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Background/Aims Long Rheumatology waiting lists in the UK were further affected by the COVID-19 pandemic;resulting in negative impacts upon the timeliness and efficiency of patient care. The use of Advanced Practitioners within Rheumatology care pathways has been shown to be safe and effective;they can support the Rheumatology workforce and expedite care where patients are appropriately triaged to them. As part of a service provision change in a NHS Trust, an Advanced Practice Physiotherapist (APP) post was funded with the intent to harness these benefits. Initial utilisation of the APP appointments within the Rheumatology provision was found to be low and could be improved. A Quality Improvement (QI) Project was initiated, with the aim to increase APP appointment utilisation to at least 85% over a period of four months, and for at least 75% of these appointments to contain patients who had been appropriately triaged. Methods The 'Model for Improvement' was chosen as the QI approach. The project was led by an APP. Firstly, a stakeholder analysis was performed to identify staff with influence and interest in the project. A root cause analysis found lack of awareness of triaging clinicians and challenges with booking processes as potential reasons for lowerthan- expected appointment utilisation. Change interventions were devised and tested over three Plan, Do, Study, Act (PDSA) cycles. PDSA one developed communication with booking and triage staff to clarify these processes with them. PDSA two educated clinical staff about the APP role, triage criteria and the booking procedures confirmed in PDSA one. PDSA three focused upon sustaining change by reinforcement of the topics established in PDSA two among staff. Outcome measures used were the percentage of available APP appointments utilised per week, and the percentage of these which contained patients who were appropriately triaged. Results APP appointment utilisation increased from a mean of 22% pre-project to 61% during the change intervention period. Sixty-three patients were seen over the 17-week change intervention period;of which 86% had been appropriately triaged. Data showed that 70% of the patients directed to the APP were managed by them (24% discharged and 46% reviewed). Of the remaining patients, 13% were followed up by a Rheumatologist, 12% did not attend and 5% had an alternative outcome such as awaiting advice. Conclusion This QI project led to an improvement in Rheumatology care provision locally. Engagement with support staff, education of clinical staff and implementation of clear standard operating procedures improved the utilisation of the Rheumatology APP resource. Results suggest that the APP role was effective locally in managing appropriately triaged patients, without a negative effect on patient care or other services. Continuing to improve utilisation will support management of the Rheumatology waiting list and improve patient care.
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Background: 5-20% of people living with HIV (PLWH) are co-infected with Hepatitis B (HBV) and coinfection is associated with an increased risk of cirrhosis and hepatocellular carcinoma (HCC), incidence of which is 5 to 6 times higher. COVID-19 led to a lapse in surveillance of this population, warranting a reassessment. Method(s): BHIVA and EACS guidelines were combined to create a standard to audit against. All people under the care of the HIV team with co-infection were included, and analysed for the prior six months. Local ethics approval was granted. The results were then presented to clinicians, and local guidelines created to reflect the most recent research on co-infection which were shared with the department. A re-audit was then conducted against the modified guidelines. Result(s): 42 people were living with co-infection of HBV and HIV, with a 50:50 gender split;32 were of Black African ethnicity (76%). The median age was 50.5. Nobody had a HBV resistance profile done at baseline. 3 people did not have suppressed HIV viral load (VL), and 8 people did not have a suppressed HBV VL. In the previous 6 months only 26 (62%) had had a HBV VL, 20 (48%) had had an alfa-fetoprotein (AFP) check, and 21 (36%) had had an ultrasound liver. An US had been requested in 21 (50%) of patients. 100% were on a tenofovir-containing drug regimen. Following presentation and rewriting of guidelines, performance of investigations improved. An US had been requested in 26 (62%) cases although only performed in 16 (38%) and an AFP had been measured in 25 (60%). Vaccination of partners had also improved. Conclusion(s): The provision of care of those with coinfection was significantly impacted by the COVID pandemic, but reinforcement of information, and re-issuing of guidelines improved patient care. Attendance of appointments for blood tests and scans remains a major challenge for improving patient care. Literature aimed at our local population to reinforce the importance of HCC screening is being developed.
