Psychological intervention for three COVID patients who suffered online violence.

Three patients diagnosed with COVID-19 were all young women in their thirties who have suffered from Internet violence in their personal life after hospitalization. They showed significant emotional distress such as, depression state, acute stress disorder, and dissociative disorder. The current study adopts short-term, individualized and comprehensive psychological interventions, including psychological support, encouragement, listening, safety confirmation, catharsis, psychological suggestion, and stimulation of internal potential to treat patients. The third case was provided with psychological interventions combined with antipsychotic treatment. After timely psychological interventions all three patients achieved sound results.Copyright © 2021 Chinese Medical Journals Publishing House Co.Ltd.

Influence of Coaching on Effectiveness, Participation, and Safety of an Exercise Program for Postmenopausal Women with Osteoporosis: A Randomized Trial.

Purpose: We compared two different strategies providing professional coaching to administer an exercise program for women with postmenopausal osteoporosis (POP): individual training (IT) at home with trainer's supervision provided by telephone contacts at regular time-intervals or group training (GT) with trainer's live supervision. Our working hypothesis was that IT is a valid alternative to GT when GT is not feasible. Patients and Methods: This was a single-blind, randomized study. We recruited 52 women with POP, without significant comorbidity, and no participation in any structured exercise program within the previous 6 months. They were assigned randomly to IT or GT groups (n = 26 each). Distribution of age (IT: 68±4, GT: 67±8 years) and body mass index (IT: 23.0±2.5, GT: 21.4±5.1) was similar between groups. Each group performed the exercise program in two 1-hour sessions per week for 18 months. Primary outcome measure was Health-Related Quality of Life (HRQoL), as measured by the Short Osteoporosis Quality of Life Questionnaire. Secondary outcome measures focused on domains acknowledged to influence HRQoL (disability, fear of falling, weekly physical activity, physical function) or the effectiveness of the exercise program (retention, adherence, and safety). Significance level was set at p < 0.05. Results: No significant differences were observed between IT and GT groups for any domain. Retention, adherence, and safety were also similar. HRQoL, disability and fear of falling did not change between baseline and follow-up for either group. However, for both groups, physical function (knee flexion, shoulder mobility) and functional capacity (6-minute walking test) improved. Weekly physical activity levels increased from moderate range at baseline to intense at final assessment for both groups. Conclusion: IT and GT supervised exercise programs for women with POP provide similar effectiveness, participation and safety. Hence, both modalities should be considered for future translation in clinical practice of exercise recommendations for POP.

The clinical effectiveness and validity of home spirometry in children with cystic fibrosis

Introduction: During the COVID-19 pandemic, home spirometry became essential for continued monitoring of cystic fibrosis patients, however, the clinical effectiveness was unknown. Aim(s): The aims of this study were to assess the success rate of testing patients at home and to compare the home spirometry and lab spirometry results Methods: 147 home spirometry devices (Air Next, NuvoAir, USA) were given out to cystic fibrosis patients (M:F 67:80;mean age 11.8 [4.7 - 17.3]) who had previous experience of spirometry and deemed to be competent to perform spirometry at home. Patients were asked to perform 4 tests in the first month, then 1 test per month unless clinically requested. When Lab spirometry resumed, 28 (M:F 12:16;mean age 13.1 [8.0-17.0]) patients tested on NuvoAir within 5 days (mean 0.7 days (1.0)) of Lab spirometry (Vyntus Spiro, Vyaire Medical, USA). Correlation between spirometry indices were analysed using linear regression. Result(s): 142 patients (96.6%) successfully onboarded onto the NuvoAir platform. Between July 2020 and Jan 2022, 1854 tests were performed, with 1711 (92.3%) tests over-read to be valid. 54 patients (36.7%) performed >=15 tests requested. FEV1 (R2 = 0.93, p = <0.00), FVC (R2 = 0.91, p = <0.00), MMEF (R2 = 0.87, p = <0.00) and PEF (R2 = 0.88, p = <0.00) all showed significant correlation between Lab spirometry and Home spirometry. Conclusion(s): Our results show that home spirometry is well adopted by cystic fibrosis patients and they are able to perform valid loops on this device. Continual encouragement may be required to achieve good trend data. There is also close agreements between this home spirometry device and the gold standard of laboratory spirometry.

