How can patient partnership help to improve equality as COVID‐19 moves from pandemic to endemic?

One of the stated aims of the National Health Service (NHS) within its constitution is the promotion of equality. However, there is evidence inequality has increased over the last decade and the COVID‐19 pandemic has exacerbated this. The current pressures on healthcare mean that there is a case for a shift in approach as we transition to living with endemic COVID‐19. This article sets out how putting patient partnership front and centre at an individual, systems and national level has the potential to improve equality and assist the NHS in achieving its founding principles.

Short-course remdesivir for healthcare-associated COVID-19: Case series from a non-acute care hospital

Healthcare-associated COVID-19 among vulnerable patients leads to disproportionate morbidity and mortality. Early pharmacologic intervention may reduce negative sequelae and improve survival in such settings. This study aimed to describe outcome of patients with healthcare-associated COVID-19 who received early short-course remdesivir therapy. We reviewed the characteristics and outcome of hospitalized patients who developed COVID-19 during an outbreak that involved two wards at a non-acute care hospital in Japan and received short-course remdesivir. Forty-nine patients were diagnosed with COVID-19, 34 on a comprehensive inpatient rehabilitation ward and 15 on a combined palliative care and internal medicine ward. Forty-seven were symptomatic and 46 of them received remdesivir. The median age was 75, and the median Charlson comorbidity index was 6 among those who received it. Forty-one patients had received one or two doses of mRNA vaccines, while none had received a third dose. Most patients received 3 days of remdesivir. Of the patients followed up to 14 and 28 days from onset, 41/44 (95.3%) and 35/41(85.4%) were alive, respectively. Six deaths occurred by 28 days in the palliative care/internal medicine ward and two of them were possibly related to COVID-19. Among those who survived, the performance status was unchanged between the time of onset and at 28 days. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

An early return-to-work program for COVID-19 close contacts in healthcare during the Omicron wave in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, maintaining adequate staffing in healthcare facilities is important to provide a safe work environment for healthcare workers (HCWs). Japan's early return-to-work (RTW) program may be a rational strategy at a time when there is an increased demand for the services of HCWs. We assessed whether the early RTW program for HCWs who have been in close contact with a COVID-19 case in our hospital was justified. Close contacts were identified according to the guidance document of the World Health Organization. HCWs who met all of the following conditions were eligible to apply to an early RTW program: (1) difficult to replace with another HCW, (2) received the third dose of a COVID-19 mRNA vaccine, (3) a negative COVID-19 antigen test before each work shift, and (4) consent from relevant HCWs and their managers to participate in the program. Between January and March 2022, 256 HCWs were identified as close contacts (median age, 35 years;192 female). Thirty-seven (14%) secondary attack cases of COVID-19 were detected. Among 141 HCWs (55%) who applied to the early RTW program, nurses and physicians comprised about three-quarters of participants, with a higher participation rate by physicians (78%) than nurses (59%). Eighteen HCWs tested positive for COVID-19 by the sixth day after starting the early RTW program. No COVID-19 infection clusters were reported during the observation period. These findings suggest that the early RTW program for COVID-19 close contacts was a reasonable strategy for HCWs during the Omicron wave. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

