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1.
BMJ Supportive and Palliative Care ; 11:A37, 2021.
Article in English | EMBASE | ID: covidwho-2032472

ABSTRACT

Background St Gemma's Hospice offered an onsite breathlessness group for two years. In late 2019 the content was reviewed, and in January 2020 a reviewed programme was piloted (P1) incorporating self-management strategies for patients experiencing breathlessness, fatigue and anxiety. COVID-19 restrictions led to the move to a video version, (P2) patients watching at home supported with telephone follow up. Aim To provide a comprehensive new programme, enabling education sessions to continue for patients whilst unable to attend in person. This allowed us to explore use of video as an education resource and consider if there were long term benefits for retaining this model of education delivery. Methods Developed the project by pre-programme literature search, previous model evaluation, gap analysis, and model planning. To move the project online scripted and visual resources were developed, recorded sessions on Zoom, uploading to a secure video platform accessed by password. Pre- and post- course patient VAS scores of management of symptoms, feedback from patients and staff, comparison patient numbers for onsite and online sessions and analysis of cost effectiveness. Results P1 = 15 patients Jan 2020 - March 2020. P2 = 72 patients August 2020 and March 2021. Manage symptoms on a VAS of 1-10, 1 = not managing;10 = well managing Breathlessness, mean improvement -1.4 Fatigue, mean improvement - 0.55 Anxiety, mean improvement - 2.4 Positive feedback;ongoing accessibility to toolkit resources, patient self-efficacy Cost;Onsite per patient = £116.31 versus Online Program = £76.30 Conclusions Mean values for pre- and post- evaluations indicate improvement of patients' ability to self-manage except for fatigue which was inconclusive. Consideration is required of patients' suitability, symptoms/technical ability. Offering virtual education sessions widened access for patients who struggled to attend on site due to transport, mobility or high volume oxygen. Video education is as effective as face-to-face.

2.
HemaSphere ; 6:3024, 2022.
Article in English | EMBASE | ID: covidwho-2032141

ABSTRACT

Background: Informal family caregivers play a pivotal role in supporting patients with hematologic malignancies during their treatment. Due to the toxicities of treatment patients often have serious treatment-related side-effects, and with more treatment being placed in the outpatient settings, family caregivers are often the primary source of support between Hospital visits assisting the patient and managing symptoms. The early phase of treatment has been found particularly stressful, and evidence shows that family caregivers are at higher risk of psychological distress and have unmet support needs impacting their ability to support the patient. Thus, finding new ways to support family caregivers is important within a health care context. Peer to peer support has shown great promise in hematologic patients, and there is a need to investigate psychosocial interventions such as peer to peer support in family caregivers. Aims: To investigate the feasibility of a one-on-one peer support intervention in family caregivers of newly diagnosed hematologic patients. Methods: A one-arm feasibility study was conducted. The intervention consisted of 12-weeks of one-on-one support provided by volunteer family caregivers of a hematologic cancer survivor (named caregiver ambassadors) (n = 17) to a family caregiver of a newly diagnosed patient (n =26). Support was delivered based on the needs and preferences of the family caregiver via telephone, text message, e-mail or face-to-face. The intervention also included a preparatory course for the caregiver ambassadors and available support during the intervention. Primary outcomes were feasibility parameters and secondary outcomes were collected at three time points and included anxiety, depression, sleep disturbances, self-efficacy, and quality of life. Results: The peer support intervention was feasible and safe, and participants reported very high satisfaction with the support (75%). Dropout rate was low (7%) and no adverse events were reported. Over time, family caregivers improved their psychosocial well-being, and caregiver ambassadors overall maintained their levels from baseline. Participants were satisfied with the preparatory course enhancing their role preparation as peer supporters and 14 caregiver ambassadors attended the available support network meetings (n = 6). During the intervention, the total number of contacts between participants were 389 with each dyad having an average of 15 contacts during the 12- weeks. Support was most frequently delivered by telephone and text-messages. In-person meetings were less used due to geographical distances, personal preferences including the patients' illness situation, and covid-19. Summary/Conclusion: We tested the feasibility of a new peer to peer intervention in family caregivers of newly diagnosed hematologic patients. The results demonstrated that the intervention was feasible, safe, and satisfactory in both the caregiver ambassador and family caregiver groups. Flexibility in the delivery and frequency of support was essential and accommodated the individual support needs and preferences. Providing preparation and support for caregiver ambassadors was important. This family caregiver peer to peer intervention has the potential to be a new model of support incorporated in the clinical setting.