The current developments in oncology nursing: A review

Cancer has become one of the major causes of death in the growing world population, affecting people irrespective of their age, sex and culture. Cancer diagnosis and therapy is a distressing procedure and affects the physical, emotional and mental well-being of the patient. Many studies have reported that cancer has a long-term impact on patient's lives leading to mood dysfunction, heart problems and chemotherapy toxicity. Modern-day healthcare systems are moving towards a patient-oriented approach and are designed around the patient's well-being, needs and preferences. Oncology nurses form the fundamental part of this system and provide the patient with the much-needed care, support and hope for life. Oncology nursing has developed and evolved briefly in the recent few decades due to the advancement in treatment procedures. As cancer care continues to progress, nurses play a vital role in the field of oncology. Specialized oncology nurses are providing clinical care, or as nurse researchers leading revolutionary oncology research. The future of oncology nursing is optimistic. Nursing care for cancer patients not only requires guidance through medication and treatment, but also offers encouragement and motivation to the patients. The present review provides an insight into the nursing care of cancer patients, its brief history, advancements and the current practices of oncology nursing. Future prospects of oncology nursing have also been discussed in detail.Copyright © 2022, Kuwait Medical Association. All rights reserved.

Qualitative analysis of a community pharmacy practice transformation initiative

Objective: To evaluate practice transformation team (PTT) members' perceptions of the Flip the Pharmacy (FtP) initiative as a strategy for implementing and improving community pharmacy-based patient care. Method(s): FtP is a national 2-year practice transformation initiative for implementing enhanced patient care and medication optimization services at community pharmacies, launched in 2019 with 28 PTTs including over 500 pharmacy locations. Key informant interviews were conducted with team leads, coaches, and pharmacy champions from four PTTs that participated in the first FtP cohort. The interviews were conducted using semistructured interview guides based on the RE-AIM framework and focused on participants' experiences in the first year of FtP. Interviews were audio-recorded, transcribed, and analyzed using a rapid content analysis approach. Result(s): Four leads, 8 coaches, and 8 pharmacy champions were interviewed from 4 PTTs from May to October 2021 and resulted in 10 themes: (1) community pharmacy practice experience is important when selecting coaches;(2) team readiness supports successful pharmacy practice transformation;(3) measures of patient care quality are needed;(4) payment and practice transformation opportunities happen in parallel;(5) successful practice transformation requires strategic involvement of the entire pharmacy team;(6) FtP practice transformation domains are synergistic;(7) change packages, coaching, and performance monitoring are core practice transformation supports;(8) pharmacy teams value opportunities to share and learn from each other;(9) sustaining patient care services is continuous;and (10) COVID-19 accelerated practice transformation while creating new stress points. Conclusion(s): Participants in this study perceived the FtP initiative as a helpful strategy implementing and improving community pharmacy-based patient care. Future research should explore the sustainability of the FtP initiative and similar community pharmacy practice transformation efforts.Copyright © 2022 Pharmacotherapy Publications, Inc.

Belief in science and beliefs about COVID-19: Educational gradients

Prior research has attributed the socio-economic disparity in COVID-19 infections to differences in degrees of exposure or economic resources. This study proposes beliefs about COVID-19 as a potential additional explanation. We conducted a nationally representative US survey with six measures of COVID-19 beliefs. Socio-economic status was measured through educational level. Compared with less-educated respondents, highly educated respondents treat COVID-19 more seriously, including believing in (1) face mask use, (2) asymptomatic transmission, (3) media non-exaggeration, (4) the necessity of stay-at-home orders, (5) a likelihood of themselves being infected with COVID-19 and (6) no protection of God against COVID-19. The educational gradient in COVID-19 beliefs was largely explained by differential levels of belief in science across education. Our findings suggest that encouraging public trust in science can potentially reduce the educational gradient in COVID-19 infections in the USA. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Oral paracetamol premedication: a proposal for increasing its use