93. Institutional Benchmarking Survey: Registered Dietitian Practices in Outpatient Pediatric Eating Disorder Care

Purpose: An interdisciplinary team approach is recommended by numerous practice guidelines for management of eating disorder (ED) care in pediatric populations. Registered dietitians (RDs), with their unique clinical nutrition knowledge and skill play a valuable role in treating adolescents with eating disorders and their inclusion on an interdisciplinary team is integral to the team approach. Despite this, there is little guidance on standards of care for RDs working in this setting, as well as limited research on outcomes of RD managed nutrition support which may result in inconsistent and inequitable care. During the COVID-19 pandemic, cases of youth presenting with eating disorders have increased causing unprecedented demands on healthcare resources. The pandemic has also resulted in the rapid evolution of care delivery models, including the wide adoption of telemedicine services. This study fills a considerable gap in the evidence base by seeking to understand RD practices across institutional pediatric outpatient eating disorder care settings. This is a vital step to inform the development of care standards and pave the way for future research to assess outcomes of RD involvement in eating disorder care. Methods: We surveyed 18 dietitians at tertiary care institutions across all regions of the United States using a 24-question web-based questionnaire. Participants were recruited by purposeful sampling of institutional program RDs following email referral by medical leadership in affiliated eating disorder programs. Our survey addressed topics such as frequency and duration of nutrition appointments, individuals present for nutrition appointments, use of family-based treatment (FBT), content and approaches included in nutrition appointments, and disciplines with whom RDs coordinated care. Results: Most RDs surveyed practiced within interdisciplinary teams utilizing a Family Based Treatment (FBT) approach. A majority of respondents used telemedicine for at least a portion of their eating disorder appointments;nearly half of respondents (47%) reported using telemedicine for 50-100% of their eating disorder appointments. Survey responses regarding care delivery topics, such as visit frequency and duration, nutrition education content, and approach were highly variable among participants. Conclusions: This study maintains that RDs prioritize individualized care, however it highlights a gap in guidance and practice standards for their role in outpatient eating disorder care. Furthermore, our results emphasize the importance of addressing variability in nutrition practice when interpreting outcomes of RD involvement in eating disorder care. With recent changes in health care delivery as a result of the COVID-19 pandemic, there is value in understanding how nutrition care is evolving in order to meet all patient's needs. Sources of Support: Seattle Children's Hospital provided statistics support. No funding was provided.

The Impact of Moral Injury on Patients and Colleagues

The article discusses the concept of moral injury that refers to a provider's inability to provide care due to the conflict of a clinician's task and their calling to help people. It cites a case where two physical therapists (PT) faced an ethical issue on whether to accept the organization's lower care standard mindset or make independent decisions in the patient's best interest. Also noted are these developments' consequences on the PTs' mental health and their effective delivery of care.

VIRTUAL MANAGEMENT OF HYPERTENSION: ISH POSITION PAPER

The COVID-19 pandemic caused an unprecedented shift from in-person care to delivering health care remotely. To limit the infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. However, many patients and care providers were unprepared for this rapid shift and may not be delivering optimal hypertension assessment and management. Given that it is likely that virtual care of chronic diseases including hypertension will continue into the future, the International Society of Hypertension developed a position paper to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control. This position paper is based on the currently available evidence, hypertension guidelines, and international expert opinion. Virtual care is defined as the delivery of healthcare remotely between patients, their carers, and healthcare providers. As different regions and patients have varying degrees of virtual care resources, skills, and preferences, we conceptualize the basic, advanced and complete virtual care models representing advancing degrees of virtual care. This presentation will review the position statements in these three levels of virtual care and discuss the position statements and rationale for selecting blood pressure monitoring devices, cuffless devices, accurate home blood pressure assessments, optimizing patient education, health behavior change, medication adjustment, and long-term monitoring in a virtual care environment.

The Potential Barriers and Benefits of an Online Physical Activity Program during the COVID-19 Restrictions: Latrobe Virtual Streetgames. A Qualitative Study

COVID-19 saw the global reduction of many physical activity programs. To maintain engagement, many programs adjusted their delivery to online formats. To explore the impact that a youth targeted virtual community exercise program had on its participants during the COVID-19 pandemic. Seven participants of Virtual Streetgames took part in a semi-structured one-on-one interview, with questions around the impact of COVID-19, in addition to their view on the virtual program. Three major themes were identified. "Dawning of a new world" described the changes that occurred due to the pandemic. "Traveling together" identified the difficultly to maintain regular wellbeing activities. "Making a difference" contextualized how the virtual delivery was able to influence participants. The COVID-19 pandemic had a significant impact on the participants physical, mental and social health. The use of an online physical activity program had some positive impacts on health, however it did not seem to warrant the same level of engagement when compared to face-to-face. The study helped identify those who are at risk of both short and long-term health impacts due to the COVID-19 pandemic. Additionally, it provided information on how virtual innovative interventions can influence wellbeing outcomes. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI)

Parenting in a Pandemic: Preliminary Support for Delivering Brief Behavioral Parent Training Through Telehealth

Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed.

