Guiding employees through the COVID‐19 pandemic: An exploration of the impact of transparent communication and change appraisals

Against the backdrop of the COVID‐19 pandemic and drawing on literature from change management, internal communication and cognitive appraisal theory, this study provided accounts of how transparent communication during organizational change affects employees' cognitive appraisals of the change, behavioural reactions to the change, and subsequently, turnover intentions. Our findings of 414 full‐time US employees revealed that transparent internal communication is positively related to employees' challenge appraisal of the change, which, in turn, is related to change compliance and championing. In addition, transparent communication is negatively associated with threat appraisal of the change, which in turn is connected to lower change compliance. Further, employees' turnover intention was negatively associated with their compliance and championing for the change. This study has made several contributions to internal communication scholarship, appraisal theory and change management literature. We also offer several suggestions to improve communication during organizational change periods. [ FROM AUTHOR] Copyright of Journal of Contingencies & Crisis Management is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Families' Job Characteristics and Economic Self-Sufficiency: Differences by Income, Race-Ethnicity, and Nativity

Policy debates about whether wages and benefits from work provide enough resources to achieve economic self-sufficiency rely on data for workers, not working families. Using data from the Current Population Survey, we find that almost two-thirds of families working full time earn enough to cover a basic family budget, but that less than a quarter of low-income families do. A typical low-income full-time working family with wages below a family budget would need to earn about $11.00 more per hour to cover expenses. This wage gap is larger for black, Hispanic, and immigrant families. Receipt of employer-provided benefits varies—health insurance is more prevalent than pension plans—and both are less available to low-income families, and black, Hispanic, and immigrant working families. Findings suggest that without policies to decrease wage inequality and increase parents' access to jobs with higher wages and benefits, child opportunity gaps by income, race-ethnicity, and nativity will likely persist.

EXPLORING ATTITUDES TO VIRTUAL GASTROENTEROLOGY CLINIC PROVISION: A PATIENT SURVEY

Introduction The COVID-19 pandemic has forced patients to rapidly adjust to virtual consultations in outpatients. A perceived benefit is reducing unnecessary travel. However, there is a paucity of literature describing acceptability of virtual consultations to gastroenterology patients. Methods In collaboration with the Patient Experience team, satisfaction surveys were disseminated in Gastroenterology and Hepatology clinics at Bristol Royal Infirmary electronically via SurveyMonkey® and paper format between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Data was collected on patient demographic, travel method, satisfaction with virtual clinics, and preferences for service delivery. Results 100 patients completed the survey (27% aged 55- 64yrs;21% aged 65-74 years). 50%, 27% and 23% of patients were from hepatology clinic, inflammatory bowel disease clinic and general gastroenterology clinic respectively. 84% were follow-up patients. 56% of patients normally drove to appointments, with a further 30% taking public transport. 23% of patients were travelling over 10 miles to attend appointments. 38% of patients were in full-time employment of which 63.1% had to take annual leave to attend appointments (n=24/38). 82% of patients owned a laptop of which 19.5% (n=16/82) disagreed or strongly disagreed with feeling comfortable using their computer for an online appointment. Face-to-face (F2F) consultation was the preferred mode of appointments in almost half of patients (49%), followed by a mix of F2F and telephone consultations (19%). 54% of patients agreed or strongly agreed that clinicians could address their concerns virtually, with only 16% disagreeing or strongly disagreeing with this. 65% of patients agreed or strongly agreed they felt comfortable sharing personal information during a virtual consultation, with 14% of patients disagreeing or strongly disagreeing with this. 80% of patients stated they would want to receive bad news in a F2F consultations. Conclusions Virtual consultations appear to be acceptable rather than preferable to gastroenterology patients. F2F consultations remain the overall preference, particularly when receiving bad news. Virtual consultations can provide flexibility in service delivery. This is important given almost two thirds of patients in full time employment had to take annual leave to attend an appointment. Furthermore, as services consider their carbon footprint, with half of patients driving to their appointments in Bristol, virtual consultations offer a genuine opportunity to provide a greener service.

