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Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3–4.7 (of which 0.4–0.6% were virtual) general practitioner (GP) visits and 0.9–2.3 (0.2–0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138–4,567%, and 2,201–7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society. [ABSTRACT FROM AUTHOR]

Background: The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. Aims: To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. Method: A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. Results: Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. Discussion: LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing. [ABSTRACT FROM AUTHOR]

Restrictive visitation policies produce inequities in healthcare that have meaningful consequences for patients' health and well-being. There is a surplus of existing literature exploring the consequences of reduced visitation in the setting of pediatric patients lacking decision-making capacity, but relatively little scholarship addressing visitation restriction for less vulnerable adults possessing capacity. Here, we present the case of a patient who suffered serious complications of childbirth, during the delivery of her healthy newborn, leading to prolonged hospitalization. During her treatment course, she was subsequently denied visitation with her newborn, who had been discharged from the hospital, and this had detrimental effects on her recovery. Hospital policies restricting visitation during the COVID-19 pandemic were intended to reduce the risk of disease exposure for both patients and staff, despite conflicting evidence demonstrating this benefit. In contrast, they often have negative effects on patient stress, mood, and physical recovery. The sequelae of this US-based case study argue the need for more holistic hospital visitation policies, placing a specific lens on adult patients receiving a visitation from their newborn children. [ABSTRACT FROM AUTHOR]

Background Individuals with chronic diseases are less often presented to hospitals due to the restrictions enforced during the pandemic period and the fear of contracting the disease. The purpose of the present study was to investigate the effects of the anxiety level associated with novel coronavirus on daily life, treatment compliance, and metabolic conditions in elderly diabetes mellitus (DM) patients. Methods This study included 263 patients diagnosed with type 2 DM aged >65 years. The researchers collected the study data through the face-to-face interview method. The Patient Information Form, Coronavirus Anxiety Scale (CAS), Morisky Medication Adherence Scale, Insomnia Severity Index, and the Depression Anxiety Stress Scales (DASS-21) were used for data collection. Results The mean CAS score was 4.25±3.76. Mean CAS scores were higher in the participants who reported a decrease in the frequency of shopping, grocery/market visits, public transport use, hospital visits, and attending routine checks, during the pandemic (p<0.05). Furthermore, a significant positive correlation was found between the mean CAS score and the DASS-21 score (p<0.05). There was a significant negative correlation between the mean CAS score and the treatment compliance score (p<0.05). Conclusion The pandemic and coronavirus anxiety have had an adverse effect on daily life, treatment compliance, and metabolic conditions in elderly DM patients. [ABSTRACT FROM AUTHOR]

Clinician moral distress has been documented over the past several decades as occurring within numerous healthcare disciplines, often in relation to clinicians' involvement in patients' end-of-life decision-making. The resulting harms impact clinician well-being, patient well-being, and healthcare system functioning. Given Covid-19's catastrophic death toll and associated demands on end-of-life decision-making processes, the pandemic represents a particularly important context within which to understand clinician moral distress. Thus, we conducted a convergent mixed methods study to examine its prevalence, associations with clinicians' demographic and professional characteristics, and contributing circumstances among Veterans Health Administration (VA) clinicians. The study, conducted in April 2021, consisted of a cross-sectional on-line survey of VA clinicians at 20 VA Medical Centers with professional jurisdiction to place life-sustaining treatment orders working who were from a number of select specialties. The survey collected quantitative data on respondents' demographics, clinical practice characteristics, attitudes and behaviors related to goals of care conversations, intensity of moral distress during "peak-Covid," and qualitative data via an open-ended item asking for respondents to describe contributing circumstances if they had indicated any moral distress. To understand factors associated with heightened moral distress, we analyzed quantitative data using bivariate and multivariable regression analyses and qualitative data using a hybrid deductive/inductive thematic approach. Mixed methods analysis followed, whereby we compared the quantitative and qualitative datasets and integrated findings at the analytic level. Out of 3,396 eligible VA clinicians, 323 responded to the survey (9.5% adjusted response rate). Most respondents (81%) reported at least some moral distress during peak-Covid. In a multivariable logistic regression, female gender (OR 3.35; 95% CI 1.53–7.37) was associated with greater odds of moral distress, and practicing in geriatrics/palliative care (OR 0.40; 95% CI 0.18–0.87) and internal medicine/family medicine/primary care (OR 0.46; 95% CI 0.22–0.98) were associated with reduced odds of moral distress compared to medical subspecialties. From the 191 respondents who completed the open-ended item, five qualitative themes emerged as moral distress contributors: 1) patient visitation restrictions, 2) anticipatory actions, 3) clinical uncertainty related to Covid, 4) resource shortages, and 5) personal risk of contracting Covid. Mixed methods analysis found that quantitative results were consistent with these last two qualitative themes. In sum, clinician moral distress was prevalent early in the pandemic. This moral distress was associated with individual-, system-, and situation-level contributors. These identified contributors represent leverage points for future intervention to mitigate clinician moral distress and its negative outcomes during future healthcare crises and even during everyday clinical care. [ABSTRACT FROM AUTHOR]