3.
Gynecologic Oncology ; 166:S251, 2022.
Article in English | EMBASE | ID: covidwho-2031758

ABSTRACT

Objectives: To determine (1) if health disparities experienced by rural, obese endometrial cancer survivors (ECS) were exacerbated by the COVID-19 pandemic and (2) preferred components and delivery methods for behavioral interventions. Methods: A cross-sectional survey was distributed to obese, early- stage ECS to ascertain demographic information, physical activity (PA level), self-efficacy, lifestyle intervention preferences, as well as the impact of COVID-19 on PA, diet, and mental health. Responses were compared between obese (BMI= 30-39.9 kg/m2) and morbidly obese (BMI= 40+ kg/m2) survivors as well as those who did or did not meet national PA recommendations. Results: Among 335 eligible survivors, only 70 (20.9%) completed the survey. The median age was 63 years (IQR: 14 years). Survivors were 37 months from diagnosis (IQR: 37 months). The median BMI was 39.2 kg/m2 (IQR: 8.4 kg/m2). Overall, only one-quarter of ECS were fairly or fully confident in their ability to undertake moderate PA. More morbidly obese survivors reported low self-efficacy in performing moderate PA than obese survivors (90% vs 65%;p= 0.02). Pre COVID-19, 66% of survivors did not meet PA guidelines and were more likely to be morbidly obese than obese, but the difference was not significant (78% vs 58%;p=0.08). Post COVID-19, 83% of survivors did not meet PA guidelines, with no difference between BMI groups (82% vs 84%;p>0.05). After COVID-19, 54% of survivors reported a decrease in PA, 32% made poorer nutritional choices, and 47% reported worsening mental health. Post COVID-19, no difference in the nutrition or mental health changes was seen between survivors who were meeting PA guidelines and those who were not (p>0.05). Regarding lifestyle interventions, survivors preferred information delivered electronically (online (56%) or via email (41%)) versus in person (30%) or via text (21%). Preferences for PA included exercising at home (46%) or online with a coach (33%) versus with a group fitness class (18%) or at the gym (17%). Combining health promotion with exercise was appealing to the majority of participants (37%), while others were not interested (27%) or unsure (31%). Responses were similar between patients meeting and not meeting PA recommendations (p>0.05). The most preferred lifestyle intervention components included tracking progress (56%), health recipes (56%), one-on-one counseling (46%), tips for cheap and healthy eating (41%), exercising alone (41%), and online sessions (39%). Conclusions: As a result of COVID-19, rural, obese ECS experienced a decrease in PA, worse nutritional decision-making, and poorer mental health. Preferred components of lifestyle interventions in this patient population were identified and can be used to develop future, evidence-based behavioral interventions. These interventions may be scalable in rural communities with limited access during the COVID-19 pandemic and beyond.

4.
Journal of Psychiatric Research ; 154:315-323, 2022.
Article in English | EMBASE | ID: covidwho-2031486

ABSTRACT

Objective: The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect ). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress. Methods: In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Results: Cognitive well-being (CWB;satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy. Conclusions: The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support andPA rather thanNA. This finding suggests the need for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying their CWB.

5.
International Journal of Sport Communication ; 15(3):266-278, 2022.
Article in English | CAB Abstracts | ID: covidwho-2019676

ABSTRACT

Social media sites are rich communication and marketing tools used by athletes to promote their "brand" and interact with fans. Indeed, the proliferation of social media has led to athletes promoting themselves across multiple platforms. This study examined how the world's top 10 professional alpine skiing athletes used social media to present themselves and engage with fans during the 2017-18 World Cup and 2018 Winter Olympic Games. The data for the latest Winter Olympic Games in 2022 (organized under changed circumstances because of COVID-19) were not available for this study at the time of finalization. Guided by self-presentation theory, this study used a content analysis to examine how athletes presented themselves in social media photographs. The results demonstrated that athletes employed similar posting patterns across the social media platforms (i.e., Facebook, Twitter, and Instagram). The posting distribution per athlete and channel was different, as some athletes used the same posts across all channels. Twitter boasted the highest posting frequency. Based on the coded social media posts, athletes' self-presentation mainly focused on business life content. Thus, they appeared as dressed but posed, a finding that aligns with Goffman's notion of front-stage performance. This case study extends the literature as it involves an analysis of self-presentation across multiple channels, comparing two international events while using a sample of one sport.