Frequency, Persistence, and Patient-reported Outcomes of Neurological Symptomsin Mild COVID-19: Resultsfrom the ALBERTA HOPE COVID-19 Trial

Objective: To examine the natural history of neurological symptoms in mild COVID-19. Background: Various neurological manifestations have been reported with COVID-19, mostly in retrospective studies of hospitalized patients. There are few data on patients with mild COVID19. Design/Methods: Consenting participants in the ALBERTA HOPE COVID-19 trial( NCT04329611, hydroxychloroquine vs placebo for 5-days), managed as outpatients, were prospectively assessed 3-months and 1-year after their positive test. They completed detailed neurological symptom questionnaires, Telephone Montreal Cognitive Assessment(T-MoCA), Kessler Psychological Distress Scale(K10), and the EQ-5D-3L(quality-of-life). Informants completed the Mild Behavioural Impairment Checklist(MBI-C) and Informant Questionnaire on Cognitive Decline(IQCODE). We tracked healthcare utilization and neurological investigations using medical records. Results: Among 198 patients (median age:45, IQR:37-54, 43.9% female);28(14.1%) had preexisting neurological/psychiatric disorders. Among 179 patients with symptom assessments, 139(77.7%) reported ≥1 neurological symptom, the most common being anosmia/dysgeusia(56.3%), myalgia(42.6%), and headache(41.8%). Symptoms generally began within 1-week of illness(median:6-days, IQR:4-8). Most resolved after 3-months;40 patients(22.3%) reported persistent symptoms at 1-year, with 27(15.1%) reporting no improvement. Persistent symptoms included confusion(50%), headache(52.5%), insomnia(40%), and depression(35%). Body mass index, prior neurologic/psychiatric history, asthma, and lack of full-time employment were associated with presence and persistence of neurological symptoms;only female sex was independently associated on multivariable logistic regression(aOR:5.04, 95%CI:1.58-16.1). Patients with persistent symptoms had more hospitalizations and family physician visits, worse MBI-C scores, and were less often independent for instrumental daily activities at 1-year(77.8% vs 98.2%, p=0.005). Patients with any or persistent neurological symptoms had greater psychological distress defined as K10≥20(aOR:21.0, 95%CI:1.96-225) and worse quality-of-life ratings(mean EQ-5D VAS:67.0 vs 82.8, p=0.0002). 50.0% of patients had T-MoCA<18 at 3-months versus 42.9% at 1-year;patients reporting memory complaints were more likely to have informant-reported cognitive-behavioural decline (aOR[1-year IQCODE>3.3]:12.7, 95%CI:1.08-150). Conclusions: Neurological symptoms were commonly reported in survivors of mild COVID-19 and persisted in one in five patients 1-year later. These symptoms were associated with worse patient-reported outcomes.

Physical therapy intervention for an individual with post-COVID symptoms: A case report

BACKGROUND AND PURPOSE: The major symptoms during COVID-19 are acute, but a significant portion of patients now increasingly have long term multisystem sequalae. However, most research is centered around care in the hospital. Research to further inform treatment of patients with post-COVID symptoms is vital. The purpose of this case report is to provide the physical therapist management for a patient with post-COVID symptoms in an outpatient setting. CASE DESCRIPTION: A 50-yearold woman tested positive for SARS-CoV-2 but did not require hospitalization. Ten weeks post COVID, she participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, global decrease in strength, impaired breathing pattern, poor pulmonary education, decreased endurance;and mild anxiety with activity. Patient demonstrated some emotional breakdown due to decreased strength and current condition. On initial evaluation, 6-munte walk test distance (6MWD) was 79.5 m (substantially less than age-predicted value), the UCSD Shortness of Breath Questionnaire (SOBQ) score was 72/120 and the Patient Health Questionnaire (PHQ-9) score was 6/27 (mild depression). Spirometry data revealed mild restrictive disease. Patient's goal was to partake in daily activities without shortness of breath and feeling fatigued to allow return to full-time job. The patient participated in biweekly, 60-min sessions (n = 20) and a HEP was provided. These sessions included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and patient education. During the first three treatment sessions, the patient often complained of “fogginess” as she approached fatigue. Education on breathing and energy conservation techniques allowed to overcome these symptoms and for compliance with HEP. OUTCOMES: The patient's exercise capacity, physical function, muscle strength improved following the 20 sessions. At discharge, the 6-Minute walk distance improved to 335 m (324%). Scores on SOBQ improved beyond the MID to 34/120;and PHQ-9 to 1/27 (minimal depression). At discharge, patient could perform household tasks without fatigue, allowing her to eventually return to work safely. DISCUSSION: Following 20 sessions of outpatient physical therapy, our patient with post-COVID symptoms showed substantial improvements in exercise capacity, SOBQ and PHQ-9. This case report highlights the importance of addressing fatigue and anxiety related to physical symptoms in the plan of care for patients with post-COVID symptoms. Further research is needed to define the ideal interventions to manage this condition. While the treatment of patients post-COVID symptoms presents significant challenges, this report provides some insight in designing physical therapy interventions in the outpatient setting for this population.