Introduction:The COVID-19 pandemic created an unprecedented surge toward telemedicine. This project investigated oncology clinic telemedicine utilization across the Vanderbilt University Medical Center (VUMC) from January to October 2020. Poorer prognosis and care of oncology patients is expected to be associated with increased emergency department (ED) visits. Methods:January to October 2020 clinic visits were identified from the VUMC's Electronic Data Warehouse (EDW). Oncology patients were identified by ICD-10 code and their EDW ED visit data were extracted. Joinpoint piecewise linear regression evaluated trends in tele-oncology visits. VUMC ED visits were compared for patients who did versus did not use telemedicine for oncology clinic visits. A Welch's two-tailed t-test investigated differences in ED visits/patient between these cohorts (α < 0.05). Results:A sharp increase in tele-oncology clinic visits from January to April 2020 (Monthly Percent Change = 396.26%) was followed by a steady decrease from April to October 2020 (Monthly Percent Change = −20.93%). The difference between these two trends was significant (p < 0.002). Of 18 cancer sites, breast cancers had the highest proportion (29.04%) of tele-oncology visits. There was no significant difference in January to October 2020 ED usage for oncology patients who did (0.40 ED visits/patient) versus did not (0.38 ED visits/patient) utilize telemedicine (p = 0.69). A total of 9.64% of oncology clinic visits from January to October 2020 were telemedicine visits, just below the 13.0% institutional average. Discussion:At the VUMC, tele-oncology spiked in March and April 2020 before decreasing from April to October 2020. Breast cancer clinics were most likely to use tele-oncology. Telemedicine use was not associated with increased ED visits for oncology patients, suggesting telemedicine as an alternative for routine oncology clinics. Oncology clinic telemedicine usage was 18th-highest among 33 specialties at our institutions, and among the lowest of nonsurgical specialties. [ABSTRACT FROM AUTHOR]

Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Ferritin is an acute-phase reactant that is elevated in autoimmune disorders, including systemic lupus erythematosus (SLE). However, their correlation with disease activity scores has not been confirmed. Pandemic Covid-19 makes children visitation to hospital to get the treatment of SLE were delayed. This study aimed to evaluate correlation between serum ferritin and disease activity and its role in screening for flare in pediatric SLE (pSLE) patients during pandemic Covid-19. This is a cross-sectional study conducted in Saiful Anwar General Hospital Malang. Sampling was carried out sequentially on pediatric patients who met the criteria for Systemic Lupus International Collaborating Clinics (SLICC) and were recorded between July 2021-May 2022. All patients were interviewed and assessed for disease activity using SLE Disease Activity Index 2000 (SLEDAI-2k). A score <4 was categorized as inactive disease. Biochemical, serological tests including markers of disease activity and ferritin level were measured by standard laboratory procedure. Comparison, correlation and ROC curve analyses were performed with SPSS software. There were 38 females pSLE participated in this study. The mean age of the patients were 12.6 ± 3.02 years. Serum ferritin significantly higher in active disease compared to inactive disease 84.50 ng/mL (68.00-151.75 ng/mL) ng/mL and 815.00 ng/mL (451.25-1570.00 ng/mL), a value of p<0.05 was determined to be statistically significant. A significant correlation was found between serum ferritin with SLEDAI 2K (r = 0.890, p = 0.000). Correlation was also found between serum ferritin and IgM anti-double stranded- DNA (r = 0.325, p = 0.046), but not with other laboratory and serological parameters. In ROC curve analysis, we found that Area Under The Curve (AUC) 0.989, 95%CI 0.964-1.014, p value 0,000, with cut off value 297.50 with sensitivity 85% and specificity 94.4%. Ferritin was increased in active disease as compared to inactive disease and correlated with SLEDAI score and IgM-dsDNA. Thus, ferritin may be potential as an affordable and available marker of disease activity in pSLE during pandemic Covid-19. [ABSTRACT FROM AUTHOR]

Objective: This study examined the impact of Japan's state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan's state of emergency, the number of hospital visitations by patients with diabetes was summarized from 28 weeks of data for each year, from calendar week 8 to calender week 35. Results: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. Conclusions: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should receive continuous follow-up regarding their diabetes care, keeping a close eye on relvent measurements. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. Materials/Methods: Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. Results: Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. Conclusions: Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, adults with chronic conditions delayed or avoided seeking preventative and general medical care, leading to adverse consequences for morbidity and mortality. In order to bring patients back into care, we, in this qualitative study, sought to understand the foremost health-related needs of our multi-morbid ambulatory patients to inform future outreach interventions. Via a telephone-based survey of our high-risk patients, defined using a validated EPIC risk model for hospitalization and ED visits, we surveyed 214 participants an open-ended question, "What is your top health concern that you would like to speak with a doctor or nurse about". We found 4 major themes: 1) primary care matters, 2) disruptions in health care, 3) COVID-19ʹs impact on physical and mental health, and 4) amplified social vulnerabilities. Our results suggest that interventions that reduce barriers to preventative services and disruptions to healthcare delivery are needed. [ABSTRACT FROM AUTHOR]