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Background: The Covid-19 (C-19) pandemic plugged the global economy into its worst recession since World War II. To avoid hospitals overload, physicians need simple and accurate early tools to predict clinical evolution of C-19 patients. This can help sorting patients to an intra-hospital stay or to an outpatient confinement. Method(s): A retrospective study was conducted in Hotel Dieu de France Hospital;baseline serum LDH level measured on hospital admission was obtained. The length of intra-hospital stay, number of patients transferred to the critical care unit and started on mechanical ventilation (MV) were recorded. The News-2 score on admission (N2), scan severity score (SSS), intra-hospital evolution of patients according to the Clinical Progression Scale published by the World Health Organization (WHO- CPS) and Post C-19 functional status scale (PCFS) at discharge (T0) and two months later (T2) were noted. Correlation between admission serum LDH and these parameters used the Spearman (r) and Mann-Whitney-Wilcoxon tests. Result(s): 524 C-19 patients with baseline LDH were included in the study with 359 males(68.5%) and a mean age of 63+/-16 years. Median LDH values were 328(248-430)U/L. Higher LDH values were correlated with: longer length of stay(r=0.22), ICU admission and MV with a p-value< 10 . LDH values were also correlated with: N2(r=0.45), SSS on admission(r=0.52) and follow-up(r=0.26), WHO-CPS(r=0.41), PCFS T0(r=0.2) and T2(r=0.12) all with a p-value< 10 . No correlation was found between baseline LDH and risk of death(p=0.06). Conclusion(s): LDH on admission can predict clinical degradation of C-19 patients in hospitals and after discharge. This can help to anticipate the treatment plan.
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Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.
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Background: COVID-19 has put the lives of our healthcare workers at the forefront of the battle against pandemic. Understanding how this pandemic directly affects them is vital in ensuring safe and continuous provision of service to the public. Reviewing their infection control practices is imperative in protecting their health and the patients they serve. This study aimed to determine the infection control practices of healthcare workers infected with COVID-19 in Tondo Medical Center from March 2020 to May 2021. Methodology: This is descriptive retrospective study involving healthcare workers of Tondo Medical Center infected with COVID-19 from March 2020 to May 2021. Demographic data, exposure history, clinical manifestations and infection control practices data were surveyed, encoded and tabulated. Categorical variables were presented as frequencies and percentages. Results: A total of 425 healthcare workers developed COVID-19 from March 2020 to April 2021. Their mean age was 36.4 years;more female (57.4%) and single (56.0%) staff were affected. Most cases (41.4%) came from or low/lowest risk areas. Three clustering of cases were identified. More than half of the respondents (54.4%) had unknown exposure;housemates/relatives (21.0%) were the most common source of known exposure. Three out of 10 respondents were asymptomatic;majority had mild symptoms (62.2%), the most common of which was the loss of taste/smell (26.5%). Adherence to wearing of mask was highest in the community (99.5%) than in the workplace (93.4%) and least at home (78.3%). Majority practiced social distancing in the community (97.9%) and in the workplace (95.5%). Almost half (58.7%) practiced 1-meter social distancing. Respondents practiced frequent handwashing both at home (92.2%) and in the workplace (91.9%). Only 1-2 out of 10 washed their hands for 40 seconds or more. Majority employed hand hygiene with alcohol-based rub for less than 20 seconds in the workplace (71.6%) and at home (69.5%). Majority (98.3%) performed hand hygiene after coughing or sneezing and used tissue (44.4%). Most of the respondents decontaminated their work area before and after work (66.6%). Alcohol was most used in the workplace (70.7%). More than half (59.6%) ate in the pantry, mostly alone (65.5 %). Most cleaned their cellphones daily (88.4%). Majority brought alcohol with them (97.2%) and almost half (47.5%) wore a mask for 4-8 hours. Conclusion: Some gaps have been identified in the knowledge and practices of infection control of healthcare workers infected with COVID-19 at Tondo Medical Center;hence reinforcement programs including refresher trainings and policy enhancement are warranted.