6.
Language in Society ; 51(4):719-722, 2022.
Article in English | ProQuest Central | ID: covidwho-2016466

ABSTRACT

[...]Pennycook states that the purpose of the volume is not only to provide a comprehensive and collaborative overview of the ideological forces that shape CAL, but to advocate for changes to applied linguistics, namely, decolonization and the incorporation of ideas from the Global South. Pennycook takes the field of second language acquisition to task for viewing language as a cognitive phenomenon and removing it from its social context by ignoring factors of identity such as gender, class, and race, and in the end argues that language must be considered as embodied. [...]the seventh chapter briefly explores ways in which critical applied linguistics can be incorporated into education, research, and activism, especially via a means of critical pedagogy. [...]the ideal audience for this book is the linguist, language researcher, or instructor that has a curiosity or appetite for criticality, a keen interest in society and power, and a desire to change the status quo in the world of applied linguistics, as well as society.

7.
Revista Brasileira de Psicanalise ; 56(1):195-208, 2022.
Article in Portuguese | APA PsycInfo | ID: covidwho-2011052

ABSTRACT

Due to the covid-19 pandemic, a large part of psychoanalytic and psychotherapeutic services migrated to the virtual environment. This experience demands and encourages reflections about the setting in the virtual context. Based on the supervision in two psychological teaching clinics and the illustration of a case, we intend to reflect on some specificities of virtual treatment. Virtuality seems to focus on the image, more specifically on the face of the analytical duo, which can cause one's capture by the self-image reflected on the screen. Despite the specifics of the virtual and possible distinctions in the nature of transference, it is possible to conduct virtual treatments, due to the occurrence of transference, countertransference, and association in this type of service, provided that the therapist's "internalized frame'' can offset the physical setting absence, and his voice and image can be used to reassure his presence, keeping himself "alive'' and acting as a reflective object. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Portuguese) En raison de la pandemie de covid-19, une grande partie des soins psychanalytiques et psychotherapeutiques ont migre vers le virtuel. Cette experience demande et proportionne a la fois des reflexions concernant le cadre dans les soins en ligne. Sur la base d'une experience de supervision dans deux cliniques d'enseignement psychologique et de l'illustration d'un cas, les auteurs ont l'intention d'aborder quelques specificites de ce genre de clinique. La virtualite semble entrainer une centralisation dans l'image, plus precisement sur le visage du duo analytique, ce qui peut provoquer la capture du sujet par la propre image refletee sur l'ecran. Malgre les specificites du virtuel et les distinctions possibles de la nature du transfert, les auteurs croient qu'il est possible de conduire des traitements virtuels, en raison de l'occurrence du transfert, du contre-transfert et de l'association dans ce type de dispositif, des que le therapeute emploie le cadre internalise pour rendre compte de l'absence du cadre physique, et de sa voix et de son image comme une maniere d'affirmer sa presence, restant en vie et agissant comme un objet reflechissant. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Devido a pandemia de covid-19, grande parte dos atendimentos psicanaliticos e psicoterapeuticos migraram para o ambiente virtual. Essa experiencia tanto demanda como propicia reflexoes sobre o enquadre no atendimento online. A partir da experiencia de supervisao em duas clinicas-escola e da ilustracao de um caso, os autores pretendem abordar algumas especificidades desse tipo de atendimento. A virtualidade parece causar uma centralizacao na imagem, mais especificamente no rosto da dupla analitica, o que pode provocar a captura do sujeito pela propria imagem na tela. Apesar das particularidades do virtual e das possiveis distincoes da natureza da transferencia, os autores pensam ser possivel conduzir tratamentos virtuais, por haver transferencia, contratransferencia e associacao nessa modalidade de atendimento, desde que o terapeuta se utilize do enquadre internalizado para dar conta da ausencia do enquadre fisico, e de sua voz e imagem como forma de afirmar sua presenca, manter-se vivo e atuar como objeto reflexivo. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

8.
Frontiers in Psychiatry ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2009911
9.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009661