Simple Summary: Negative mental health outcomes have affected healthcare workers, patients, and community members following pandemics: most recently, the SARS-CoV-2 (COVID-19) outbreak. Although therapy dog visitation programs are associated with reduced stress, most hospital-based programs were placed on hiatus during the COVID-19 pandemic. This study examined human–animal interactions during the reactivation of a hospital-based therapy dog program during the pandemic. Characteristics of the interactions and the participants involved were recorded and analyzed. Findings indicated that most visit recipients were healthcare workers, while the longest interaction times occurred with adult and pediatric patients. High levels of adherence to human and animal safety protocols indicate that human–dog therapy teams can safely return to hospital visitation work. This study examined human–animal interactions during the reactivation of a hospital-based therapy dog program during the COVID-19 pandemic. Data were collected from human–dog interactions at an academic medical center in Virginia. Interaction length, participant role, age group (pediatric or adult), and observed gender were recorded. Handler adherence to human and animal safety protocols (donning personal protective equipment (PPE), using hand sanitizer, and limiting visit length) was measured. Observations from 1016 interactions were collected. t-tests and analysis of variance were conducted. Most visit recipients were healthcare workers (71.69%). Patients received longer visits than other participants (F(4880) = 72.90, p = <0.001); post hoc Bonferroni analyses (p = 0.05/4) showed that patients, both adult (M = 2.58 min, SD = 2.24) (95% C.I = 0.35–1.68) and pediatric (M = 5.81, SD = 4.38) (95% C.I. 3.56–4.97), had longer interaction times than healthcare workers (M = 1.56, SD = 1.92) but not visitors (p = 1.00). Gender differences were not statistically significant (t(552) = −0.736), p = 0.462). Hand sanitizer protocols were followed for 80% of interactions. PPE guidelines were followed for 100% of visits. Most interactions occurred with healthcare workers, suggesting that therapy dog visits are needed for this population. High adherence to COVID-19 safety protocols supports the decision to reactivate therapy animal visitation programs in hospitals. Challenges to safety protocol adherence included ultra-brief interactions and crowds of people surrounding the dog/handler teams. Program staff developed a "buddy system" mitigation strategy to minimize departures from safety protocols and reduce canine stress. [ABSTRACT FROM AUTHOR]

Background: Despite their broad commitment to family-centred care, children's hospitals and associated pediatric intensive care units (PICUs) restricted family presence during the COVID-19 pandemic. This study aimed to describe family presence policies and practices in Canadian PICUs from March to May 2020, and their evolution by August to December 2020. Methods: We conducted an environmental scan of family presence policies and restrictions in all 19 Canadian PICUs using 2 methods. We conducted a literature review of public-facing visitation policy documents in June 2020 using a standardized data extraction form. We also administered a cross-sectional survey of PICU leadership (managers and physician chiefs) between August and December 2020 by telephone or videoconferencing. We used inductive content analysis to code qualitative data, generating summative count data. We analyzed quantitative data descriptively. Results: As part of the literature search, we collected 2 (12%) PICU-specific, 14 (82%) pediatric-specific and 1 (6%) hospital-wide visitation policy documents from the early pandemic. One policy document provided guidance on all of the policy elements sought; the number of enabled caregivers was not included in the documents for 7 of 19 units (37%). All 19 Canadian PICUs were represented among the 24 survey respondents (15 physician chiefs and 9 operations or clinical managers). Before the COVID-19 pandemic, all units allowed the presence of 2 or more family members. Early in the pandemic, reported practices limited the number of adult caregivers for patients without SARS-CoV-2 infection to 1 (n = 21/24, 88%) or 2 (n = 3/24, 12%); all units prohibited siblings. Some centres restricted caregivers from switching bedside presence with one another (patients without SARS-CoV-2 infection: n = 16/23, 70%; patients with confirmed or suspected SARS-CoV-2 infection: n = 20/23, 87%); leaving their child's PICU room (patients without SARS-CoV-2 infection: n = 1/24, 4%; patients with confirmed or suspected SARS-CoV-2 infection: n = 16/24, 67%); and joining in-person rounds (patients without SARS-CoV-2 infection: n = 9/22, 41%; patients with confirmed or suspected SARS-CoV-2 infection: n = 17/22, 77%). All respondents endorsed policy exceptions during end-of-life care. Some reported policies and practices were adapted over the study period. Interpretation: Early COVID-19-related family presence policies in Canadian PICUs varied among centres. Although some centres adapted policies and practices, this study revealed ongoing potential threats to family centred care at the mid-pandemic stage. [ABSTRACT FROM AUTHOR]

Objective: To understand how surrogates of critically ill patients adjusted to challenges that resulted from the COVID-19 pandemic.Methods: Participants (N = 62) were surrogates of critically ill adults with COVID-19 in the ICU at an urban, academic medical center from March to June 2020. Participants were recruited using convenience sampling and took part in one-time qualitative individual interviews via telephone. Qualitative data were analyzed using thematic content analysis.Results: Qualitative analyses yielded four types of challenges: Communication with the medical team, communication among family members, understanding and tracking medical information, and distress related to visitor restrictions. To adjust to challenges related to communication, participants developed routines for receiving updates from the medical team and providing updates to other family members. To adjust to the challenge related to comprehension, participants sought information from external sources such as family members in healthcare fields. To adjust to the challenge related to visitation, participants found some comfort in video calls with the patient.Conclusions: Surrogates of critically ill patients with COVID-19 faced multiple types of challenges yet adjusted to those challenges.Practical Implications: Future research should focus on ways to support the wellbeing of surrogates during times of restricted hospital visitation. Clinical trial registered at ClinicalTrials.gov (NCT03969810). [ABSTRACT FROM AUTHOR]

