Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

Outreach for Science Facilities: Armagh Observatory and Planetarium's programme for the Cherenkov Telescope Array

We describe an outreach programme being delivered by the Armagh Observatory and Planetarium (AOP) for the Cherenkov Telescope Array (CTA). Founded in 1790 and with a rich astronomical heritage, AOP today combines the research and education arms of our organisation to bring a research-informed outreach programme to the public, most often through our planetarium-related activities. We have developed and written, in-house, a short full dome planetarium show ("Exploring the High-Energy Universe”) that describes the science of gamma-ray astronomy and introduces the CTA as the first ground-based gamma-ray observatory open to the whole scientific community. In parallel, we are engaged in developing a series of short videos to introduce the scientists and the science of the UK CTA consortium, again designed for public audiences. These videos can be accessed through our social media channels. Delivery of such outreach programme in bite-sized pieces is an essential element in attracting and engaging audiences. We explain how we have developed the skill set to do this in our Education Team at AOP whilst our facility has been closed for the past year, a result of the Covid-pandemic. There is also scope in extending these concepts for providing outreach support for other science facilities. © Copyright owned by the author(s) under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0)

Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction

Background Olfactory dysfunction is a common consequence of COVID-19 infection and persistent symptoms can have a profound impact on quality of life. At present there is little guidance on how best to treat this condition. A variety of interventions have been suggested to promote recovery, including medication and olfactory training. However, it is uncertain whether any intervention is of benefit. This is an update of the 2021 review with one additional study added. Objectives 1) To evaluate the benefits and harms of any intervention versus no treatment for people with persisting olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. Search methods The Cochrane ENT Information Specialist searched the Cochrane ENT Register;Central Register of Controlled Trials (CENTRAL);Ovid MEDLINE;Ovid Embase;Web of Science;ClinicalTrials.gov;ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. Selection criteria We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance that had persisted for at least four weeks. We included any intervention compared to no treatment or placebo. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. Main results We included two studies with 30 participants. The studies evaluated the following interventions: systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant and palmitoylethanolamide plus luteolin. Systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant compared to no intervention We included a single RCT with 18 participants who had anosmia for at least 30 days following COVID-19 infection. Participants received a 15-day course of oral corticosteroids combined with nasal irrigation (consisting of an intra nasal corticosteroid/mucolytic/decongestant solution) or no intervention. Psychophysical testing was used to assess olfactory function at 40 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are Linable to draw meaningful conclusions from the numerical results. Palmitoylethanolamide plus luteolin compared to no intervention We included a single RCT with 12 participants who had anosmia or hyposmia for at least 90 days following COVID-19 infection. Participants received a 30-day course of palmitoylethanolamide and luteolin or no intervention. Psychophysical testing was used to assess olfactory function at 30 days. This is a single, small study and for all outcomes the certainty of evidence was very Low. We are unable to draw meaningful conclusions from the numerical results. Authors' conclusions There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.

Post-discharge early assessment with remote video link (PEARL) initiative for patients discharged from hospital medicine services.

OBJECTIVES: The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services. METHODS: We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL. RESULTS: Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits. CONCLUSION: In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.

A faster diagnosis for mesothelioma and lung cancer with a one-stop shop clinic for suspected pleural malignancy

Introduction: We audited the effect of implementing a One-stop Shop (OSS) clinic for combined assessment/diagnostic pro ce dure for suspected pleural malignancy, mainly lung cancer and mesothelioma, on achieving the NHS 28-day Faster Diagnosis Standard in the context of the COVID pandemic. Method: We retrospectively collected data on all cases of suspected pleural malignancy undergoing an outpatient procedure after implementing the OSS over 16 weeks (10th March to 30th June 2021). We analysed a cohort seen in the OSS clinic (“OSS”) and a cohort seen via the original clinic pathway (“Non-OSS”). We also analysed an earlier control group during an 18-week period prior to the COVID pandemic from November 2019 to March 2020 (“Pre- OSS”). Results: 21 patients were seen in the OSS clinic compared to 20 non- OSS and 31 pre-OSS. Final diagnoses were 15% (n=11) lung cancer, 18% (n=13) mesothelioma, 22% (n=16) other malignancy and 44% (n=32) benign. The proportions of initial diagnostic procedure were 22% (n=16) diagnostic aspirate, 36% (n=26) therapeutic aspirate, 8% (n=6) chest drain, 1% (n=1) indwelling pleural catheter, 21% (n=15) medical thoracoscopy and 17% (n=12) ultrasound only. The mean time from referral to follow-up with diagnosis for OSS patients was 19 days which was less than both non-OSS patients (mean 30 days) and pre-OSS patients (mean 38 days). Conclusion: Patients seen in the One-Stop Shop clinic received a final diagnosis considerably quicker than those in the standard pathway. Interestingly, after implementing the OSS, patients seen via the standard pathway also received a final diagnosis faster after than before (pre-COVID). This suggests that even if there is not capacity to see all patients in the OSS, all may benefit, perhaps due an increase in efficiency across the service. Our model can be successfully applied to services in the post-COVID era to streamline the diagnostic pathway

Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic.

OBJECTIVES: Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic. METHODS: We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors. RESULTS: The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01). CONCLUSIONS: During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.

Wellness of hospitalists and hospital medicine advanced practice providers during the COVID-19 pandemic, 2020-2021.

