Experiences of newly qualified therapeutic radiographers who transitioned to work during Covid-19

Introduction The Covid-19 pandemic continues to impact on how radiotherapy is delivered, how staff do their job and how patients are cared for. Part of the UK NHS response to the covid-19 crisis was to accelerate final year radiotherapy students into work as therapeutic radiographers. The study objective is to explore the experiences of a cohort of new registrants who started work in May 2020. Methods In depth interviews were conducted remotely with newly qualified therapeutic radiography registrants regarding their first 12 months working in UK NHS cancer centres. Data were analysed within and across cases using a framework analysis and synthesised thematically. Results Eleven radiographers were interviewed, working across six different sites. Key generated themes are the risk of impaired professional socialisation due to incongruence between students’ expectations and the reality in clinical departments. We use Bridges Transitional Model to show how a combination of the disrupted/undefined end to university and a perceived lack of recognition of professional knowledge, skills and values evident in our data may leave participants stuck in a middle stage of the transition process. Slower than expected professional development led to demotivation, which was also associated with rising covid-19 case numbers. Conclusion The covid-19 pandemic accentuated and heightened the existing challenge of professional integration and socialisation faced by new therapeutic radiography staff. Demotivation and potentially attrition are more likely in this environment. Compassionate leadership that fosters the mentorship of junior cohorts as part of a flexible preceptorship package could mitigate these risks.

Spatial and Temporal Monitoring of SARS-CoV-2 in a Sewershed

In response to the global pandemic, Clean Water Services (Washington County, Oregon) monitored 4 wastewater treatment plants (WWTPs) and 16 manholes over a period of 15 months to determine whether spatial and temporal trends in SARS-CoV-2 concentrations corresponded with reported COVID-19 cases. A total of 738 samples were analyzed for SARS-CoV-2 using reverse transcription droplet digital polymerase chain reaction (RT-ddPCR). SARS-CoV-2 concentrations at WWTPs appeared to be a leading indicator, with increases in wastewater observed two to three weeks before cases rose. Neighborhoods with high LatinX and high poverty populations also had higher SARS-CoV-2 concentrations. Additionally, outbreaks at local food processing plants corresponded with viral peaks in their associated manhole. Surprisingly, SARS-CoV-2 was rarely detected in hospital effluent despite the presence of known cases, and experiments revealed hospital disinfectants can destroy the RNA signal. Collectively, these findings demonstrate the value of wastewater-based epidemiology for monitoring the local burden of COVID-19. Copyright © 2021 Water Environment Federation

Impact of Sampling Type, Frequency, and Scale of the Collection System on SARS-CoV-2 Quantification Fidelity

With the rapid onset of the COVID-19 pandemic, wastewater-based epidemiology sampling methodologies for SARS-CoV2 were often implemented quickly and may not have considered the unique drainage catchment characteristics. This study assessed the impact of grab versus composite sampling on the detection and quantification of SARS-CoV-2 in four different catchment scales with flow rates ranging from high flow (wastewater treatment plant influent) to medium flow (neighborhood scale) to low -flow (city block scale) to ultralow flow (building scale). At the high -flow site, grab samples were comparable to 24 h composite samples with SARS-CoV-2 detected in all samples and differed in concentration from the composite by <1 log 10 unit. However, as the size of the catchment decreased, the percentage of negative grab samples increased despite all respective composites being positive, and the SARS-CoV-2 concentrations of grab samples varied from those of the composites by up to almost 2 log 10 units. At the ultra-low -flow site, increased sampling frequencies generated composite samples with higher fidelity to the 5 min composite, which is the closest estimate of the true SARS-CoV-2 composite concentration that could be measured. Thus, composite sampling is more likely to compensate for temporal signal variability while grab samples do not, especially as the catchment basin size decreases.

Measuring height for people with high body mass index at home: Standing up for inclusion