Peri-operative intravenous paracetamol use has not been shown to be superior to oral administration in a randomised controlled trial looking at postoperative pain [1]. The use of intravenous paracetamol carries a wellrecognised increased financial and environmental cost compared to oral paracetamol. We audited the use of paracetamol in patients attending theatre at a district general hospital and propose a method to increase premedication with oral paracetamol. Methods We retrospectively audited the notes of all patients who underwent an elective surgical procedure in theatres, across a 5-day period at a district general hospital. Data regarding the use of paracetamol were collected. Patients who were already an inpatient and those having surgery under local anaesthetic alone were excluded. Results Forty-seven patients were included, five of whom had a spinal and 42 a general anaesthetic with representation from six different surgical specialities. Five of the patients included were under 18 years. Thirty-seven patients received paracetamol peri-operatively. Thirty-four patients received only intravenous paracetamol, two patients received oral paracetamol and one patient received both due to length of time between preoperative oral dose and surgery. Ten patients did not receive any paracetamol. No patients included had a documented allergy or contraindication to paracetamol. Discussion Our department recognised the financial and environmental benefits associated with oral pre-medication. Although many of these anaesthetists would prefer to prescribe pre-operative analgesia, the data indicate that there are barriers that prevent prescription and/or administration. As a result of the COVID-19 pandemic, elective orthopaedic surgery with an enhanced recovery protocol including the use of oral paracetamol premedication, was underrepresented in our data. Previous encouragement to prescribe oral premedication has produced good, short-term results but does not appear to provide long-lasting change. We propose a Patient Group Directive for the administration of pre-operative oral paracetamol by the admitting nurse on arrival to the pre-operative ward. We anticipate that this will both standardise and embed oral paracetamol premedication into the department and will therefore provide long-term change.

Evaluating Barriers and Potential Solutions to Speaking Up About COVID-19 Symptoms: A Survey Among Nursing Home Workers

Background. Nursing homes (NHs) are high risk settings for COVID. Staff are the primary source for introducing COVID into a NH. Preventing staff from working when ill is key to resident safety. NH staff face significant socioeconomic pressures that may influence their willingness to report COVID symptoms. Understanding the drivers behind unreported illness can inform ways to prevent working when ill. Methods. We conducted a confidential survey of 120 COVID-positive NH staff in Orange County, CA from Dec '20-Feb '22 to quantify the frequency and drivers of unreported COVID symptoms. We designed a 40-item survey to assess demographics, course of illness, symptom reporting behavior, and monetary, logistic, and emotional (stigma/fear) barriers to reporting using a 5-point Likert scale. Recruitment flyers were shared with all 70 NHs in the county and referrals were accepted from NH leadership. Participants received $50 for completing the 20-30 min phone-based survey. We calculated summary statistics, transformed all data to a 0-100 scale, assessed the reliability of each factor related to reporting at the group level using Cronbach's alpha, and assessed discriminant validity with t-tests comparing responses among subsets expected to differ. Results. Table 1 shows participant characteristics. 49% of surveys were during the 2020-21 winter wave and 51% were during the Delta/Omicron waves, with a relatively even distribution of certified nursing assistants (CNAs), nurses, and nonfrontline staff. Most cases (70%) were detected by routine testing at the NH and most (63%) had >=1 symptom prior to their test. Only 39% disclosed their symptom to a supervisor. It is unknown how many staff would have disclosed symptoms if they were not captured during routine testing. Responses were consistent across 15 discrete factors with Cronbach alpha >0.7. Overall, fear and encouragement from supervisors were the most salient factors for speaking up about COVID symptoms (Table 2). Responses varied between the two waves and between frontline vs nonfrontline workers. Conclusion. Frequent surveillance testing of NH staff during a pandemic is critical due to many factors that drive reluctance to speak up about potential symptoms. Encouragement from supervisors to report symptoms and stay home when ill may improve NH safety.

Bariatric surgeons' experiences of working in the first year of the pandemic

Background: The first year of the Covid-19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored. Aim(s): The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self-reported personal and professional impact. Method(s): Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on-line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community. Finding(s): Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally. Conclusion(s): This study has identified the need to build resilience of bariatric surgeons so that the practice of self-care and the encouragement of help-seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing. Copyright © 2022 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

Physical abuse in adolescents during the COVID-19 pandemic

Covid-19 has now spread to almost all parts of the world which has caused changes in the social order of life for humans. The spread of Covid-19 in Indonesia is relatively high, so the Indonesian government has adopted a policy using social distancing (large-scale social restrictions). Various pressures experienced by residents tend to result in exces-sive stress and emotions. This can have an impact on the occurrence of violence in families and generally the victims are ado-lescents. Physical abuse is an act that can cause physical pain such as slapping, stran-gling, hitting, kicking, stabbing, twisting the arm, threats with sharp weapons or weapons, and murder. The method used in this research is descriptive analytical method. The research sample was 192 people from various provinces in Indonesia aged 10-24 years. The results of this study revealed that some of the physical abuse behaviors were obtained by adolescents at elementary school age, namely in the age range of 10 years or more with details, including hard encouragement by others with a total of 48 (25.0%), getting hit with a hand with a total of 38 (52.8%), getting slapped by other people with a total of 43 (22.4%), getting hit with a hard object from another person with a total of 22 (11.5%), having been pushed and also being arrested with a total of 16 (8.4%), having been pelt-ed with something painfully from others with a total of 24 (12.5%), and had received treatment in the form of being bitten, punched, and kicked by another person with a total of 26 (13.5%). Physical abuse can have long-term effects, such as physical and psychological disturbances from the teenag-er, which can even lead to death. In addition, physical abuse can also cause adolescents to experience mental disorders such as depression and show traumatic symptoms. Copyright © the Author(s),2022 Licensee PAGEPress, Italy.