Point-of-care testing is cost-effective, rapid, and could assist in avoiding hospital visits during a pandemic. However, they present some significant risks that current technologies cannot fully address. Skin flora contamination and insufficient specimen volume are two major limitations preventing self-collection microbiological testing outside of hospital settings. We are developing a hybrid testing procedure to bridge the laboratory test with patient-side specimen collection and transportation for molecular microbial classification of causative bacterial infection and early identification of microbial susceptibility profiles directly from whole blood or urine specimens collected patient-side by health care workers such as phlebotomists in nursing homes or family clinics. This feasibility study presents our initial development efforts, in which we tested various transportation conditions (tubes, temperature, duration) for direct-from-specimen viable pathogen detection to determine the ideal conditions that allowed for differentiation between contaminant and causative bacteria in urine specimens and optimal growth for low-concentration blood specimens after transportation. For direct-from-urine assays, the viable pathogen at the clinical cutoff of 105 CFU/mL was detected after transportation with molecular assays while contaminants (≤ 104 CFU/mL) were not. For direct-from-blood assays, contrived blood samples as low as 0.8 CFU/mL were reported positive after transportation without the need for blood culture. [ABSTRACT FROM AUTHOR]

Context: Coronavirus Disease 2019 (COVID-19) has caused unprecedented disruptions to cancer care, including through strict hospital visitation policies. Since a substantial proportion of the U.S. population report a non-English language as their primary language, it is critical that information is disseminated in multiple languages.Objectives: To examine the availability of language translations of visitation restrictions on adult National Cancer Institute-designated comprehensive cancer centers (CCCs) Web sites.Methods: Cross-sectional analysis of visitation policies abstracted from public-facing Web sites of CCCs in June 2020. Using U.S. Census data, CCC's city and state proportions of self-identifying Hispanic/Latinx population were categorized into three cohorts: low (<10%), moderate (10%-20%), and high (>20%).Results: As of June 2020, all 50 CCCs published a COVID-19 visitation policy on their Web site. Of these, 33 (66%) posted policies only in English, whereas 17 (34%) included one or more non-English translations. A minority of CCCs published Spanish language resources, which did not differ based on state or city demographics: for example, only 42% (8 of 19), 10% (1 of 10), and 38% (8 of 21) of CCCs published Spanish language resources in cities with low, moderate, and high Hispanic/Latinx populations, respectively.Conclusion: `Most CCC's did not publish non-English language translations of their visitor policies. Even in cities and states with larger Hispanic/Latinx populations, most CCCs did not publish resources in Spanish. This study highlights a key opportunity to mitigate communication barriers and deliver culturally competent, patient-centered care. [ABSTRACT FROM AUTHOR]

A commentary is presented in which the authors argue that inconsistent visitor restriction policies contribute to health inequity among minority older adults with limited English proficiency (LEP). Two patient and caregiver interactions and experiences are discussed including a 70-year-old Spanish-speaking man with mild cognitive impairment who went to the emergency department (ED) after a fall and an 80-year-old Spanish-speaking woman with respiratory distress and heart failure.

The article discusses trends in U.S. Emergency Department visits related to suspected or confirmed child abuse during the COVID-19 pandemic in the U.S. Topics include that public health emergencies increase risk for child abuse and neglect because of increased stressors and loss of financial and social supports; and that the pandemic has affected health care–seeking patterns for victims.

Worldwide, long-term care (LTC) homes have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. The significant risk of COVID-19 to LTC residents has resulted in major public health restrictions placed on LTC visitation. This article describes the important considerations for the facilitation of social connections between LTC residents and their loved ones during the COVID-19 pandemic, based on the experiences of 10 continuing care homes in Alberta, Canada. Important considerations include: technology, physical space, human resource requirements, scheduling and organization, and infection prevention and control. We describe some of the challenges encountered when implementing alternative visit approaches such as video and phone visits, window visits and outdoor in-person visits, and share several strategies and approaches to managing this new process within LTC. [ABSTRACT FROM AUTHOR]

Objective: The pandemic of COVID-19 has affected many aspects of life, and emotional symptoms have been reported to worsen during this time. Also, elective visits in the Breast Clinic have been cancelled or postponed based on the priorities defined in local and international guidelines. Our aim was to investigate the effect of these delays on the breast symptoms and emotional status of our patients. Materials and Methods: We called patients whose appointments should have taken place between March and May 2020. After asking for their consent to participate in the study, we asked questions about their breast and emotional symptoms and any worsening of these due to cancellation of their schedules because of the COVID-19 outbreak. We also inquired the relation of breast symptoms with news and thoughts about COVID-19, and if the patients or their close relatives or friends had been affected by COVID-19. We compared the worsening of breast symptoms in patients with and without a positive self- or family history of COVID-19. Results: None of the breast or emotional symptoms had significantly got worse in the patients. Also, there was no significant difference between the two groups regarding the changes in their breast symptoms or emotional health. Conclusion: We believe that these results might be evidence in favor of the Breast Clinic triage system, which conforms to most international and specifically to our local recommended strategies. [ABSTRACT FROM AUTHOR]