Introduction: Despite the population with body mass index (BMI) ≥40 kg/m2 increasing rapidly, current health survey data collection methods can exclude such people due to difficulties measuring height and weight. Accurate height measurement is vital in calculating BMI. If standard measures with a stadiometer are unsuitable due to physical disability, knee height or half-span can be used to infer height. Physical disability risk increases with obesity class. Method: For a broader study in a Scottish local authority area, people in receipt of health and social care services with likely BMI ≥40, were seen at home. Mobile participants were risk assessed for using a portable stadiometer and measured if able. Where unable or immobile, knee height and half-span were measured to infer height, using published calculations. Data collection was during the Covid pandemic, meaning measures had to be pragmatically achievable by one individual. Results: Measures were taken from 15 women and 10 men (n=25), aged 40-87 years, mean 62 (s=11.8), BMI range 40-77, mean 55 (s=10.4). The portable stadiometer was used for only one participant, due to its narrow base. Alternative measures gave diverse heights: 16 participants had ≥10cm discrepancy between knee height and half-span outcomes. 22 participants had gross lower leg oedema making knee height measures imprecise. Large body habitus impeded sternal notch location and arm straightening, making half-span measures inexact. Published equations were not representative of this population group. Taking participant's height either against a doorpost with a tape measure or recumbent height were pragmatic solutions for improved accuracy. Conclusions: For people with very high BMIs, their large body habitus, with related comorbidities means standard height measures can be invalid. Lack of measurement may obscure numbers affected. Improved portable stadiometer design should include a wider base, with a clear safe working load. Given the rise in this population, and their high health need, health survey methodology needs to ensure appropriate methods for their inclusion and accurate documentation, to enable appropriate future health service planning.

Challenges in weighing community-dwelling individuals with high body mass index: A barrier to accessing safe routine care

Introduction: Numbers of people with body mass index (BMI) ≥40 kg/m2 are increasing rapidly. Due to high weight and functional disabilities, such individuals may be unable to use standard scales. Inability to be weighed accurately means individuals can be prevented from accessing safe and effective routine care, including appropriate equipment (such as beds, chairs and hoists), ambulance transport, access to scanners for diagnostic tests and correct medication dosages Method: For a broader study in a Scottish local authority area, individuals in receipt of health and social care services with likely BMI ≥40, were visited at home. Participants were risk-assessed for using scales, including mobility, falls risk, moving and handling needs, space and staff available and flooring in situ, prior to weight being measured. Data collection occurred during the Covid pandemic, meaning measures needed to be pragmatic, without extra staff or repeat visits. Scales available included wide bariatric stand-on, wheelchair or bed-weighing scales, with alternative measures sought if these proved unsuitable. Results: Weights (range 98.5-211.8 kg, mean=150.3, s=29.3), were recorded for 15 women, 10 men (n=25), aged 40-87 years, mean=62, (s=11.8). 19 individuals who could stand, used specialist bariatric scales, 16 of whom would have been unable to safely use standard scales due to narrowness of the platform, lower maximum weight or falls risk. For those unable to stand, one used wheelchair-weighing scales and two used bed-weighing scales. One bed-bound individual was unable to be weighed due to carpet in situ, but had a recent weight taken in hospital. Two bedbound care-home residents had current weights, one from hoist scales and one from chair scales. 80% of participants were housebound, so unable to attend other premises easily to get weighed. Conclusions: Obtaining weight measures for those with very high weights often requires specialist scales. Anecdotally community professionals report difficulties in accessing appropriate scales, citing this as a gap in service provision. Given the growing BMI ≥40 population, both care providers and population surveys need to ensure lack of specialist scales do not leave this population without access to routine care and under-documented.

Pediatric emergency department utilization during the COVID-19 pandemic in New York City

OBJECTIVES: This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses. STUDY DESIGN: We performed an observational retrospective review of patients younger than 18 years old seen in a New York City pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation. RESULTS: ED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01). CONCLUSIONS: Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.

Expectations of therapeutic radiography students in Wales about transitioning to practice during the Covid-19 pandemic as registrants on the HCPC temporary register.

INTRODUCTION: The Covid-19 crisis continues to profoundly impact on radiotherapy practice in the UK. We explore the views of therapeutic radiographer students on entering their first post in unique circumstances as a means to evaluate the support that may minimise negative impacts on their transition to practitioners. METHOD: Focus groups were conducted outside of students' final year educational programme and immediately prior to them starting work. Qualitative data were analysed using a framework analysis. RESULTS: Emergent themes from the eleven participants were: Covid-19 as a layer on top of underlying anxieties; Degree of readiness for imminent psychological, emotional and practical challenges; Feeling valued as a health professional/radiographer at this time; A mixed student and qualified staff professional identity as HCPC temporary registrants. CONCLUSION: Uncertainties related to Covid-19 were seen to add a destabilising component to existing anxieties and challenges. In this context, there are significant risks of impaired professional socialisation due to incongruence between students' expectations and the reality in clinical departments. IMPLICATIONS FOR PRACTICE: Informed academic support and flexible clinical preceptorship that address anxieties and congruence barriers are vital to guide new practitioners through a health crisis that presents significant challenges but also opportunity for professional development.