A Qualitative Evaluation of a Community-Led Telehealth Training Program for Cancer Survivors

INTRODUCTION: Telehealth services are increasingly used to facilitate cancer survivorship care. Barriers including unreadiness, digital literacy, and access may be overcome with dedicated patient training programs. This study assesses experiences of educators and cancer survivors in a community-led telehealth training pilot program. METHOD(S): Individual semi-structured interviews with Cancer Awareness Network educators and patients conducted October 2021 to February 2022 were transcribed and analyzed in NVivo 12 using thematic analysis. RESULT(S): Participants include 6 educators (19 to 68 years old, 83% Black, 100% female) and 3 patients (60 to 85 years old, 100% Black, 67% female). Educators and patients found training acceptable, with successful techniques including repetition, encouragement, and demonstration followed by teach-back. Both endorsed increased confidence, and patients used telehealth without significant issues after one session. The COVID-19 pandemic was both a facilitator and barrier to training as it motivated patients to use telemedicine to avoid in-person visits but hindered in-person training. Other facilitators included family/caregiver support and provision of devices and WiFi. Patient-level barriers included apprehension, older age, limited digital literacy, old devices, remembering passwords, and WiFi setup. Organization/system-level barriers included interparty communication for training setup, participant recruitment, and knowledge of hospital-specific telehealth platforms. Suggestions included instructional videos, increased outreach, and follow-up for reinforcement. Conclusion(s): Telehealth training improves patient confidence and uptake using various teaching techniques. Future steps include program expansion and incorporation of suggestions. Training programs with supplemental resources are a feasible and seminal intervention for telehealth equity among cancer survivors with low digital literacy, increased age, and/or digital poverty.

Challenges of COVID-19 prevention and control: A narrative review

This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms 'COVID-19', 'challenges', 'prevention', and 'control' in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.

The Clinical Effectiveness and Validity of Home Spirometry in Children with Cystic Fibrosis

Aims During the COVID-19 pandemic, home spirometry became essential for continued monitoring of cystic fibrosis patients, however, the clinical effectiveness was unknown.The aims of this study were to assess the success rate of testing patients at home and to compare the results to the gold standard testing (in lab spirometry). Methods 147 home spirometry devices (Air Next, NuvoAir, USA) were given out to cystic fibrosis patients (M:F 67:80;mean age 11.8 [4.7 - 17.3]) who had previous experience of spirometry and deemed to be competent to perform spirometry at home. Patients were asked to perform 4 tests in the first month, then 1 test per month unless clinically requested. When Lab spirometry resumed, 28 (M:F 12:16;mean age 13.1 [8.0-17.0]) patients tested on NuvoAir within 5 days (mean 0.7 days (1.0)) of Lab spirometry (Vyntus Spiro, Vyaire Medical, USA). Correlation between spirometry indices were analysed using linear regression. Results 142 patients (96.6%) successfully onboarded onto the NuvoAir platform. Between July 2020 and Jan 2022, 1854 tests were performed, with 1711 (92.3%) tests over-read to be valid. 54 patients (36.7%) performed >=15 tests requested. FEV1 (R2 = 0.93, p = <0.00), Ratio (R2 = 0.70, p = <0.00), FVC (R2 = 0.91, p = <0.00), MMEF (R2 = 0.87, p = <0.00) and PEF (R2 = 0.88, p = <0.00) all showed significant correlation between Lab spirometry and Home spirometry. Conclusion Our results show that home spirometry is well adopted by cystic fibrosis patients, however, continual encouragement may be required. We have also shown that valid spirometry loops can be performed by cystic fibrosis patients on this device. There is also close agreement between this home spirometry device and the gold standard of lab spirometry and therefore, results can be deemed valid and reliable.