BACKGROUND: The early phase of the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the wellness of hospitalists and hospital medicine advanced practice providers (APPs). However, the burden of the pandemic has evolved and the change in hospitalist and hospital medicine APP wellness is unknown. OBJECTIVE: To evaluate the longitudinal trend in wellness of hospitalists and hospital medicine APPs during the COVID-19 pandemic and guide wellness interventions. DESIGN, SETTING AND PARTICIPANTS: Between May 4, 2020, and June 6, 2021, we administered three surveys to Internal Medicine hospitalists (physicians) and hospital medicine APPs (nurse practitioners and physician assistants) at 16 Mayo Clinic hospitals in four U.S. states. MEASUREMENTS: We evaluated the association of hospitalist and hospital medicine APP characteristics with PROMIS® measures of global wellbeing-mental health, global wellbeing-social activities and relationships, anxiety, social isolation, and emotional support, using logistic and linear regression models. RESULTS: The response rates were 52.2% (n=154/295; May 2020), 37.1% (n=111/299; October 2020) and 35.5% (n=114/321; May 2021). In mixed models that included hospitalist and hospital medicine APP characteristics and survey period, APPs, compared with physicians, had lower odds of top global wellbeing-social activities and relationships (adjusted odds ratio 0.42 [0.22-0.82]; p = .01), whereas survey period showed no association. The survey period showed an independent association with higher anxiety (May 2020 vs. others) and higher social isolation (October 2020 vs. others), whereas profession showed no association. Concern about contracting COVID-19 at work was significantly associated with lower odds of top global wellbeing-mental health and global wellbeing-social activities and relationships, and with higher anxiety and social isolation. Hospitalist and hospital medicine APP characteristics showed no association with levels of emotional support. CONCLUSIONS: In this longitudinal assessment of hospitalists and hospital medicine APPs, concern about contracting COVID-19 at work remained a determinant of wellness. The trend for global wellbeing, anxiety, and social isolation may guide wellness interventions.

Delirium occurrence and association with outcomes in hospitalized COVID-19 patients.

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27-5.83) for in-hospital mortality and an OR 4.54 (3.25-6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

COVID 19 Testing Cannot Replace Clinical Judgement

Since the onset of the coronavirus disease 2019 (COVID-19) due to the SARS-CoV-2 virus, recommendations for diagnostics and therapeutics have rapidly evolved. The World Health Organization recommends nucleic acid amplification testing (NAAT) such as reverse transcriptase PCR (RT-PCR) as the standard for COVID-19, with a sensitivity of 95%. However, many factors can affect the results including timing of test, specimen quality, specimen handling, pooling specimens, and other technical reasons, resulting in false negatives. The case below describes a patient with a clinical presentation concerning for COVID-19 despite three negative RT-PCR tests and highlights the importance of treating patients based on their entire clinical impression rather than a single data point. A 53-year-old Hispanic male with no medical history presented to the hospital with 4 days of dyspnea and cough. He was admitted to the intensive care unit with acute hypoxemic respiratory failure requiring heated high flow nasal cannula. No associated fever, myalgias, anosmia, diarrhea, and he denied any known ill contacts, inhalation exposures or prior smoking history. Laboratory workup was notable for thrombocytosis, lymphopenia, elevated ferritin, C-reactive protein, D-dimer and lactate dehydrogenase as commonly seen with COVID-19. Infectious screen resulted with negative SARS-CoV-2 PCR by nasal swab, negative respiratory viral panel, negative HIV PCR, and negative fungal pneumonia screen. Imaging showed bilateral ground-glass opacities consistent with multifocal pneumonia (figure). He was started on a 5-day course of antibiotics for community acquired pneumonia and given high suspicion for COVID-19 pneumonia was started on dexamethasone 6mg daily with a plan to repeat SARS-CoV-2 testing. Repeat SARS-CoV-2 PCR was negative on hospital day 2 and 4 but SARS-CoV-2 antibody was positive on hospital day 6 (10 days after symptom onset). Given the positive antibody test and clinical course consistent with COVID-19 pneumonia, he was continued on dexamethasone for a total of 10 days, completed a 5-day course of remdesivir, and received 1 unit of convalescent plasma with clinical improvement. He was discharged home on hospital day 15 with supplemental oxygen. With increasing rates of infection with the SARS-CoV-2 virus, it becomes critically important to quickly and accurately diagnose patients. While RT-PCR has high sensitivity, there are still several factors that affect the accuracy and may result in false-negative results with potential implications such as delay in treatment and failure to quarantine. This case highlights the importance to treat patients based on a comprehensive clinical impression rather than a single test result.

Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine.

Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients.Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians.Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32-6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association.Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.

Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects (benefits and harms) of interventions to treat olfactory dysfunction in people with COVID-19 infection. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach. Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Inpatient Care of Patients with COVID-19: A Guide for Hospitalists.

Since its emergence in December 2019, the virus known as severe acute respiratory syndrome coronavirus 2 has quickly caused a pandemic. This virus causes a disease now known as coronavirus disease 2019, or COVID-19. As an increasing proportion of the at-risk population becomes infected, and patients with severe illness are hospitalized, it is essential for hospitalists to remain current on how to best care for people with suspected or confirmed disease. Establishing a system for logistical planning, and accurate information sharing is strongly recommended. Infection control remains the ultimate goal. As such, health care workers should be educated on universal and isolation precautions, and the appropriate use of personal protective equipment. Social distancing should be encouraged to prevent the spread of infection, and creative and innovative ways to reduce contact may need to be considered. Moreover, it is imperative to prepare for contingencies as medical staff will inevitably get sick or become unavailable. Hospitalists have the difficult task of caring for patients while also adapting to the many logistical and social elements of a pandemic.

Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to patients with suspected or confirmed COVID-19 infection in order to protect the healthcare workers (HCWs) caring for them. To assess the benefits and harms of antimicrobial mouthwashes and nasal spray in improving outcomes for patients with suspected or confirmed COVID-19 infection.