Impacts of COVID-19 on proton therapy - Shaping the future of patient selection

Objectives: This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy centres. Method(s): This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines.1,2 A literature search was performed in Medline, Embase, Web Of Science and Scopus as well as grey literature. Keywords including "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 14 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Result(s): Six of 14 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of alternative therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment volume and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Discussion/Conclusion: Few publications detailed patient selection or workflow methods used during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in proton therapy, collecting this data could aid in future planning for proton therapy in Australia.

Assessment of TUMS affiliated hospitals' preparedness for dealing with Covid-19.

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19. Method(s): The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals' directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census. Result(s): On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals' readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion(s): The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.Copyright © 2022 Jaafaripooyan et al. Published by Tehran University of Medical Sciences.

An Outbreak of Covid 19 Infection at the Massey Street Children's Hospital, Lagosisland, Nigeria

Aims 1) To review the admissions into the emergency unit of children with pneumonia and other uncommon presentation of Covid from October2020 to January 2021 2) To highlight leadership role in managing a hospital Outbreak Conclusion There was a high number of admission of pneumonia cases into the emergency unit in December 2020 and some children with uncommon symptoms of Covid. The testing rate in children was almost zero. The belief was, these contributed significantly to the source of outbreak in the hospital as Lagos state is also the epicenter of the disease. With more than 60% of the workforce testing positive to the virus, the morale of staffs was low, mortality worsened during this period as there were fewer staff available to work. Leadership instituted alternate day shifts for staffs, and resolved to strengthen the adherence to Covid protocols by providing more PPEs, continued to train and retrain staff in management of Covid infection and IPC. No crowding allowed in call rooms, lounge and library, restriction of visitors to the hospital and regular cleaning of surfaces. Virtual meetings replaced physical meetings. Staffs who tested positive but not needing admission received a home based treatment pack for free and self-isolated at home for 14days. 3 staffs were admitted in the central isolation unit in the state. Thankfully, no death was recorded among the staff and by March the infection had reduced drastically. The staffs' mental health issues were addressed, there were zoom sessions with mental health experts. Today, we have a workforce that is fully vaccinated against Covid 19 (received booster dose).

Stressors Experienced by Primary Caregivers of Severe Acute Brain Injury Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study

Objective: To understand the psychosocial stressors reported by caregivers of severe acute brain injury (SABI) patients recovering from coma in neuroICUs. Background: Caregivers of SABI patients are at risk of developing long-term adverse psychological outcomes following neuroICU discharge, particularly those of patients admitted in a comatose state and remaining disabled. Understanding the top psychosocial stressors reported by these caregivers is critical for design of interventions to improve psychological outcomes. Design/Methods: At the time of neuroICU discharge, we conducted semi-structured, recorded interviews with 15 primary caregivers of SABI patients, all of whom were comatose for greater than 24 hours and needed tracheostomy and/or feeding tube placement. Participants were recruited as a convenience sample from 6 US centers. A codebook for psychosocial stressors was developed from open coding of the first 5 interview transcripts amongst 9 study team members. Using NVivo software, two team members then independently coded each transcript, refined the codebook, and resolved coding discrepancies. Results: Fourteen of 15 caregivers provided demographic data: 13 (92.9%) were female, 5 (35.7%) were racial minorities, and 9 (64.3%) reported fewer than 4 years of college. Six of the 15 (40.0%) patients had recovered to a Glasgow Coma Scale of 9 or higher at the time of interview. The psychosocial stressors most commonly reported by participants were: navigation of the healthcare system, including hospital visitor restrictions due to COVID-19;uncertainty about prognosis;communication with healthcare providers;juggling of practical matters beyond the hospitalization;and navigation of social relationships. Caregivers also referenced challenges with direct caregiving responsibilities, changes to the relationship dynamic with the hospitalized patient, and loss of normality. Conclusions: Across multiple US centers, caregivers of SABI patients in various stages of coma recovery at time of neuroICU discharge share a wide variety of psychosocial stressors. Interventions designed to improve psychological outcomes will need to acknowledge these stressors directly.

Healthcare Personnel Perceived Benefit of Infection Prevention Strategies during COVID

Background. During the COVID-19 pandemic, many infection prevention policy and practice changes were introduced to mitigate hospital transmission. Although each change had evidence-based infection prevention rationale, healthcare personnel (HCP) may have variable perceptions of their relative values. Methods. Between October-December 2020, we conducted a voluntary, anonymous, IRB-approved survey of UNC Medical Center HCP regarding their views on personal protective equipment (PPE) and hospital policies designed to prevent COVID acquisition. The survey collected occupational and primary work location data (COVID unit or not) as well as their views on specific infection prevention practices during COVID. Chi squared tests (two tailed) were used to compare differences in the proportions. Results. The overall results are displayed (Figure). Among the 694 HCP who responded to the survey, we found HCP were largely (68%) satisfied that the organization was taking all the necessary measures to protect them from COVID-19. A significantly greater proportion (14% more) of HCP (81.7% compared to 67.6%;95% CI of difference 9.4-18.5%, P< 0.0001) agreed that all PPE was available to them compared to those who were confident that the organization was taking necessary steps for protection, highlighting that safety is more than simply availability of supplies. More than 90% felt that daily screening of patients/visitors and patient/visitor mask requirements were important for protecting them from acquiring COVID in the workplace and that wearing a mask themselves was a key intervention for protecting others. Fewer HCP (72-80%), although still a majority, perceived that eye protection and daily symptom screening for HCP were beneficial. Symptom screening for patients/visitors was perceived by 19% more HCP (90.9% compared to 72.2%;95% CI of difference 15-23%) to be beneficial than symptom screening of HCP (P< 0.0001). Conclusion. Although infection prevention strategies were implemented based on evidence and in alignment with CDC recommendations, it is important to acknowledge that the perception and acceptance of these recommendations varied among our HCP. Compliance can only be optimized with key interventions when we seek to understand the perceptions of our staff.