The Swedish Prison and Probation Service (SPPS) formed a national crisis management team on March 12, 2020, in response to the global Covid-19 pandemic. The team, consisting of experts from multiple departments within the SPPS, coordinated efforts within the government agency to support the jails, prisons, probation offices, and national transportation service in managing the pandemic while upholding operational security and the safety of staff and inmates. The SPPS handled the Covid-19 outbreak by taking measures to minimize the risk of contagion spread, consistent with the recommendations of the Public Health Agency in Sweden. These recommendations differ from those introduced in many other countries. For example, Sweden chose to avoid a general lockdown. The SPPS's measures to minimize contagion spread included: canceling all visitation at-and furlough from-jails and prisons, placing inmates with suspected and confirmed Covid-19 infections in isolation, creating digital solutions to minimize travel and in-person meetings, as well as providing protective gear to manage infected inmates and inmates within a risk group. To date, the SPPS has had 143 confirmed inmate cases of Covid-19 and no deaths due to the virus. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss an elective surgery recovery plan after the COVID-19 pandemic. Also cited are the March 2020 recommendation by the American College of Surgeons to cancel all elective cases with multiple surgical associations, the need to develop a plan on how to perform elective surgeries safely amidst possible COVID-19 infection, and some proposals to restore confidence of patients like conducting polymerase chain reaction and serology tests before a procedure.

We sought to discover whether hospital visitation restrictions imposed during COVID, and remaining at some institutions, influenced surrogate decision-making. Thematic analysis of semi-structured interviews of people who served as healthcare surrogates for patients admitted to the intensive care unit with a palliative care consultation in January of 2021 at a large tertiary care hospital. Thirteen healthcare surrogates agreed to be interviewed out of the fifty-six who were identified and invited to participate. The following themes emerged: 1) Decision-making was delayed as surrogates desire to make decisions in conjunction with the patient; 2) visitation restriction disrupted processes of grief and end-of-life rituals; 3) it prevented healing that occurs with closeness to loved ones; 4) visitation permission was poorly communicated and inconsistent; 5) virtual connection was inconsistent and proved ineffective in context; 6) communication was often stressful and confusing. From the point of view of healthcare surrogates, visitation restriction disrupted the normal process of decision-making by impeding important healing and grief rituals, and making connection difficult, despite policies and technology that was meant to assist. Practice Implications: Visitation restriction carries risk such as delaying decision-making and the perceived healing benefits of visitation. • Healthcare surrogates felt that visitation restrictions impeded healing and grief rituals. • Healthcare surrogates desire to make medical decisions in conjunction with the patient. • Visitation restrictions may have delayed important decision-making in the intensive care unit. • Future visitation restrictions should consider how surrogates make decisions. [ABSTRACT FROM AUTHOR]

Background: Coronavirus-2 (COVID-19) is a global pandemic. As of August 21, mortality from COVID-19 has reached almost 200,000 people, with the United States leading the globe in levels of morbidity and mortality. Large volumes of high-acuity patients, particularly those of advanced age and with chronic comorbidities, have significantly increased the need for palliative care resources beyond usual capacity. More specifically, COVID-19 has changed the way we approach patient and family member interactions.Discussion: Concern for nosocomial spread of this infection has resulted in strict visitation restrictions that have left many patients to face this illness, make difficult decisions, and even die, alone in the hospital. To meet the needs of COVID patients, services such as Emergency Medicine and Palliative Care have responded rapidly by adopting novel ways of practicing medicine. We describe the use of telepalliative medicine (TM) implemented in an emergency department (ED) setting to allow family members the ability to interact with their loved ones during critical illness, and even during the end of life. Use of this technology has helped facilitate goals of care discussions, in addition to providing contact and closure for both patients and their loved ones.Conclusion: We describe our rapid and ongoing implementation of TM consultation for our ED patients and discuss lessons learned and recommendations for others considering similar care models. [ABSTRACT FROM AUTHOR]

The article discusses changes to visitation policies and communication practices for critically ill patients in Michigan intensive care units (ICUs) during the COVID-19 pandemic. Topics discussed include concern over patient–family communication in ICUs; use of video communication between patients and family members using tablets or smart phones; and risk for depression, anxiety, and posttraumatic stress to family members of ICU patients.

Background The SARS-CoV-2 pandemic has resulted in disruptions to oncology practices amongst healthcare institutions globally. To adapt, telehealth has been increasingly implemented into oncologic care, including that of esophageal cancer patients, which has been met with overall success. However, there remains a lack of evidence in the literature pertaining to the outcomes of virtual postoperative appointments for esophagectomy patients. Methods We conducted a retrospective cohort study to assess the clinical outcomes of esophageal cancer patients attending phone call follow-up (virtual) visits compared to standard in person care after esophagectomy. Demographic data, clinical and disease characteristics, and hospital visit data within 6 months of operation were collected. This included surgical clinic visits, endoscopies, and emergency room (ER) admissions. Results 168 esophagectomy patients underwent follow-up care between March 2020 to May 2022; 70 virtual and 98 in-person. Patients attending virtual appointments had significantly fewer ED admissions (−0.48, p = 0.005*, 95%CI [−0.80, −0.14]). Number of endoscopy visits (0.36, p = 0.110, 95%CI [−0.08, 0980]) and the number of clinic visits (0.42, p = 0.118, 95%CI [−0.11, 0.93]) were similar between the two cohorts. ER visits for virtual cohort included feeding tube complications (20.0%), dysphagia (20.0%), and abdominal pain (13.3%). For the in-person cohort, feeding tube complications (12.8%) and chest pain or cardiac features (9.3%) were the most common reasons. Conclusion The results of this study provide evidence for the increased use of telehealth following esophagectomy. The reduction in emergency admissions in the virtual cohort may be due to increased comfort with phone call appointments or increased fear of hospital visitation during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: As health care professionals and family members, we know that many patients died alone in healthcare settings during the first six months of the COVID-19 pandemic. An extensive literature review confirms this as well, and concludes that visiting restrictions during the pandemic had negative impacts on patients and their loved ones. There is a right to not die alone contained in the Dying Patient's Bill of Rights; however, it happened time and time again during the early months of this pandemic when countless people in long-term care settings and hospitals were reported to be isolated during their final hours of life. No one should die alone! What can we learn from this experience to try to minimize this from happening during the next pandemic? Method: This study will explore the state of the literature on the status and impact of visitor restrictions during the COVID-19 pandemic, in conjunction with a survey of a defined sample of practicing registered nurses in the United States. This study seeks to respond to the primary research question of how patients'/family members' end-of-life needs can be met in a pandemic when hospital visitation is severely limited or non-existent? There are for (4) related sub-questions concerning effective direct and indirect methods of family presence. Results: The literature concludes that countless people were isolated without family presence during their final hours of life during the first six months of COVID-19. The initial survey process is currently underway, with the identification and analysis of recommendations for improvement in early 2023. Conclusion: The goal of this study is to develop best practices for meeting the end-of-life needs of hospitalized patients and their loved ones during a pandemic, so that to the extent possible, no one dies alone. [ABSTRACT FROM AUTHOR]