ABSTRACT

Background: Uveal melanoma is a rare cancer. Up to 50% of patients (pts) develop metastasis, mainly hepatic. Overall survival in metastatic pts is 12 months (mo), contrasting with a good overall condition until death. To evaluate the impact of integrating early palliative care on patient needs and self-efficacy, we designed a comparative randomized trial in MUM pts. Methods: 162 pts will be randomized (1:2) between the control and the experimental groups in two French centres (Institut Curie-Paris and Centre Antoine Lacassagne-Nice). In the control group, palliative care is introduced according to international guidelines. In the experimental group, it is added earlier, concomitant to the announcement of metastases by the medical oncologist. The main objective is to assess if early supportive care impacts on patient psychological needs at 6 mo, versus standard of care, based on the SCNS-SF34 questionnaire. Secondary objectives include patient's other needs at 6 and 12 mo, quality of life (QLQC30), progression-free and overall survival, and partners' needs (SCNS-P&C). MUM pts, suitable for a treatment with no curative intent, ECOG PS 0-1, with no physical or biological sign of disease, and capable of filling questionnaires are eligible. Questionnaires are completed by all pts at each oncological visit (baseline, 3, 6, 9 and 12 mo). Supportive care visits take place every 6 weeks if needed and address patient's information needs, disease and treatment understanding, social and psychological status, symptoms, and partners' involvement. Prognostic uncertainty and disease seriousness in the absence of symptom is addressed depending on pts' expressed needs. Medical oncologists and supportive care physicians from both centres attend communication skill training provided by an expert during the study. Analyses: SCNS-SF34 psychological needs scale scores at 6-mo will be compared with a Student's t-test, in an ITT analysis. For 10 points mean score difference expected between groups (within standard deviation of 20 points) and a two-sided type 1 error of 5%, inclusion of 54 pts (control group) and 108 pts (experimental group) provides the study 85% of power. The planned inclusion period is 3 years, pts will be followed for one year, for a total study duration of 4 years. From July 2020 to January 2022, 63 pts have been enrolled in the trial;2 pts declined. Five pts were removed early from the study: one for consent retrieval, 4 for early death due to metastasis. COVID-19 delayed enrollment for 5 months. We plan to complete the study Q4 2023 and to analyze the data Q4 2024.

10.
BMC public health ; 22(1):1661, 2022.
Article in English | MEDLINE | ID: covidwho-2009378

ABSTRACT

BACKGROUND: Greenspace programmes are health projects run outside in nature, typically with the aim of improving mental health. Research suggests that programmes may also be effective in supporting people with problem substance use (PSU), but there is limited understanding of the key components that make them successful for this client group. Previous work has claimed that a realist-informed intervention framework for greenspace programmes for mental health could be transferable to programmes that support people with PSU, and that this could provide insight into the causal processes within programmes. However, this claim is yet to be explored in depth. The aim of this study was to further test, refine, and consolidate the proposed framework to show how greenspace programmes could support people with PSU. METHODS: Using a realist approach, 17 participants (8 programme staff;9 wider stakeholders) were interviewed about contexts, mechanisms, and outcomes (CMOs) relative to greenspace programmes for mental health and PSU. Semi-structured interviews were used since they facilitated exploration of the proposed framework but were flexible enough to allow identification of new CMOs for framework refinement. Interviews were audio-recorded, fully transcribed, and analysed inductively and deductively against the proposed framework. RESULTS: Findings supported the proposed framework and indicated that greenspace programmes support people with poor mental health and PSU due to: feelings of escape;space to reflect;physical activity;self-efficacy;feelings of purpose;relationships;and shared experiences. However, data showed that programmes must also consider: explicit intervention focus to ensure adequate support for clients;existing challenges with funding and stakeholder buy-in;and the impact of COVID-19. Findings allowed development of a refined framework that shows how greenspace programmes can support people with PSU. CONCLUSION: The findings of this project are theoretically novel and have practical relevance for those designing greenspace programmes by providing recommendations on how to optimise, tailor, and implement future interventions. Findings could be particularly relevant for academic researchers, multidisciplinary health professionals, and for those working in the third sector, developing and delivering greenspace programmes for people to improve their mental health and to support them with PSU.

