetes Self-Care Behaviors: A Rapid Review

OBJECTIVE The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. METHODS A systematic rapid review was conducted using four electronic databases. Studies reporting on the lock-down's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. RESULTS Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). CONCLUSION The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.Copyright © 2023 by the American Diabetes Association.