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The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a good number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of the number of available and dedicated psychologists, including remotely, from the countries hosting the most refugees, are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained on the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organising and coordinating these actions must be carefully considered and implemented in an evolving way to optimise their effectiveness. © 2022
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Background Early evidence described by a number of scholars worldwide suggests that neu-roCOVID-19 has both mild [e.g. loss of smell (anosmia), loss of taste (ageusia), neurological tics (heterophilia), visual disturbances, headaches, dizziness, disorien-tation] and more severe sequelae (e.g. cognitive impairment, seizures, delirium, psychosis, strokes). Long-term neurological problems or neurological deficits may also occur. The aim of this study was to describe the examination and neurother-apy of a boy following SARS-CoV-2 infection and NeuroCOVID-19 in whom neurological tics and motor automatisms as well as cognitive impairment, particularly attention deficit disorder, developed as a consequence. Case study: We present a boy K.S., 7 years old, without any neurodevelopmental disorders, following a SARS-CoV-2 infection in May 2021 and the contraction of neuro-COVID-19 confirmed by a genetic test for the quantitative detection of neutralising antibodies (responsible for immunity) in the IgG class against SARS-CoV-2. The boy had relatively mild pseudomonal symptoms of the illness: temperature 38.5, runny nose, cough, muscle aches, headaches and general weakness. He was treated symptomatically and recovered after 2 weeks. Two months later, at the beginning of July 2021, neurological tics consisting of an upward turning of the eyeballs to the left appeared. These tics intensified in August 2021 and were accompanied by motor automatisms consisting of the left hand stiffening in salute-like position, while at the same time there was an inclination of the head to the left. In September 2021, after exertion in the swimming pool, an epileptic seizure occurred which caused the boy to start drowning. In the days that fol-lowed the above described tics and motor automatisms increased. He also developed sleep disorders, which consisted of him waking up several times during the night, during which time neurological tics and motor automatisms also ap-peared. Gradually, cognitive dysfunctions, especially attention deficits and behavioural changes, joined in, making it impossible for the boy to function independently at school and in many situations of daily life. Neurophysiological examination: qEEG, ERPs and sLORETA tomography performed on 11.09.2021 using automatic seizure activity detection software showed the pres-ence of the neuromarker benign partial rolandic epilepsy (BPERS) and neurocog-nitive disturbances resembling the symptoms of attention deficit hyperactivity disorder (ADHD), compared with the neuromarkers of children with this condition (n=100) from the normative database of the Human Brain Index (HBI) in Switzer-land. Detection of the neuromarkerBPERS was helpful in selecting an individu-alised neurostimulation protocol. The patient participated in 20 neurofeedback sessions using (1) SMR reinforcement, theta inhibition;(2) theta inhibition, B1 reinforcement (15-18 Hz);(3) qEEG-guided neurofeedback. Neurostimulation with neurofeedback was conducted twice a week, for 15-20 minutes gradually increasing to 30-40 minutes per session. The patient also received individual goal-directed psychotherapy After successive sessions of neurofeedback, a gradual reduction neurological symptoms was observed. By the end of neu-rotherapy, neurological tics, motor automatisms, neurocognitive disorders and behavioural disturbances had completely disappeared. The patient functions well in school and achieves very good results. Conclusions: HBI methodology was helpful in finding functional neuromarkers of benign partial Rolandic epilepsy and disturbed cognitive control. Therefore, it was possible to offer more effective neurorehabilitation of the disorders, which contribute to a better quality of life for the patient.