Building the state of the art from the thoughts of our people -Implementing developed world experience in developing world

Introduction: At the beginning of the pandemic, I was working in University Hospital of Leicester (UHL), a leading hospital in UK as a speciality doctor as a part of post graduate training in anaesthesia of Sri Lanka. 5 months into the pandemic, I find my self returning to Sri Lanka after the training and only to be appointed as a consultant anaesthetist in a designated COVID treatment hospital. This is my story of converting a normal ICU space to a COVID -ICU. Main body: The pandemic came late to Sri Lanka. Even after 5 months of pandemic, the Intensive care unit in a designated COVID hospital was not ready to accept any patients. Leaving UK, at the peak of pandemic after a steep learning curve, I realised that we Sri Lankans are just living on borrowed time. Being a developed country, UK also experienced inadequacies with manpower and equipment. Looking at a low income country like Sri Lanka, the challenges of converting the space in to COVID ICU seemed to be impossible. Starting from the scratch, with the constant encouragement of the colleges and authorities, a COVID ICU was built at a Base Hospital - Teldeniya, which was situated 15 miles away from a city. UHL was able to increase its ICU capacity within days. Most hospitals in UK did this within days to weeks. The story was not the same for Sri Lanka. People took time to realise the need for the COVID ICU. This made me desperate and sad thinking about the support the ICU authorities had at UHL. Our ICU started with one bed, adding to the total of 14 designated ICU beds in Sri Lanka. This number was bearable, as the number of reported cases were low all over the country. With the beginning of the year 2021, the number of reported COVID-19 cases gradually increased, with more patients needing ICU admissions. The bed number at BH Teldeniya was also increased to 5, but with minimal resources. When the pandemic reached its peak in early 2021, the miracle happened. There was an island wide appeal to donate equipment for COVID ICUs in Sri Lanka. This made people to change their attitude about the disease and about the COVID - ICUs. Generous donors from all over Sri Lanka and from overseas got together for this good cause. With no time, my ICU was well equipped with all kinds of sophisticated equipment. My greatest winning was to obtain a liquid oxygen plant to the hospital, allowing me to use high flow nasal oxygen therapy in deserving patients. Today, BH Teldeniya serves it maximum to the critically ill COVID-19 patients. Now I can sleep well in the night thinking that, my patients will get the same treatment as a patient in UHL. The unit is well equipped, and I can even lend equipment to ward HDUs. All this was possible due to simple thoughts of Sri Lankans. Conclusion: In 20 years' time, I will look back at the time of pandemic and be proud of my journey from a developed country to a developing country to make the difference that would change the fate of critically ill Sri Lankans.

VACCINATION AGAINST COVID-19 SHOULD BE ENCOURAGED in PATIENTS with RHEUMATIC DISEASE, AS MOST PATIENTS DEVELOP A SEROLOGICAL RESPONSE AGAINST the VACCINE and VACCINATION REDUCES SELF-IMPOSED ISOLATION and SHIELDING BEHAVIOR

Background: Vaccine trials of the SARS-CoV-2 mRNA vaccines were encouraging but excluded most patients with rheumatic diseases (RD) and patients treated with immunosuppressive therapy. However, reports of a more severe COVID-19 disease course in patients with RDs prompted strategies for expediting vaccination of RD patients in most countries. In addition to the impact experienced by most people of the pandemic, patients with RDs were adversely impacted by the potential risk of severe COVID-19 due to their disease and immunosuppressive treatment. Fear of COVID-19 led to disproportionate anxiety, self-isolation, and shielding behavior for many RD patients at the beginning of the pandemic. Objectives: We investigated antibody levels in serum against SARS-CoV-2 after a two-dose vaccination with an mRNA vaccine in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Further, we examined the association between reactogenicity and immunogenicity and how vaccination influenced patient behavior concerning fear of COVID-19 and shielding. Methods: Patients with SLE or RA from the COPANARD (Corona PANdemic Autoimmune Rheumatic Disease)1 cohort received two doses of an mRNA vaccine between January and August 2021 and had total antibodies against SARS-CoV-2 measured before vaccination and 2 and 9 weeks after the second vaccination. In addition, patients answered an electronic questionnaire before and eight weeks after vaccination concerning behavior, anxiety, and symptoms of depression (PHQ-9). Results: Three-hundred-and-three patients and 44 blood donors (healthy controls) were included. Signifcantly fewer patients (90%) had measurable antibodies against SARS-CoV-2 compared to blood donors (100%) after the second vaccination (p<0.001) (Figure 1). Treatment with Rituximab was the strongest predictor of unfavorable vaccine response, as only 27% were seropositive after vaccination. We found a negative effect of prednisone and methotrexate but no effect of age, comorbidity, or pausing medication on seroconversion. Patients experienced signifcant improvement after vaccination in 10 out of 12 questions regarding behavior and fear of COVID-19, but no change was observed in symptoms of depression (p=0.62) or anxiety (p=0.46). Conclusion: The majority of patients with SLE or RA had a measurable sero-logical response to the COVID-19 mRNA vaccine after two doses. Treatment with Rituximab was the strongest predictor of no seroconversion. Our fndings warrant encouragement of vaccination against COVID-19 for patients with RD, as most patients benefts with both a serological immune response and reduced isolation and shielding behavior.