Temporal trends in microbial detection during the COVID-19 pandemic: Analysis of the Japan surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database

The impact of the COVID-19 pandemic on the incidence of microbial infections and other metrics related to antimicrobial resistance (AMR) has not yet been fully described. Using data from Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE), a national surveillance database system that routinely collects clinical and epidemiological data on microbial infections, infection control practices, antimicrobial use, and AMR emergence from participating institutions in Japan, we assessed the temporal changes in AMR-related metrics before and after the start of the COVID-19 pandemic. We found that an apparent decrease in the incidence of microbial infections in 2020 compared with 2019 may have been driven primarily by a reduction in bed occupancy, although the incidence showed a constant or even slightly increasing trend after adjusting for bed occupancy. Meanwhile, we found that the incidence of Streptococcus pneumoniae dramatically decreased from April 2020 onward, probably due to stringent non-pharmaceutical interventions against COVID-19. Antimicrobial use showed a weak increasing trend, while the use of hand sanitiser at the included medical institutions increased by about 50% in 2020 compared with 2019. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Resilience and Resistance in the Community Sector: Organisational Challenges and Responses by the Australian DFV Sector in the Time of COVID-19 Pandemic

The COVID-19 pandemic led to increases in family violence in Australia and elsewhere. In response, organisations in the domestic and family violence (DFV) sector, had to adapt to the emerging public health measures and worked collaboratively to protect the most vulnerable in the community. These services, including courts, rapidly transformed their methods of service delivery that are likely to continue for some time. But what have been the implications/impacts of these rapid changes on the DFV service sector in Australia? How have these impacts informed the future needs of the DFV sector? And what is needed to strengthen this community sector of the future? This article reports on the findings of a national research project examining the impacts of COVID-19 on the DFV service sector and the adaptations and innovations that emerged in response. The study highlights that the surge in demand for services put pressure on an already overwhelmed workforce/service sector and provided an opportunity for front line workers to contribute to building a robust sector to respond to future crisis events. These findings have significant implications for future DFV sector service delivery, and for the social work profession as a whole.

MH service delivery, 988 gratitude, on readers' minds in 2023

Editor's note: Last week in Mental Health Weekly's Annual 2023 Preview Issue, we featured some of your responses to the most pressing challenges and new opportunities that await you in the new year. Here are more of your responses. Thanks to all who submitted comments.

CML Outcomes and Care Delivery During the COVID-19 Pandemic in Low- and Middle-Income Countries.

PURPOSE OF REVIEW: The study aims to evaluate the impact of COVID-19 on the delivery of health care and services to patients with chronic myeloid leukemia in low- and middle-income countries (LMICs) accessing treatment through The Max Foundation. RECENT FINDINGS: An online survey was developed and sent via email to 527 partner physicians who had active patients under their care in July 2020, asking about the disruption of health services with multiple-choice answers or a five-point ordinal scale. Data from The Max Foundation's Patient Access Tracking System (PATS®) was analyzed to evaluate program performance in 2020 compared with 2019. PATS® is used to track key patient information and supply chain data to ensure robust reporting, quality assurance, and safety. Among the 111 physicians who responded (20% response rate), 48% reported that someone on their team had contracted COVID-19. A total of 95 (85%) physicians reported at least some disruption of services to patients due to COVID-19, with 29 (26%) reporting frequent or complete disruption. Almost all physicians in the South Asia and Asia Pacific regions reported disruption (96% and 95%, respectively), compared with three quarters of physicians in Latin America. Institutions overcame challenges using a variety of solutions including telemedicine (60%), electronic prescriptions (45%), home delivery via courier services (31%), government workers (9%), and dispensation coordination with regional hospitals (14%). The COVID-19 pandemic has disrupted services for CML physicians and patients worldwide. Overall, these disruptions did not appear to significantly affect The Max Foundation's ability to provide patients with access to treatment, as novel approaches in telemedicine, supply chain, and dispensing, as well as provision of guidance and support for physicians were utilized to overcame disruption of services.

A coordinated health policy in response to COVID-19: A case of Botswana.

INTRODUCTION: This paper documents policy decisions and transformations in response to the COVID-19 pandemic in Botswana and utilizes the multi-sectoral approach (MSA) in providing this analysis. METHOD: A desk review of the different government gazette documents was conducted to trace health policy evolutionary developments and their impact on the general lives of the people of Botswana. FINDINGS: Revealed the actors, roles in this policy transformation and the conditions that enhanced the smooth implementation of the policies are discussed. CONCLUSION: The paper concludes by making some recommendations for the country's preparedness and anticipatory guidance for any other pandemic or disaster that may arise. CLINICAL RELEVANCE: This paper highlights the importance of the multisectoral approach in addressing crises such as pandemics. It also demonstrates the need for countries to have well-defined guidelines to allow decision making in the delivery of efficient health services to the general population during pandemics.