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Background: The COVID-19 pandemic accelerated the use telemedicine for rheumatologic patients. Patient reported outcomes (PRO) can provide prioritization criteria for the form of face-to-face care in situations of social restriction, and optimization of early care by identifying high-risk patients. Objectives: Our aim was to demonstrate the main associated factors for a fall or fracture reported by rheumatoid arthritis (RA) patients in an electronic MDHAQ (Multidimensional Health Assessment Questionnaire) during this period. Methods: Patients with RA according to 2010 ACR/EULAR and access to digital platforms were enrolled in the study, from January to august 2021. A weblink was sent to MDHAQ in electronic platform. The study was approved by the ethics committee of Hospital de Clínicas de Porto Alegre-Brazil and all patients agreed with a Term of Informed Consent. Results: A total of 129 RA patients completed the electronic MDHAQ, mean age was 60 years (S.D. 14) and 83% were female. The mean DAS28, SDAI and HAQ were 3.8 (S.D. 1.6), 14.2 (S.D. 11.0) and 1. 2 (S.D. 0.7). Of those 129 patients, 14 reported a fall or fracture in the last 6 months of response and only 16 patients were physically active. Relevant symptoms known as factors associated with risk of fall and its prevalence in this study were: pain (82%), followed by articular pain (68%), fatigue (43%), muscle weakness (37%) and weight gain (22%). Among patients who reported a fall or fracture, 83% had a RADAI ≥ 16 and mean FAST3 (Fibromyalgia Assessment Screening Test) index of 19 (IC95 % 17-21). FAST3 based on MDHAQ and independent RADAI showed positively association with a reported fall or fracture for these patients, with a p value of 0.023 and 0.025, respectively. Other factors, such as high disease activity based on DAS28 or MDHAQ, obesity and age were not statistically signifcant with the reported episode. Conclusion: Maintaining PRO is aligned with patient-centered care, allowing relevant data source and identifcation of high-risk patients-in our study: patients in pain, sedentary and in major risk of fracture. Also, use of combined in like FAST3 or independent articular pain scores such as RADAI, might be helpful to identify those high-risk patients in need for orientation for reinforcement of physical activity, prioritization for in person visits and early clinical adjustments.
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Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective/retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transportation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.
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SCOPO DEL LAVORO: Stressful effects of COVID-19 lockdown measures adopted to restrict population movements to help curb the epidemic impacted on people's daily lives. Biella is Northern Italy province. For decades this province has had suicide rates higher than the Piedmonts and Italian average. In two most recent decades a positive correlation between financial stressors, 2008 economic crisis related, and suicide has been found. As the current economic crisis COVID-19 related is expected to exacerbate again the vulnerability to suicide of this province, during the first lockdown the Crisis Center for Suicide Prevention of Biella set up a telephone counselling service. We aimed to evaluate whether it represented a suitable and useful tool for suicidal crisis prevention. MATERIALI E METODI: We evaluated whether some techniques such as “emotional stabilization”, represented a suitable and useful tool for suicidal crisis prevention. Suitability and usefulness were assessed, based on caller feedback obtained during the first and last interviews using the so-called “thermometer of emotions”: callers were asked to describe (a) the intensity of their emotions with respect to stress, anxiety, depressed mood, anger, and sleep and (b) the need to manage these emotions. Callers were also asked to provide feedback regarding their overall satisfaction with the service on a scale from 0 to 10. The phones were attended by two psychologists and each intervention usually consisted of four phases: (i) psychoeducation, (ii) emotional stabilization, (iii) identification and reinforcement of personal resources, (iv) ending the telephone counselling session. RISULTATI: A total of 199 telephone counselling sessions were made involving 47 callers, about 87% of whom never had any previous contact with a mental health service. Ten callers went on to urgent outpatient psychiatric visit, while three cases required a network intervention involving their general practitioner and social services, guaranteeing a multidisciplinary continuity of care. During the telephone counselling sessions, callers described different conditions including fear of financial loss, family conflicts, agitation, depression, and suicide ideation. Through the use of the “thermometer of emotions”, callers who have undergone telephone interviews and interventions, have gradually provided lower scores both in the emotions intensity and in the need of managing them (data in elaboration). All callers reported a high level of satisfaction with the telephone counselling service (average rating of 9.5 out of 10). The phone service was closed in June 2020. CONCLUSIONI: The most innovative element of this project was that it proposed interventions for the emotional stabilization, something that is usually used in face- to-face sessions. Using the right protocols, it proved to offer continuity care and reduce pressure on hospital emergency departments while delivering good outcomes and patient satisfaction. Therefore, the COVID-19 pandemic provided an opportunity to overcome normative, technological, and cultural barriers regarding the use of remote healthcare services.