GERIATRIC PATIENT RECEPTIVITY TO THE INTEGRATION OF TELEHEALTH IN UROGYNECOLOGY CARE

Introduction: Several urogynecology conditions can be managed through telehealth visits as this is a combined surgical and medical specialty. However, geriatric patients may experience difficulty using such a modality due to the inherent ageism within the medical system. This manifests in portal developers and providers presuming the elderly's obligatory conformance to what is provided and a limited interest in this population's constraints, thus disregarding their needs when designing the interface as well as forgoing conversations on patient portals with their patients. With the COVID-19 pandemic catalyzing the digitalization of medicine, excluding the needs of this patient population risks impacting their care. Online health portal use must be optimized accordingly to improve access to geriatric urogynecology patients. Objective: To identify facilitators, concerns, technical or personal issues encountered, and the desired features of the online patient portals among geriatric urogynecology patients. Methods: This is a cross-sectional study of patients (> = 65 years of age) at an academic medical center in Northwest Ohio, where telehealth practices had been well established since early 2020. The data collection occurred between June 1-30, 2021. Two focus groups were conducted with the identified themes used to devise the anonymous survey. The questions addressed comfort with telehealth visits for urogynecology-specific conditions and the practicality of patient portals for physician visits. The promoters and deterrents were compared using the Pearson's Chi-squared test between those comfortable and uncomfortable having telehealth visits for preoperative, postoperative, and medical management. Results: A total of 205 patients completed the study (91% response rate, 225 surveys distributed). Mean age was 68.9 (SD 4.9) with 81% of participants being Caucasian and 10% being African American. Promoters of patient portal use identified included provider encouragement, enrollment on-site with concurrent education, and clarification of relevance of the telehealth to one's care (Table 1). Patients who were uncomfortable with telehealth use reported anxiety and technical issues as deterrents for using such technology. This included difficulty using the hardware, accessing the portal, and significant input needed to log on. More than half of the patients were comfortable having online visits for preoperative (51.7%), postoperative (66.3%), and medical management (73.7%) (Table 2). Up to 60.5% of the patients believed that telehealth visits were equally stressful as in-person visits, while 24.4% believed that the logistics of in-person visits were the cause of stress. Most of the patients who considered in-person visits stressful reported provider encouragement, enrollment by the hospital, and clarification of benefits as major promoters for portal use. Specific design features such as additional drop-down lists, colors, and icons in addition to an intuitive design were desired. Patients who preferred in-person visits were deterred primarily by technical and privacy concerns, anxiety, and cost of use (Figure 1). Conclusions: To improve access to care, augment the utilization of online patient portals, and combat ageism, enhancing the geriatric urogynecologic patient portal experience is vital. Investment in this population's needs includes education of patients, active enrollment, engagement by healthcare systems, and addressing technical concerns (Table Presented).

Improving Care for Children Through Continuous Professional Development for Nurses at Ola During Children's Hospital, Freetown, Sierra Leone