SATISFACTION WITH TELEHEALTH AMONG PATIENTS WITH IBS DURING COVID-19: INITIAL FINDINGS FROM A CROSS-SECTIONAL SURVEY

Introduction: The COVID-19 pandemic prompted a rapid shift to telehealth for care delivery. We aimed to assess satisfaction with and preferences for telehealth to improve care experiences for patients with irritable bowel syndrome (IBS). Methods: We conducted a prospective survey-based cross-sectional study from September 29 to November 9, 2020 in a diverse, community-based integrated healthcare system in Southern California. We included members age 18-90 with an International Classification of Diseases 9, 10 code for IBS from an office-based encounter between June 1, 2018 to June 1, 2020. A specifically developed survey (TIBS-CoV2) was emailed to patients. We collected demographic and clinical data from the electronic medical record. We assessed satisfaction via 5-point Likert scale (“strongly agree and agree” was defined as satisfied;“strongly disagree and disagree” as dissatisfied). Using Chi-square and Wilcoxon Rank Sum tests, we compared demographic and clinical characteristics of those who were satisfied and dissatisfied with telehealth in patients with ROME IV IBS. We used multivariate logistic regression to identify predictors for telehealth satisfaction. Results: Of 44,789 surveys sent, 2598 (5.8%) patients responded, 1473 (56.7%) completed the entire survey (median age 60.0 [42.4-71.2], 80.1% female;66.3% non-Hispanic white, 22.1% Hispanic, 5.0% black, 4.0% Asian) and 744 (28.6%) had ROME IV confirmed IBS. 651 (87.5%) patients with IBS used telehealth for their care: 436 (67.0%) were satisfied, 62 (9.5%) were dissatisfied and 153 (23.5%) felt neutral about their experience. No significant differences were seen in sex, race/ethnicity, BMI, marital status, income, IBS subtype or severity between satisfied and dissatisfied groups (Table 1). Telehealth satisfaction was associated with full-time employment (188, 43.1%, p>0.001), a college degree or higher (244, 56.0%, p=0.01), or daily social media use (338, 77.5%, p=0.01). Dissatisfaction was associated with older age (59.2±17, p<0.01), retirement (26, 41.9%, p=0.02) and low self-perceived health literacy (4, 6.5%, p=0.008). Satisfied patients would consider telehealth over a face-to-face visit for a travel time of 30-59 minutes (170, 39.0%, p=0.01);dissatisfied patients did not consider travel time a factor (23, 37.1%, p>0.001). Multivariate analysis confirmed age, a college degree, daily use of social media and travel time of 30-59 minutes as independent predictors of telehealth satisfaction (Table 2). Conclusions: A majority of patients with IBS are satisfied with telehealth and are more likely to use telehealth since the COVID-19 pandemic. Factors including age, available time, education level, health literacy and comfort with technology likely influence satisfaction with telehealth in IBS and may help to identify patients who would be most responsive to a focused IBS-telehealth program.(Table presented) (Table presented)