This study aimed to explore how the COVID-19 pandemic shaped the experiences of family caregivers of older adults who were hospitalized with COVID-19 and discharged to post-acute, skilled home health care (HHC) services. Thirty semi-structured interviews with family caregivers of older adults who received services from a large, not-for-profit HHC agency following hospitalization with COVID-19 infection were conducted between March-July 2021 and analyzed using thematic analysis. During the pandemic, family caregivers encountered societal and institutional barriers to assisting older adults across post-acute care transitions. These barriers included hospital visitation restrictions as well as difficulties accessing community-based resources and medical equipment. Despite limitations and delays in HHC services, many family caregivers identified post-acute HHC, delivered in-person or via telehealth, as important to addressing care gaps for older adults, as well as their own needs for training and support during the pandemic. Policies intended to reduce the spread of COVID-19 introduced new challenges for caregivers during HHC. However, HHC agencies and their staff adapted within this context to provide a needed bridge of support. • Caregivers experienced barriers to assisting with post-acute care during COVID. • Hospital discharge and transfer policies reduced information/communication sharing. • Post-acute home health care was important to addressing care gaps for older adults. • Caregivers expressed the value of support from social workers and aides. [ABSTRACT FROM AUTHOR]

1. Characterize patients in a home-based primary and palliative care (HBMC) practice who died during the spring 2020 COVID-19 surge in New York City 2. Identify multiple levels of disruption that occurred during the COVID-19 surge 3. Describe three ways that home-based medical and palliative care practices are positioned to support end-of-life care for homebound older adults during emergencies COVID-19 end-of-life research has focused primarily on patients who died in hospitals and nursing homes. Less is known about homebound patients receiving home-based primary and palliative care (HBMC) in the community. To describe characteristics and end-of-life care experiences of patients in an HBMC practice who died during New York City's initial 2020 COVID-19 surge. Mixed-methods, retrospective quantitative and narrative analysis of demographic, clinical, and end-of-life data from unstructured electronic medical record notes for all patients who died between March 1 and June 30, 2020. 112 (9%) of the practice's 1,300 patients died during this period, with the average monthly mortality rate doubling in April 2020, the peak of the NYC surge. Thirty-four (30.4%) had confirmed or probable COVID-19. 58 (52%) were referred to hospice, and 50 enrolled. Eighty-two patients (73%) died at home. Our qualitative analysis found that COVID-19 disrupted regular caregiving routines, often requiring new or inexperienced caregivers to step in; rapidly evolving COVID-19 knowledge and protocols complicated access to services (e.g., requiring patients to present a negative COVID-19 test to begin hospice despite testing shortages); avoiding hospitals and emergency departments became an urgent concern due to visitor restrictions and families' fears of loved ones dying alone; and COVID-19 complicated ongoing care for complex conditions (e.g., continuing dialysis for COVID+ patients). Throughout the surge, the HBMC team drew on their collaborative practice and longstanding relationships with patients, families, and hospice and home care providers to navigate service disruptions and provide comfort and emotional support. Overall, COVID-19 created severe disruptions and barriers to necessary care, further complicating care for this very high-risk, high-needs population. HBMC played an integral role in supporting patients and their families through the pandemic surge. As a model focused on interdisciplinary, whole-person care for medically complex patients, HBMC may be uniquely positioned to support homebound patients at the end of life, both during emergencies and beyond. [ABSTRACT FROM AUTHOR]