Background: One in ten children in Sierra Leone dies before their fifth birthday, often as a result of treatable conditions such as malnutrition, malaria and respiratory infections. Ola During Children's Hospital (ODCH), Freetown, is the only tertiary paediatric referral unit in the country, and nursing staff are the major workforce in the hospital. However, there are no postgraduate paediatric nursing qualifications in-country, leaving gaps in staff's paediatric specific knowledge and skills. ODCH management and Welbodi Partnership developed a programme of Continuous Professional Development (CPD) for nurses at the hospital, aiming to improve their knowledge, skills and the quality of nursing care. Part-funded through an ICATCH grant, a group of nursing staff were trained as independent Trainers, Mentors and Managers, to design and deliver CPD modules independently. Together they co-developed and delivered a series of paediatric training modules. Methods: A mixed methods process evaluation was undertaken, guided by the REAIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework. Descriptive statistics were drawn from training and mentorship registers and semi-structured qualitative interviews undertaken with Key Informants (clinical staff, n = 16) at project end. Results: Reach - 81 nurses were trained as trainers and/or mentors and/or managers. Due to high rates of staff turnover it was not feasible to track the proportion of nursing staff reached, however, the vast majority of nursing staff at the hospital are expected to have received training or mentorship training through the programme (approximately 230 staff). Effectiveness - All Key Informants described positive changes to nurses' performance and improvements to multi-disciplinary working. Nurses reported increased confidence in performing their duties efficiently and effectively, and in working across cadres and with doctors. Adoption - 21 (95%) of the staff trained as Trainers and 46 (82%) of the staff trained as Mentors, subsequently delivered training/mentorship. The primary barrier to adoption was the expectation of financial renumeration, however this was addressed through transparent communication and ongoing encouragement. Implementation - Adaptive programming was required throughout, particularly in response to the COVID-19 pandemic;training was redirected towards new COVID-19 Standard Operating Procedures and training methods altered (e.g. smaller groups and information sharing via WhatsApp) Maintenance - As of June 2021, 7 Trainers (32%) and 17 Mentors (14%) were 'active' (had delivered training or mentorship in the previous month). The primary barrier to maintenance was staff being transferred to other hospitals or being on study leave. Welbodi Partnership will continue to work with the Hospital Management on further embedding these CPD practices and addressing the barriers identified. Conclusion: CPD delivered via training-of-trainers was well adopted at ODCH and perceived to improve nurse's performance and multidisciplinary working. However, staff turnover may pose a significant barrier to maintenance. Further attention is needed to develop a robust strategy to mitigate against this.

CHANGES IN THE NEEDS OF IBD PATIENTS FOR TREATMENT BEFORE AND AFTER THE COIVD19 EPIDEMIC (ANALYSIS USING TWITTER DATA)

Background Currently, in the treatment of inflammatory bowel disease (IBD), there is an emphasis on cooperation between physicians and patients, taking into account patients' life events and values. On the other hand, since the COVID-19 epidemic, patients' needs for treatment may have changed compared to the past, but few studies have clarified this. Therefore, in this study, we examined the treatment needs of patients and their changes after the COVID epidemic in Japan based on patients' posts on Twitter, a social media frequently used by IBD patients. Methods We collected posts related to IBD treatment from Twitter using 11 keywords (Remicade, Humira, etc.). We limited the number of posts extracted to 100 for each period and each word. Extracted posts were manually categorized and analyzed for characteristic words. We collected the Data only for tweets in Japanese. The data collection period was seven periods: two periods before the COVID epidemic and five periods after the COVID epidemic (corresponding to the first to fifth waves of the COVID epidemic in Japan). These are April 10-14, 2019;August 10-14, 2019;April 10- 14, 2020;August 10-14, 2020;January 6-10, 2021;May 10-14, 2021;and August 18-22, 2021, respectively. We used the statistical software R to extract the submissions. <div>Results We extracted A total of 2,111 tweets. Of these, we excluded posts unrelated to IBD, and we included 1,862 in the analysis. The contents of the tweets were: positive opinions about treatment, negative opinions about treatment and side effects, intended to gather information from patients, work and school (anxiety about taking time off for treatment), impact on pregnancy and childbirth, hospital visits (time spent in hospital, treatment time, worry about infection from hospital visits), encouragement among patients, family Tweets about the COVID epidemic ranged from 5% to 14% of the total. Tweets about anxiety about hospital visits increased significantly from 5% before the COVID epidemic to 18.5% after the epidemic. In addition, tweets about COVIDs were more common in biologics tweets than in 5ASA drugs. Conclusion To make appropriate Shared Decision Making, healthcare providers need to understand the needs of patients and provide relevant information.</div>

Quality of Sexual and Reproductive Health Services for Adolescents: Findings from A Survey of U.S. Physicians

