Chart based data as a resource for tracking and improving a person-centred palliative approach in long-term care.

AIMS AND OBJECTIVES: To enhance the practice of a person-centred palliative approach in long-term care. BACKGROUND: Implementing a person-centred palliative approach in long-term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs. DESIGN: We conducted a four-stage directed content analysis of long-term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS: We qualitatively analysed 78 resident charts across three long-term care homes in southern Ontario to capture the extent to which person-centred care was absent, initiated or implemented in different types of documented care interactions. RESULTS: Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person-centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%). CONCLUSIONS: While person-centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning. RELEVANCE TO CLINICAL PRACTICE: Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person-centred palliative approach to care. PATIENT OR PUBLIC CONTRIBUTION: An advisory group consisting of long-term care resident and staff representatives informed the overall study design and dissemination of the results.

Local Monitoring Should Inform Local Solutions: Morphological Assemblages of Microplastics Are Similar within a Pathway, But Relative Total Concentrations Vary Regionally.

Pathways for microplastics to aquatic ecosystems include agricultural runoff, urban runoff, and treated or untreated wastewater. To better understand the importance of each pathway as a vector for microplastics into waterbodies and for mitigation, we sampled agricultural runoff, urban stormwater runoff, treated wastewater effluent, and the waterbodies downstream in four regions across North America: the Sacramento Delta, the Mississippi River, Lake Ontario, and Chesapeake Bay. The highest concentrations of microplastics in each pathway varied by region: agricultural runoff in the Sacramento Delta and Mississippi River, urban stormwater runoff in Lake Ontario, and treated wastewater effluent in Chesapeake Bay. Material types were diverse and not unique across pathways. However, a PERMANOVA found significant differences in morphological assemblages among pathways (p < 0.005), suggesting fibers as a signature of agricultural runoff and treated wastewater effluent and rubbery fragments as a signature of stormwater. Moreover, the relationship between watershed characteristics and particle concentrations varied across watersheds (e.g., with agricultural parameters only being important in the Sacramento Delta). Overall, our results suggest that local monitoring is essential to inform effective mitigation strategies and that assessing the assemblages of morphologies should be prioritized in monitoring programs to identify important pathways of contamination.

From science to politics: COVID-19 information fatigue on YouTube.

OBJECTIVE: The COVID-19 pandemic is the first pandemic where social media platforms relayed information on a large scale, enabling an "infodemic" of conflicting information which undermined the global response to the pandemic. Understanding how the information circulated and evolved on social media platforms is essential for planning future public health campaigns. This study investigated what types of themes about COVID-19 were most viewed on YouTube during the first 8 months of the pandemic, and how COVID-19 themes progressed over this period. METHODS: We analyzed top-viewed YouTube COVID-19-related videos in English from December 1, 2019 to August 16, 2020 with an open inductive content analysis. We coded 536 videos associated with 1.1 billion views across the study period. East Asian countries were the first to report the virus, while most of the top-viewed videos in English were from the US. Videos from straight news outlets dominated the top-viewed videos throughout the outbreak, and public health authorities contributed the fewest. Although straight news was the dominant COVID-19 video source with various types of themes, its viewership per video was similar to that for entertainment news and YouTubers after March. RESULTS: We found, first, that collective public attention to the COVID-19 pandemic on YouTube peaked around March 2020, before the outbreak peaked, and flattened afterwards despite a spike in worldwide cases. Second, more videos focused on prevention early on, but videos with political themes increased through time. Third, regarding prevention and control measures, masking received much less attention than lockdown and social distancing in the study period. CONCLUSION: Our study suggests that a transition of focus from science to politics on social media intensified the COVID-19 infodemic and may have weakened mitigation measures during the first waves of the COVID-19 pandemic. It is recommended that authorities should consider co-operating with reputable social media influencers to promote health campaigns and improve health literacy. In addition, given high levels of globalization of social platforms and polarization of users, tailoring communication towards different digital communities is likely to be essential.