11.
Annals of the Rheumatic Diseases ; 81:50, 2022.
Article in English | EMBASE | ID: covidwho-2008893

ABSTRACT

Background: An important but insufficient aspect of care in people with infam-matory arthritis (IA) is empowering them to acquire good understanding of their disease and build ability to deal effectively with the practical, physical and psychological impacts of it. This extends beyond drug therapy and emphasises the ability to self-manage, with the right support, as an essential component of care. Good self-efficacy and coping skills reduce health and fnancial burden to the individual as well as the health service, beneftting society overall. Provision of excellent supported self-management education is at the heart of what NRAS does and it was due to the difficulty of getting Commissioners to fund our face-to-face group self-management that led to our building an e-learning programme to expand on and replace our 6-week programme. Objectives: To co-create an intuitive, easy to use, modular e-learning programme, free for all and which health professionals (HCPs) could refer their patients to. This makes supported self-management and evidence-based education accessible to all, wherever they live. SMILE enables HCPs to meet both NICE guideline and quality standards in RA against which rheumatology units in England and Wales are currently audited, as well as EULAR Recommendations for self-management strategies in infammatory arthritis. Methods: In 2019 with initial funding in place, we worked with our provider to help us realise our goal of developing a state-of-the art e-learning experience in a modular format for people with RA. The programme had to be 1) simple to use;2) interactive;3) innovative and engaging;4) able to measure impact through achievement of learning objectives and use of a validated patient reported outcome measure. The programme also had to be integrable with our Salesforce database enabling us to collect data and target resources to individuals, driven by identifed need. Results: Delayed by COVID, we launched with 4 modules on 17/09/2021. The 4 modules comprise: Foundation Module covering the importance of self-management which has the RA Impact of Disease PROM embedded;Newly Diagnosed;Meet the Team and Managing Pain and Flares. A ffth module on Medicines in RA will be launched 1st quarter 2022 and 4 further modules will be uploaded in 2022. To date (26/01/22), 760 people have registered, of which 313 have completed a baseline RAID and this reveals that <50% are achieving minimal acceptable state of 3 or less. Over 78% of registrants are not NRAS members, and 634 modules have been completed. Early indications are that almost all are achieving learning objectives. More data will be available by June 2022. Conclusion: Early indications demonstrate that people are successfully engaging with the programme and we have marketing activity lined up to raise further awareness of the value of SMILE with both potential users and rheumatology teams in 2022. Massive workforce issues together with signifcant backlogs of existing patients caused by the pandemic, have restricted the ability of Teams to provide education and self-management support for their patients. SMILE offers high quality, evidence-based learning opportunities for their patients and has been co-created with health professionals and people with RA at every step. With remote consultations here to stay, the importance of patients having access to evidence based online learning which they can tailor to their specifc needs and improve their self-efficacy is even more critical.

12.
Journal of Public Health in Africa ; 13:35, 2022.
Article in English | EMBASE | ID: covidwho-2006886

ABSTRACT

Introduction/ Background: Public must routinely practice precautionary behaviors to control the spread of COVID-19. This paper measured changes in the public's knowledge, attitudes, and practices (KAP) related to COVID-19 at different intervals to provide recommendations for behavioral interventions and policies in the country. Methods: We conducted three cross-sectional surveys between May 2020 to February 2021 involving 5231 Tanzanians (KAP1-1822;KAP2-1813 & KAP3-1596) residing in all 8 zones, where one region/zone was selected randomly. KAP-1 and 2 were conducted between May and August 2020, and KAP-3 in February 2021. Both qualitative and quantitative methods were employed. We determined the level of comprehensive Knowledge, Attitude and Practice. Descriptive statistics, chi-square and t- tests were used in data analysis. Results: Among 5231 respondents, 53.6% were males. Mean age ranged between 31.6 to 37.0 years. Majority (35.9%) completed primary school. COVID-19 awareness in all KAPs was very high (over 98%). Comprehensive knowledge increased from 37.3% in KAP-1 to 44.9% in KAP-3;p=0.001. Strongly positive attitude towards different Covid-19 preventive measures declined from 68.4% in KAP-1 to 59.5% in KAP-3. The need for COVID-19 vaccines has significantly dropped from 93.3% in KAP-1 to 68.5% in KAP-3. Lowest recorded mean practices scores were in KAP- 2 (28.2 (SD=12.9)) compared to 71.6 (SD=15.9) in KAP-1. Radio and TV were the most preferred source of information. Impact: The findings are expected to generate a better understanding of the drivers and barriers for COVID- 19 spread, prevention and possible control measures to inform Risk Communication and Community Engagement in the country. Conclusion: Results highlight the importance of consistent messaging from health authorities using preferred channels, as well as the need for tailored health education programs. Furthermore, reinforcing /supporting beliefs of self-efficacy and effectiveness of the recommended COVID-19 prevention and control measures is important.