1. Apply bereaved family suggestions for improving end-of-life care quality in the context of COVID-19 2. Describe opportunities to improve end-of-life care quality using qualitative methods on family and caregiver narrative reports The COVID-19 pandemic led to changes, such as visitation restrictions, that impacted the nature of care delivered to seriously ill patients, especially around including family and caregivers at the end of life. The VA Quality Improvement Resource Center (QuIRC) for palliative care aimed to identify actionable practices to improve end-of-life care quality during the global pandemic. The VA's Bereaved Family Survey (BFS) is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents. QuIRC leveraged the qualitative comments from the BFS. Between February 2020 and March 2021, there were 5,372 responses to two open-ended questions and one open share space in the VA's BFS, of which 1,000 (18.6%) responses were randomly selected. 445 (44.5%) of the responses were related to COVID-19. These were analyzed using standard qualitative content analysis with dual review. Four opportunities with a total of 32 actionable practices were suggested by bereaved family members. Opportunity 1: Facilitate the use of video communication (included four actionable practices). Opportunity 2: Provide timely and accurate responses to family concerns (included 17 actionable practices). Opportunity 3: Accommodate family/caregiver visitation at the end of life (included eight actionable practices). Supporting quote: "We were able to be with him as he took his last breath. We were so very thankful we were able to be with him." Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit (included three actionable practices). Supporting quote: "It was so comforting to know, sitting here in [remote location], that [patient name] was not dying all alone." The findings from this quality improvement project are applicable during a global pandemic, but also translate to improving end-of-life care in all circumstances, such as when family members or caregivers are geographically distant. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has impacted the lives of children and families, created additional stressors, and increased risks for maltreatment. The pandemic has changed the way child welfare agencies operate, requiring changes to policies and practice. Minimal research has considered the effects of the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction. This mixed-methods research study seeks to understand CPS staff satisfaction, variables impacting satisfaction, and challenges that increased since the pandemic began for child welfare workers in Ohio. A sample of staff members (n = 267) from 50 CPS agencies across Ohio participated in the study. This mixed-methods study used logistic regression, chi square analyses, and thematic analysis to analyze the data from a survey sent to child welfare agencies in Ohio. Caring for minor children, primary role at work, and years in child welfare were significantly associated with job satisfaction. Those working in foster care/placement, adoption/permanency, family support/visitation, kinship were 7.57 times more likely than those doing intake/investigation work to be satisfied with their job (p =.007). Thematic analysis of staff issues that increased during the pandemic resulted in six themes: Stress and Anxiety, Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection. The COVID-19 pandemic has created additional stressors for child welfare staff. Practice implications are discussed to help increase job satisfaction, staff wellbeing, and mitigate turnover. [ABSTRACT FROM AUTHOR]

Context: To improve access to care and continuity during the COVID-19 pandemic, family physicians increased their use of virtual care. However, there were concerns that having family physicians see fewer patients in-person was leading to an increase in emergency department (ED) use. Objective: We aimed to understand whether the use of virtual care in the primary care setting was associated with increased emergency department visits. Study design and Analysis: Population-based study comparing the mean ED visits in Feb to Oct 2019 (pre-pandemic) with those in Feb to Oct 2021, stratified by the family physician's percent of care delivered virtually in 2021. Setting or Dataset: Linked health administrative data in Ontario, Canada where primary care and ED visits are fully insured and free at the point-of-care for all permanent residents. Population studied: All family physicians with billings from February to October 2021 (n=15,155) and all patients living in Ontario and attached to a family physician as of March 31, 2021 (n=14,705,864). Outcome measures: The mean number of ED visits among patients, stratified by the percent of care delivered virtually by their attached physician. Results: Mean total ED visits decreased by 15% from 299 per 1000 people in 2019 to 254 visits per 1000 people in 2021. From February to October 2021, 9.2% (n=1,395), 28.1% (n=4,262), 17.8% (n=2,691) and 2.6% (n=400) physicians provided 0%, >60-80%, >80-<100%, and 100% of care virtually, respectively. The largest proportion of patients were seen by physicians who provided >60-80% of care virtually (31.7%, n=4,657,341). Patients whose family physicians provided 100% of visits in-person had the highest mean number of ED visits (488 per 1000), while patients whose physicians delivered >80%-<100% care virtually had the lowest volume of ED use (243 visits per 1000). Trends in ED use across physician virtual care strata were similar in 2019. Conclusions: Family physicians with a higher proportion of virtual encounters did not have higher rates of emergency department use among their patients. Differences observed in patient ED use across levels of physician virtual care provision were similar in 2019, suggesting pre-existing patterns unrelated to the expansion of virtual care during the pandemic. [ABSTRACT FROM AUTHOR]

• Examined mental health ED visits before and during the COVID-19 pandemic. • Adult depression/anxiety, but not substance use or SMI, visits decreased in 2020. • Youth ED visits for behavior problems decreased in 2020 in the lower SES group. • Adults in the lower SES group had higher frequency of mental health ED visits. • Black patients had lower frequency of ED visits for some mental health concerns. This study investigated whether emergency department (ED) visits for mental health concerns increased during the COVID-19 pandemic, taking a health disparities lens. ED encounters from the only academic medical center in Mississippi were extracted from March-December 2019 and 2020, totaling 2,842 pediatric (ages 4–17) and 17,887 adult (ages 18–89) patients. Visits were coded based on primary ED diagnosis. For adults, there were fewer depression/anxiety ED visits during the pandemic, not moderated by any demographic factor, but no differences for serious mental illness or alcohol/substance use. For youth, there were significantly fewer ED visits for behavior problems during the pandemic among children in the lower socioeconomic status (SES) category; there were no differences for depression/anxiety. Regardless of year, adults in the lower SES category were more likely to visit the ED for mental health, Black adults were less likely to visit the ED for depression/anxiety or alcohol/substance use, and Black children were less likely to visit the ED for behavioral concerns. Results suggest that access to outpatient and telehealth services remains critical for mental health care during the pandemic and underline the importance of race- and SES-related factors in use of the ED for mental health concerns beyond the pandemic. [ABSTRACT FROM AUTHOR]