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BACKGROUND: Type 2 diabetes mellitus (DM) is a comorbid factor with a double risk of increased morbidity and mortality due to COVID-19. Therefore, diabetic patients need to prevent COVID-19 seriously. However, they also need to regularly check their condition in health-care services, such as hospitals and community health centers, making them more vulnerable to COVID-19 infection. One factor playing a significant role in controlling diabetes is self-management. Self-management activities can increase independence in caring for and controlling the health of diabetic patients. Then, it also enhances self-efficacy to improve the quality of life among diabetic patients. AIM: This study aimed to examine the effect of self-management on quality of life among patients with Type 2 DM. METHODS: Fifty patients with type 2 DM consented to participate in the study. The patients were assigned to either the control group receiving standard care or the experimental group receiving standard care and self-management. The program was constructed using Kanfer’s three self-management steps, including self-monitoring, self-assessment, and self-reinforcement. The effect of the intervention was measured by the WHO Quality of Life Questionnaire (WHOQOL-BREF), consisting of 26 statement items on a 5-point Likert scale and a self-management intervention evaluation checklist. Data were analyzed using an independent sample t-test. RESULTS: The results showed a significant difference between the pre-and post-intervention in the experimental group’s quality of life of type 2 DM patients (P = 0.000 and α = 0.01). CONCLUSION: This study found that self-management effectively increases the quality of life among diabetic patients. The health-care providers, especially the nurses interested in community and family health nursing, are suggested to improve the self-management of diabetic patients to prevent complications and improve the quality of life of the patients.
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Introduction: Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis. Purpose: To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era. Methods: The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA's Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively. Results: A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043). Conclusion: Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.
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During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient’s trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.
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BACKGROUND: Nurses are at the forefront of handling the coronavirus disease 2019 (COVID-19) and have a significant risk in handling the disease. The rapid transmission of the virus causes nurses to experience various mental health problems and stigma in performing their duties. AIM: This study explored mental health conditions and the stigma of nurses at the forefront of handling the COVID-19. METHODS: This research was a qualitative study with 17 nurses serving in hospitals and health centers in various provinces in Indonesia. The data analysis of this research employed a descriptive analysis technique. RESULTS: The data analysis revealed four themes: Nurses carrying out their duties as a professional call, psychological and physical responses as a reaction to work stress, stigma due to running a profession, and social support as a reinforcement for carrying out their duties. CONCLUSION: This study concludes that nurses require protection and guarantees for the work risk and the stigma consequences from the community.