13.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005644

ABSTRACT

Background: The COVID-19 pandemic increased the use of telehealth to reduce exposure, which was critical for patients with cancer. The extent to which patients with cancer view telehealth visits as meeting their medical needs was investigated using a cross-sectional survey. Methods: Patients currently receiving cancer treatment at a single cancer institute who had had at least one telehealth visit were emailed an online survey. Response rate was 5% (94/1944). The survey measured patients': 1) Emotional Thermometer (i.e. distress, anger, depression, anxiety, and need for help on a 0-10 scale);2) Telehealth usability questionnaire (TUQ;21-items with various subscales, like interaction quality;α=0.98).);and 3) Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale (five items, e.g., “How confident are you in your ability to make the most of your visits with your doctors?”). Respondents completed the PEPPI-5 for in-person visits and for telehealth visits. Descriptive statistics were calculated for all measures. A generalized linear model was estimated predicting PEPPI-5 for telehealth visits from emotional thermometer and TUQ scores. The interaction between emotional thermometer and TUQ scores was estimated to test the hypothesis that emotional distress moderated the relationship between TUQ and efficacy in patient-provider interactions during telehealth visits. Results: Across all five thermometers, 30.8% (28/91) reported a high score on at least one metric. The most frequently reported high score was for anxiety, 23.3% (21/90) and least frequently reported high score was for anger, 12.2% (11/90). The mean TUQ score was 5.5 (SD=1.5) and mean PEPPI-5 score for telehealth visits was 8.1 (SD=2.4). As shown in Table, emotional thermometer scores did moderate the relation between TUQ and patient self-efficacy during telehealth visits. For high emotional thermometer scores, self-efficacy decreased as TUQ scores decreased. Conclusions: For patients experiencing high emotional distress, low comfort and ability with telehealth usability resulted in low patient self-efficacy in communicating with providers and getting medical needs met. Telehealth is a convenient and effective modality;however, in times of emotional distress for patients who are not familiar with telehealth, in-person clinic visits may result in greater patient self-efficacy. (Table Presented).

14.
Journal of NeuroInterventional Surgery ; 14:A112-A113, 2022.
Article in English | EMBASE | ID: covidwho-2005440

ABSTRACT

Objective Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. This study hypothesized that an early intervention vSMA improves patient and caregiver health literacy and preparedness, simultaneously educates trainees on effective communication skills, and reduces clinician burnout. Methods Patients and caregivers of admitted patients were screened through the neurosurgery, neurocritical care, and neurology electronic medical record census. A weekly 60- minute secure virtual session consisted of introductions, a 10- minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed pre- and post-surveys. We report data on this feasibility study and present challenges, both expected and unforeseen. Results A total of 170 patients were screened;13 patients and 26 caregivers participated in at least 1 session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Surveys demonstrated 96.4% of caregivers and 75% of patients were satisfied with the session. 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member. 88.8% of providers felt validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the non-participant group. The primary obstacle encountered included technological frustrations with the consent process and the sessions themselves. Conclusions Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the post-survey included better understanding of caring for a stroke patient, and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts towards telehealth, but our study highlights the importance of avoiding marginalization of the elderly and less technologically inclined populations (Table Presented).

15.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003497

ABSTRACT

Background: COVID-19 resulted in sudden interruptions to medical education, including challenges to delivering global health (GH) experiences. Narrative medicine (NM), which emphasizes literary perspective and uncertainty within healthcare, may be a tool to increase physician resilience. GH and NM perspectives both have potential to augment resident education during the unprecedented disruption of COVID-19. Our objective is to describe a new curriculum incorporating NM and topics in GH disparities for pediatric interns. Methods: For the academic year 2020-21, a curriculum focused on disparities in global maternal child health (MCH) coupled with a practicebased introduction to NM was developed and piloted for pediatric interns at a single pediatric residency program during their month-long advocacy rotation. Two weeks prior to the session, interns received 2 MCH articles and 2 narrative fictional pieces with themes relevant to MCH. During a single 90-minute session, global and local disparities in MCH were reviewed, with focus on synthesis of primary data sources. An introduction to the history of NM was provided along with guided discussion of the fictional pieces. Time was provided for independent writing, with the option for interns to share their pieces. Results: Interns were sent pre-/post-surveys focused on prior experience with NM and GH;no questions about probing resident resilience were included. All 26 interns participated in the session during the academic year, with pre-survey results from 26 and post-survey results from 17. A majority had previous didactic GH learning;while a majority knew of NM as a discipline (N = 19), fewer (N = 9) had participated in any NM experience (Figure 1). Post-session data are presented in Figure 1 and Table 1. The session was wellreceived with high interest in further GH and NM content during residency. Conclusion: The addition of a joint GH and NM session to an existing pediatric resident advocacy curriculum during COVID-19 provides both foundational knowledge in GH disparities and opportunity for self-reflection during uncertain times. To our knowledge, this is the first description of such a curriculum that incorporates these two disciplines. Preliminary evaluation indicates increased knowledge and awareness of narrative medicine after the session, with majority desire for further NM and GH education during residency training. Further evaluation will consider the role of NM in increasing pediatric resident resilience and in improving self-efficacy in advocacy.