Purpose: Quality sexual and reproductive health (SRH) care for adolescents includes implementation of youth-friendly clinical practices (e.g., practices that support minor’s rights to confidential care) and provision of recommended clinical services (e.g., access to the full range of contraceptive methods). There is limited data from providers regarding the quality of SRH care for adolescents in the United States. This analysis examines physician-reported prevalence of youth-friendly practices and SRH services overall and by physician specialty to inform focused improvement efforts. Methods: Data were from the DocStyles online panel survey administered with U.S. healthcare providers September-October 2020. The survey assessed whether the following youth-friendly practices were in place just before the COVID-19 pandemic: walk-in hours, evening/weekend hours, time alone with a provider at every visit, confidentiality policy communicated at every visit, and routine encouragement of parent-adolescent communication. SRH services assessed included long-acting reversible contraception (LARC) insertion and removal, clinic-based sexually transmitted infection (STI) testing, and counseling about STI prevention at contraception initiation. We restricted the analytic sample to family practitioners (n=364), internists (n=247), pediatricians (n=180), and obstetricians/gynecologists (n=213) primarily working in outpatient settings who reported providing family planning or STI services to at least one patient aged 15-19 years per week just before the pandemic. Descriptive statistics were calculated overall and for each physician specialty, and chi-squared tests were used to examine differences. We also explored associations between physician-report of adolescent SRH quality improvement (QI) efforts in the year just before the pandemic and each youth-friendly practice and SRH service. Generalized linear models were used to produce adjusted prevalence ratios (APR) controlling for physician specialty, individual versus group practice, and adolescent patient volume for SRH services. Results: Among physicians who provided SRH services to adolescents overall, the proportion with youth-friendly practices in place ranged from 44.7% for weekend/evening hours available to 60.5% for routine encouragement of parent-adolescent communication. Walk-in hours and evening/weekend hours available were highest for pediatricians and lowest for obstetricians/gynecologists. Nearly three-quarters of pediatricians and obstetricians/gynecologists reported always providing time alone and communicating the confidentiality policy whereas only about half of family physicians and one-third of internists reported each of these practices. Overall, 37.6% reported their practice provided LARC placement and removal, 79.3% provided clinic-based STI testing, and 66.3% always discussed STI prevention with adolescents initiating contraception. Across these services, prevalence was consistently highest for obstetricians/gynecologists and lowest for internists, although the proportion of internists and pediatricians providing LARC services was similarly low (12.2% and 13.3%, respectively). Overall, about one-quarter (28.5%) of physicians reported that adolescent SRH QI efforts were conducted in the past year, and QI was associated with increased likelihood of having youth-friendly practices in place and providing SRH services for all indicators except weekend/evening hours and LARC services (APR range: 1.10-1.55). Conclusions: Findings suggest opportunities to improve youth-friendly practices and delivery of SRH services for adolescents, which vary by physician specialty. Implementing adolescent-focused SRH QI initiatives may be one approach to strengthening certain youth-friendly practices and clinical services. Sources of Support: None.

SOCIAL CONNECTION AND RECOVERY FROM ALCOHOL USE DISORDER DURING THE COVID-19 PANDEMIC: QUALITATIVE FINDINGS FROM A US NATIONAL SAMPL

Purpose: Social support is critically important to recovery from alcohol use disorder (AUD). During the COVID-19 pandemic, community and government social restrictions and mandates reduced inperson contact and increased social isolation, heightening the risk of relapse for many persons in recovery. A key question concerns what forms and sources of social connection and support were important for maintaining recovery during the pandemic. Methods: This study used a large, pre-existing, national cohort, Knowledge Panel, to recruit participants with resolved AUD for an online survey. The sample consisted of 1,492 adults, 71% of whom had been in recovery more than 5 years. In addition to close-ended questions on COVID-19 stressors and coping responses, an open-ended question asked participants what was most helpful in sustaining their recovery during the pandemic. A qualitative codebook was created, and iterative coding was conducted by multiple analysts using Dedoose, followed by preliminary analysis of themes from codes on COVID-19 restrictions and sources of social connection and support. Results: Participants commonly referenced talking to, staying in touch with, and/or spending time with family members, including children (latter mentioned more commonly by women) as helpful in maintaining recovery. Participants also highlighted support and encouragement from family. Communication and interaction with friends were also integral to recovery maintenance. Support, care, and contact from and towards others in their networks, including those in recovery, were also cited. Many participants continued to attend Alcoholics Anonymous (AA) meetings and other mutual support groups throughout the pandemic. When in-person gatherings were not possible, participants sustained social connections through various forms of telecommunication. Unexpectedly, some participants characterized the lack of social interactions during COVID-19 as beneficial to their continued recovery, as it removed opportunities and temptations to drink with others. Conclusions: Despite profound disruption to social routines during the pandemic, many individuals in recovery experienced helpful social connections and support that were important to maintaining recovery. For some, social restrictions were perceived as beneficial and limiting opportunities for relapse. These findings underscore the importance of social support and networks in long-term recovery, warranting further investigation into the dynamics of support systems conducive to recovery maintenance.