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Background: Any information which will affect adversely and drastically a patient's view of his/her future is called as bad news. Breaking a bad news involves ethical, legal, professional and human rights related issues. But there was no proper training currently among most of the postgraduate medical students of India. This results in miscommunication of information and ultimately lack of trust and piling up of legal cases. Medical fraternity including postgraduates of clinical departments has had some experience of breaking bad news at any point of time. There was limited mixed method study to explore this aspect of communication skills in India. Description: It was a Mixed Method Study conducted among 122 medical postgraduates excluding non-clinical postgraduates of a tertiary care hospital, Tamil Nadu by Universal Sampling Method using Focus Group Discussion with FGD Guide and a pre-validated questionnaire through Google forms. Quantitative data analysed through SPSS software and qualitative data analysed through manual thematic analysis. Outcome: Around 51% were from non-Tamil origin and 53% were aware of some type of communication models. SPIKE, ABCDE and BREAK were the models mentioned by the participants About 89% had experience of delivering bad news in the past and among the bad news delivered 75.3% was declaring deaths, 67.1% was communicating the patients about COVID positivity status, 64.7% was communicating the patients about a non-reversible complication of a disease, 38.8% was about communication of cancer diagnosis, 18.8% was about HIV positivity status and 10.6% was communication of positive genetic test results. Challenges mentioned by the participants were language issues, lack of better communication skills, not expertise in the field to answer the questions of the patients/relatives, fear of physical assault, fear of legal issues, personal mental health issues, lack of counselling skills, lack of self-confidence, fear of losing reputation of a life-saving Doctor and fear of questions faced in death audit/case audit. About 58% of the participants did not feel comfortable in delivering bad news and 57.7% felt empathic towards them. In addition, 96.5% maintained privacy while delivering the bad news. Before conveying the bad news, 42% of them agreed that warning shots should be given and 52% felt that after communicating the bad news, the patients should be encouraged to express their feeling and they should clarify their doubts. Around 80% felt that breaking a bad news is a skill and it needs training and expressed that they want to undergo intense training on the same. Conclusion: Breaking a bad news is a skill and half of the participants felt uncomfortable in delivering bad news. Three fourth of them mentioned that they need further training for delivering bad news even after though they have undergone initial training during PG orientation program and expressed various challenges including language issues and lack of communication and counselling skills. Hence, reinforcement of training in breaking bad news should be part of their teaching to reduce ethical and legal issues in future.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has spread with alarming speed, infecting millions globally, including Eswatini. Despite the institutionalization of measures by the Ministry of Health (MoH) to fight the pandemic, the cumulative number of people infected with COVID-19 has kept increasing daily. We sought to assess risk factors for COVID-19 infections among Health care workers (HCWs) in selected health facilities of the Lubombo region of Eswatini. Methods: A cross-sectional design and systematic stratified sampling were used to select the participants. Results: The study enrolled 333 HCWs, with the majority (201, 60.4%) being females, and the participants’ mean age was 33 years. The study showed that not having an isolation arrangement in a health facility for people suspected to have COVID-19 presents risk to HCWs for COVID-19 (Crude Odds Ratio (COR) = 2.5, 95%CI: 1.0–6.2), p = 0.50;Adjusted Odds Ratio (AOR) = 3.0, 95% confidence interval (CI) 1.0–8.7, p = 0.038). Likewise, HCWs who rarely followed infection prevention and control (IPC) measures were at higher risk of COVID-19 infection than those who followed such measures (COR = 4.2, 95%CI: 1.1–17.2, p = 0.041;AOR = 6.5, 95%CI: 1.4–30.0, p = 0.016), and HCWs exposed to a colleague diagnosed with COVID-19 were at higher risk of being infected themselves (AOR = 11.4;95%CI: 0.9–135.7;p = 0.054). Conclusion: An active COVID-19 symptoms screening, triage and isolation arrangement for suspected COVID-19 clients for all clients entering the facility increases protection of HCWs from COVID-19. Reinforcement of all infection prevention and control measures to prevent exposures from infected patients and colleagues is essential.
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Background. The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19. Methods. 10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/ post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar's test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021;data were collected through May 2021. Results. To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/ reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/ reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001). Conclusion. This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care.