16.
Psychosomatic Medicine ; 84(5):A61, 2022.
Article in English | EMBASE | ID: covidwho-2003467

ABSTRACT

It is well established that exposure to Adverse Childhood Experiences (ACEs) can have a profound negative impact on physical and mental health and other health-related processes (e.g. decision making;Chang et al. 2019). Research has also indicated that individual differences in coping styles represent one pathway through which exposure to ACEs can confer risk for negative health outcomes (Sheffler et al. 2019). It is less clear however, whether the negative effects of exposure to ACEs extend also to one's self-efficacy for preventing and overcoming COVID-19. The current study aimed to examine the relationship between ACEs, measured as the total number of adverse childhood experiences endorsed on the Adverse Childhood Experiences Scale, and self-efficacy for preventing and overcoming COVID-19, measured using a modified version of the Self-Efficacy for Middle East Respiratory Syndrome. In addition, we examined whether the use of avoidant coping strategies (denial, venting, and behavioral disengagement) derived from a principal components analysis of the Brief Coping Questionnaire, statistically mediated the association between ACE scores and COVID-19 self-efficacy. Young adults (N = 86, Mage = 23.6;69% female;34% Asian, 33% white, 23% Latinx, 8% Mixed Race, 2% Black or African American) completed measures as part of a larger study. A series of linear regression analyses indicated that both exposure to a greater number of ACEs (β = -.23, p = .033) and greater use of avoidant coping strategies (β = -.36, p < .001) were associated with lower COVID-19 self-efficacy. On the other hand, ACE scores did not significantly predict the use of avoidant coping strategies (β = .09, p = .41) and when entered into a model simultaneously, both ACEs (β = -.20, p = .049) and coping (β = -.34, p = .001) remained significant predictors of COVID-19 self-efficacy. These results indicate that ACE scores and the use of avoidant coping strategies independently affect COVID-19 self-efficacy, and confirm that the negative health effects of ACEs extend also to perceptions of ability to prevent and overcome COVID-19.

17.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003228

ABSTRACT

Background: Black, Latin, and Native American persons are racial and ethnic underrepresented minorities (URMs) among science, technology, engineering and math (STEM) degree recipients. Participation in extracurricular STEM activities has been associated with a higher likelihood of choosing STEM as a career. Given the evidence supporting out-of-school STEM programs and their contributions to the perceived self-efficacy of URM youth in choosing STEM careers, we developed a program to expose URM children to STEM in the healthcare setting at a freestanding tertiary pediatric hospital. Methods: Lurie Junior Scholars (LJS) was developed by faculty and trainees in summer 2020. Pilot funding was secured through the Patrick M. Magoon Institute for Healthy Communities. Recruitment was targeted at URM children between eight and eighteen years of age;methods included emails to the Division of Emergency Medicine, paper flyers in the emergency department, and word of mouth. Children with any relation to our workforce were eligible for the program. Parents of URM children who expressed interest early in the recruitment process were designated as key informants and were interviewed to help determine the timing, duration, frequency, and content of the sessions. Due to the Covid-19 pandemic, we developed a virtual curriculum. Participants were divided into two groups: 8-13 years of age and 14-18 years of age, and were provided kits that included a plastic stethoscope, copies of ultrasound imaging, reusable splint materials, and a model skeleton. Participants completed pre- and post-program electronic surveys to measure change in knowledge, attitudes and beliefs towards learning STEM and pursuing healthcare careers. Results: Thirteen students participated in our pilot program;seven in the younger group and six in the older group. Nine participants completed surveys: six in the older group and three in the younger group. Among older participants, we found an increase in self efficacy in learning STEM and an increased awareness of healthcare careers based on a four-point anchored rating scale. Similarly, all participants reported an increase in their knowledge about healthcare careers at the end of the curriculum. In an open-ended question, students reported that they enjoyed learning about “doctor tools” and having these items to keep, and recognized the hands-on portions of these sessions as their favorites (e.g. practicing CPR, creating splints, listening to their own hearts/lungs/abdomens). Conclusion: LJS sought to expose URM children to STEM in the healthcare setting and enhance their awareness of STEM career opportunities. This pilot project recruited children affiliated with the workforce in Emergency Medicine. Our short-term goals were to increase participant knowledge and self-efficacy of STEM and healthcare fields. Given the long-term goal of increasing STEM secondary education and careers, further follow up and continued engagement with students would be beneficial.