Delivery of a National Paediatric Gastroenterology, Hepatology and Nutrition Virtual Teaching Programme during the Covid- 19 Pandemic

Introduction At the onset of the Covid-19 pandemic, hospital educational activities were halted in order to focus on healthcare delivery and maintain social distancing. As a response to this disruption, BSPGHAN trainees set up the BSPGHAN Education Series, a twice- weekly virtual learning programme. The core objective of this programme was to deliver high quality paediatric gastroenterology, hepatology and nutrition (PGHAN) teaching during the pandemic. In this study, we analysed the attendances and feedback received from the education series, in order to guide future directions. Methods We reviewed the Zoom meeting attendance logs and Survey Monkey feedback forms for the BSPGHAN Education Series from April 2020 to December 2020. Results In nine months, a total of 55 talks were delivered by 43 speakers. 23 (41.8%) sessions were gastroenterologythemed, 25 (45.4%) were hepatology-themed and 7 (12.7%) were nutrition-themed. Thirteen paediatrics gastroenterology units (12 in the UK and 1 in the United States) and all 3 UK tertiary paediatric liver centres contributed to the talks. The highest contributing centres were Birmingham Children's Hospital (20 sessions), followed by King's College Hospital (9 sessions) and Leeds Children's Hospital (7 sessions). Attendance logs and feedback forms were available for 53 sessions. A total of 2369 attendances were logged, with a median of 41 attendees per session (IQR 31-54). Attendees from 22 countries have participated in these sessions. A total of 810 survey feedback forms were received, with a median of 14 forms received per session (IQR 10-18). 32% were filled in by PGHAN Grid trainees, 23% by consultants, 15% by clinical fellows. Allied Health Professionals (AHPs) comprised 6% of feedback returns. 54% of survey feedback respondents accessed the teaching sessions from home. An average of 98% (95% CI 96.3-99.2) survey respondents strongly agreed/agreed that the sessions were relevant to their learning. 97% (95% CI 96-98.7) of survey respondents strongly agreed/agreed that the sessions delivered were of high quality. Discussion The BSPGHAN series has been a positive initiative arising from the pandemic, providing access to high quality PGHAN education when local availability was paused, and giving a platform for the society internationally. Our report shows that the BSPGHAN Education Series has been wellreceived by attendees. The virtual sessions are more accessible compared to in-person teaching sessions, as evidenced by the high percentage of feedback respondents accessing the sessions from home. Looking ahead, the BSPGHAN Education Group, set up in October 2020, will play a vital role in the further development of the Education Series. Sessions are recorded and made available to BSPGHAN members on the BSPGHAN websitefurther work may include creating online learning modules centred around these recordings. AHP involvement is an area for development- for 2021, we hope to include more topics that will be relevant to their interests.

Respiratory manifestations of long COVID

As we near the third year of the COVID-19 pandemic, greater attention is now being paid to the potential long-term consequences of SARS-CoV-2 in the hundreds of millions of people infected globally. A syndrome termed "long COVID" has emerged, which predominantly manifests as persistent fatigue, dyspnea, chest pain, and cognitive dysfunction following acute infection. The incidence of long COVID is in the range of 15% based on current best evidence, and symptoms are likely a result of several different pathophysiological mechanisms including multi-organ injury from acute infection, systemic viral persistence, immune dysregulation, and/or autoimmunity. Pulmonary symptoms represent a significant component of long COVID, and there is a growing body of research describing the epidemiology, risk factors, physiology, and radiology of the respiratory manifestations of long COVID. In this clinical review, we examine the most recent evidence relating to "respiratory long COVID," discuss how innovative technologies such as Xenon-129 gas transfer magnetic resonance imaging (MRI) and respiratory oscillometry are helping to elucidate its unique pathophysiology, and consider the role of preventative strategies and possible treatments such as adapted pulmonary rehabilitation. The burden of respiratory long COVID is likely to continue to grow, and all healthcare professionals who care for patients with respiratory disease must prepare for this emerging chronic condition. This will require increased resources from healthcare decision makers, inventive approaches to healthcare delivery, further research, and the same spirit of collaboration that has enabled the many success stories to date in the global effort against COVID-19. Copyright © 2023 Canadian Thoracic Society.