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Background: The successful use of hormone therapy (HT) has contributed to improved 5-year cause-specific breast cancer survival rates, and evidence shows that long-term use produces a larger reduction in recurrence and mortality, with nearly 50% reduction in breast cancer mortality during the second decade after diagnosis. Despite the proven benefits, hormone therapy adherence is suboptimal (less than 80% of daily doses taken), and about 33% of women who are prescribed HT do not take their medication as prescribed and are at increased risk of disease recurrence and increased mortality. Smartphone ownership has increased substantially over the past decade, providing an extraordinary opportunity for innovation in the delivery of tailored interventions to improve patients' adherence to hormonal therapy. Purpose: We present preliminary results of a pilot study that involves a theory-based, culturally tailored, interactive mobile app + patient navigation to improve adherence to HT among breast cancer patients attending the breast clinic at the Mays Cancer Center (MCC). Methods: This is a 2-group parallel, randomized control trial that is currently recruiting 120 breast cancer patients and randomly assigning them to the intervention (60) or the control (60) group. The intervention group receives two components: 1) the HT Helper phone app;and 2) assistance from a patient navigator who will provide educational, psychosocial support and reinforcement, address common barriers, and facilitate the interaction with the medical team as needed. The control group receives the usual care and information provided by the MCC's breast clinic to patients undergoing HT. The app and navigation support are based in Social Cognitive Theory and principles of motivational interviewing. Results: Due to the COVID-19 pandemic, we were forced to suspend the start of the intervention until May 2021. We have recruited 27 patients and will present a general description of participants and preliminary results of the 3- month follow-up. This theory-based intervention will empower patients' self-monitoring and management. It will facilitate patient education, identification/reporting of side effects, delivery of self-care advice, and simplify communication between the patient and the oncology team. Conclusions: The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using HT and other oral anticancer agents. The ultimate goal of this innovative multi-communication intervention is to improve overall survival and life expectancy, enhance quality of life, reduce recurrence, and decrease healthcare costs.
ABSTRACT
Background Effective feedback is an important tool in medical education for the learning and growth of trainees and for faculty development. It allows learners to remain on course in reaching competence in clinical, research, and interpersonal skills, yet the impact of teaching feedback during hematology-oncology training has not been studied in depth. To tackle the lack of effective constructive feedback within our hematology oncology fellowship program, we initiated a quality improvement (QI) project to identify barriers in delivering and receiving high-quality feedback in the program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. In the initial phase of the pilot study, a pre-intervention survey identified the two main barriers for effective feedback in our program as discomfort in giving feedback and lack of protected time. A virtual workshop improved quality of feedback by addressing these barriers and providing tools necessary to give and receive constructive feedback. We aimed to highlight the sustainability of these interventions. Methods Utilizing the results of the pre-intervention survey, we built three 2-hour interactive virtual workshop sessions conducted through the ASCO Quality Training Program. Skills that were emphasized and practiced included appropriate set-up, low-inference observations, dialogic feedback conversations and a structured approach to reinforcing and modifying feedback. A follow up session was conducted three months later allowing for reinforcement of the skills. Post-intervention surveys were given immediately after the initial workshop and after the follow-up session. All surveys were identical employing Likert scale and open-ended questions. Weekly email reminders for protected feedback time were also set up. This project was developed through the ASH Medical Educators Institute. Results Eleven out of 15 attendees completed each of the questionnaires. At baseline, 81.8 % of the participants reported they do not have protected time to complete evaluations. This decreased to 63.6% immediately post-intervention and to 27.3% at the three-month point. Similarly, only 65.5% of the participants reported they were comfortable giving feedback prior to the workshop, increasing to 81.8% immediately after the intervention and was sustained at 81.8% at three months. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Majority of the participants agreed that the workshop helped address barriers for effective feedback in our program. Conclusions This study showed the sustainability of positive changes, even during the COVID-19 pandemic, for giving and receiving quality feedback implemented in our fellowship program. Its outcomes are salient given that it utilizes a simple intervention that could be expanded to other training programs as feedback is a systemic problem in medicine. It also underscores the importance of formal workshops in overcoming barriers for effective feedback. Limitations of this QI study include the small sample size and single-institutional design. Our future goals include incorporating a formal yearly curriculum assigning weekly protected time for feedback to ensure these results are sustainable and reproducible with incoming fellows. Disclosures: No relevant conflicts of interest to declare.