18.
Psychosomatic Medicine ; 84(5):A61, 2022.
Article in English | EMBASE | ID: covidwho-2003035

ABSTRACT

Individual differences in experiences of stress are considered a primary pathway through which health disparities are thought to arise. Because COVID-19-related outcomes differ across demographic characteristics, it is important to examine factors associated with increased stress among diverse participants during the COVID-19 pandemic. Higher discrimination based on demographic characteristics has been associated with heightened stress prior to the pandemic, and lower self-efficacy for preventing and overcoming COVID-19 might disproportionately lead to stress among demographic groups where individuals are more likely to hold “essential worker” positions. Therefore, the current study examined whether experiences of discrimination and COVID-19 self-efficacy associate with stress assessed during the COVID-19 pandemic. A sample of N=75 participants (Mage= 24;35% Asian, 30% White, 23% Hispanic/Latino, 11% multi-racial, and 3% Black;72% Female;65% Straight/Heterosexual) completed an online questionnaire packet assessing their COVID-19 self-efficacy (assessed using a revised version of the Middle Eastern Respiratory Syndrome Self-Efficacy Scale), perceived daily discrimination (Daily Discrimination Scale), and perceived stress (Stress Overload Scale - Short Form). Results from a sequential linear regression indicated that neither demographic characteristics (race, gender identity, sexual orientation, and age) nor COVID-19 self-efficacy predicted stress during the COVID-19 pandemic. On the other hand, perceived discrimination predicted stress above and beyond demographic and COVID-19 self-efficacy differences, β = 0.43, p < 0.01, ΔR2 = 0.17. Though in the direction we might expect, there were no significant demographic differences in perceived discrimination, indicating that differences in perceived daily discrimination in our sample might be associated with factors not presently studied (e.g., socioeconomic status) or may arise through an intersection of group membership. These results demonstrate that perceived daily discrimination is an important predictor of stress during the COVID-19 pandemic and highlight the importance of addressing daily discrimination as a potential avenue for mitigating stress-related COVID-19 outcomes.

19.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003034

ABSTRACT

Background: Family caregivers of children with medical complexity (CMC) report financial problems, job loss due to caregiver responsibilities, fragmented care coordination, and difficulty accessing social services. Home health care services (such as certified nursing assistants or CNAs) provide critical support for these families but are often underfunded and understaffed. Parents also worry about the erratic availability and quality of care offered by external CNAs. These issues led to development of an innovative home care delivery model in Colorado which allows parents or family members of CMC to be paid as their child's CNA. This family certified nursing assistant (fCNA) program has been operating for 20 years, but little is known or published to inform communities and policymakers in other states of the benefits and challenges of this home healthcare model. Methods: We assessed stakeholders' perceptions of the fCNA program by interviewing 25 English- and Spanish-speaking family caregivers (FCs), 10 home health providers (HHPs), and 10 primary care providers (PCPs) of CMC who receive fCNA services. Semi-structured interviews explored perceptions of the program focusing on specific factors such as caregiver self-efficacy, caregiver burden, and implications for QOL. Qualitative content analysis methods were used to generate themes to characterize the fCNA model's benefits and challenges. Results: FCs and HHPs were very knowledgeable about the fCNA program, whereas PCPs had variable knowledge depending on the proportion of CMC in their practice. The three groups aligned around 6 major themes to characterize the program: Financial impact, emotional impact, physical impact, self-efficacy, respite, and access. In general, the program was perceived to be very popular among families of CMC. Major strengths included the financial and employment benefits, the ability to have reliable/high quality services (with added protection during Covid-19), and improved FC confidence and self-efficacy (via the training and the work). There were mixed perceptions of the emotional and physical impact. Stakeholders reported added fulfillment, joy, and bonding time in the FC caring directly for the child, but also reduced attention to other family members, decrease FC self-care/respite, and potential for injury as the child ages. Several challenges were identified regarding program access and health equity. These included training requirements, limited English-proficiency, lower health literacy, immigration status, and rural resources. Conclusion: The fCNA program is seen as extremely popular and beneficial for families of CMC. However, improvements could be directed towards equitable access, and increasing respite for FCs already in the program.

20.
Journal of General Internal Medicine ; 37:S248, 2022.
Article in English | EMBASE | ID: covidwho-1995811

ABSTRACT

BACKGROUND: Latinos are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. The objectives of this study were to implement a crowdsourcing open contest to solicit a name for a social marketing campaign addressing COVID-19 for Latinos in Maryland, and evaluate the contest through mixed-methods analysis. METHODS: We conducted descriptive statistics of entries and votes, and demographics of participants. Submitted text was analyzed through inductive thematic analysis to understand community attitudes towards the COVID-19 pandemic. RESULTS: We received 74 entries within a brief 2-week period, limited by the urgency COVID-19 pandemic. The top 10 entries were chosen by a panel of community judges and the winner was decided by popular votes. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We subsequently incorporated these themes into campaign advertisements, and these ended up being the highest performing ads. CONCLUSIONS: Crowdsourcing is an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by healthcare disparities such as Latino communities.

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