Healthcare encounters and outcomes of filipino patients with systemic lupus erythematosus managed at a tertiary covid-19 referral center

Background: The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines. Method(s): A review of records of all patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed. Result(s): Our population of 403 patients was predominantly young (mean age 34.53 +/- 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of them were teleconsultations (81.70%). During an average gap of 53.6 +/- 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n = 160) was lupus disease flare and the most common cause of death (n = 40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died. Conclusion(s): Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes.

"The bottom line is that it is all about trust": Interviews with Health Services Administrators about perceived barriers and facilitators to vaccine administration in jails

Background: Compared to the general population, individuals incarcerated in jails and prisons are more vulnerable to infection and mortality from communicable diseases, such as COVID-19 and influenza. However, vaccination rates among incarcerated individuals as well as staff who work in jails and prisons remain disproportionately low. Healthcare administrators working in jails have first-hand experience about barriers to vaccine provision, but their perspectives are infrequently collected and analyzed. Method(s): We reached out to Health Services Administrators (HSAs) from all 14 Massachusetts (MA) county jails for qualitative in-depth interviews to understand how their personal and professional feelings about vaccination relate to the barriers and facilitators that surround administration of vaccines in jail. Result(s): Eight people participated in the study (8/14= 57% response rate). Key themes emerged, including 1) HSAs expressed divergent opinions on incarceration as the correct opportunity to vaccinate individuals, 2) HSAs' personal views on vaccines influenced their operationalization of vaccination in jail and 3) opinions varied on whether their institutions' vaccine protocols needed modification. Conclusion(s): Our findings highlight the critical need to leverage the feedback and influence of stakeholders such as HSAs in efforts to improve preventative healthcare delivery in carceral health systems. Copyright © 2023 Cambridge University Press. All rights reserved.

Treatment adherence of patients with rheumatoid arthritis during Covid-19 pandemic

Background: Covid-19 impacted not only people's lives but also slowed down the healthcare delivery system and supply chain leading to a global drug shortage.1 According to the Ministry of Statistics, India's growth in the year 2020 went down by 3.1% because of the pandemic, which impacted patient's capacity to continue with the expenditure related to chronic disease management. Rheumatoid arthritis (RA) for a patient comes with a out-of- pocket high cost long term immunosuppressive medicine and increased chances of secondary infections leads to non-adherence of patients. The current study is to observe the adherence to Janus Kinase (JAK) inhibitors in a hospital-based rheumatology service in Eastern India during the Covid-19 pandemic period. Method(s): Data of the patients enrolled physically and electronically under active follow-up in the Rheumatology Outpatient Department (OPD) of the hospital were analyzed.2 The patients with a confirmed diagnosis of RA, receiving JAK inhibitors for 6 months or more were included in the study from 21st March 2020 to 31st July 2020. A questionnaire was also administered to these patients to understand the impact of Covid-19 on the treatment of RA. Data related to demographic features, clinical, laboratory, drug history, and current treatment were collected and statistically analyzed. Result(s): Out of the total 42 patients (aged 38-76 years) who received JAK inhibitors, 24 (6 were COVID positive) were seen with the OPD during the Covid-19 pandemic. In our study, a higher proportion of patients with an annual income of INR 1M-1.5M had a 15% income decrement (Figure 1), though the patient adherence to JAK inhibitors was high compared to biologics, even in the patients who faced up to 25% reduction in annual income. Out of 24, only 4 patients stopped the treatment with JAK inhibitors due to the limited availability during the initial period of the lockdown. Overall patient adherence to JAK inhibitor treatment was 85% and was higher compared to the biologics (previous data). There was higher non-adherence in the biologic group at lower-income slabs (5-10 Lacs & 10-25 Lacs group) than in the higher income slabs, compared to JAK inhibitors inspite of better availability. Higher-income groups showed lower non-adherence in both groups. Conclusion(s): In the milieu of the Covid-19 pandemic, the treatment adherence in patients with RA was driven by the cost and availability of the medication amidst the pandemic. The association of injectable biologics with higher immunosuppression in patients perception during pandemic also affected the treatment adherence in patients. Thus it can be concluded that patient perception and availability were the main driving factor in adherence to RA therapy.

OSHA COVID-19 Draft Rule in Healthcare Expected Soon

The article offers information on rules drafted by Occupational Safety and Health Administration (OSHA) for protecting healthcare workers in COVID-19 standard. Topics include information on emergency temporary standards;consideration of less restrictive policies for healthcare workers who have been vaccinated;and comments of Deborah Burger, president of National Nurses United (NNU).