British Columbia restricted visitations to long-term care (LTC) homes to reduce the risk of outbreaks during the coronavirus disease 2019 (COVID-19) pandemic. However, visitors can often play an integral role in maintaining the wellbeing of residents, and restricting can lead to social isolation, worsening physical and mental health, as well as reduced care received among residents. We need to better understand the impact of COVID-19 and restriction policies on LTC residents, including measures such as social visits and technology assistance. A compassionate and humanistic approach is needed to balance infection control with the quality of life of LTC residents. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in strict provincial guidelines to prevent its spread. Physical distancing requirements, the postponement of elective pediatric cardiac surgeries and non-invasive cardiac interventions, and hospital visitor restrictions have significantly impacted services provided by our pediatric cardiac program. Rapid modifications to current inpatient and outpatient practices were required to maintain a family-centered care approach. Strategies our team used to maintain a family-centered care approach focused on six key areas including inpatient care, outpatient pediatric cardiology clinics, family meetings, discharge planning and teaching, the connection of inpatient pediatric patients to the outside world, and social support. The majority of our strategies are adaptable to other pediatric cardiology programs and some may prove useful after the pandemic and as restrictions lift. These strategies each have their own limitations and challenges that must be considered when adapting them to other pediatric cardiology programs and continuing their use after the pandemic has resolved. • Six key strategies to maintain family-centered care in during the pandemic • Limitations and challenges of each of the six strategies • Considerations for healthcare teams prior to implementation of virtual platforms [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic created a number of rapidly emerging and unprecedented challenges for those engaged in substance use disorder (SUD) treatment, forcing service providers to improvise their treatment strategies as the crisis deepened. Drawing from five ongoing federally funded SUD projects in Appalachian Tennessee and hundreds of hours of meetings and interviews, this article explores the pandemic's impact on an already structurally disadvantaged region, its recovery community, and those who serve it. More specifically, we note detrimental effects of increased isolation since the implementation of COVID-19 safety measures, including stakeholders' reports of higher incidences of relapse, overdose, and deaths in the SUD population. Treatment providers have responded with telehealth services, but faced barriers in technology access and computer literacy among clients. Providers have also had to restrict new clients to accommodate social distancing, faced delays in health screening those they can accept, and denied family visitations, which has affected retention. In light of these challenges, several promising lessons for the future emerged--such as preparing for an influx of new and returning clients in need of SUD treatment; making arrangements for long-term housing and facility modification; developing a hybrid care delivery model, taking advantage of new regulations enabling telemedicine; budgeting for and storing personal protective equipment (PPE) and related supplies; and developing disaster protocols to withstand threats to intake, retention, and financial solvency. [ABSTRACT FROM AUTHOR]

Introduction As a verified burn center, we prepare for mass casualty & constantly strive to remain at the forefront of the burn technology & research. There was nothing that prepared us for a statewide stay-at-home order nor the hospital lockdown that would come with the coronavirus pandemic. The hospital lockdowns resulted in disheartening loneliness that would prohibit the visitation of family to the ill or injured patients. The difficulty of locking down well parents proved challenging. Our new hospital policy restricted parent movements & their anxiety of exposure also heightened the desire to discharge. We questioned whether the peds patient was better suited in the hospital or at home. This shifted our usual practice. During March-May, our hospital restricted parent movements out of the patient's room, no visitors, no swap outs during the day. This resulted in early debridements, often at the bedside, & application of the polylactic acid polymer substitute. This allowed for a discharge within 24 hrs & return to clinic in 48 hrs. Methods We reviewed the charts of 10 pediatric patients that normally would have remained hospitalized pre-COVID & these patients were admitted underwent debridement & early application of a polylactic acid polymer skin substitute. The charts were reviewed to determine if there were any readmissions, ER visits, delays in wound healing, delays in OR time, if needed, opposition from parents or nurses from about readiness for discharge. Results The charts indicated there was one return admission. The readmit was from a planned split thickness skin graft & the polylactic acid polymer was used to stage the deeper area while allowing the majority to heal. Charts demonstrated satisfaction of the parents that didn't want to be in the hospital during COVID. No nurses felt uncomfortable & all patients demonstrated stable vitals & good UOP at the time of discharge. This indicates several initial application on admission & was discharged within 24 hours. Conclusions This could at face value be a simple means to an end. The review of records indicates this was successful by most definitions of outcome. The limitation discovered was the ability to optimize outpatient therapy. Burns in the time of COVID, made use reexamine how we have cared for burns & whether there was room to perform more without an inpatient or a decreased inpatient stay. This change in practice also illustrated the ability to the wounds we initially thought may be deeper & possibly need excision actually healed well with no current development of hypertrophic scarring. Our institution will consider the early practice of debridement & lactic acid polymer application even when the restriction are eased. It also forced us to reevaluate how much we are grafting & reexamine what can heal on its own. [ABSTRACT FROM AUTHOR]

The author discusses changes faced by Australian doctors in training (DITs) to their examination schedules, training and educational chances due to the COVID-19 pandemic. Topics discussed include health workplaces and governments forced to move and accept the change, minimized unnecessary visits to healthcare facilities and junior doctors to be rushing to complete audit.

The article focuses on the hospital visitation is essential, and provides comfort to patients, promotes family-driven patient advocacy, and prevents sundowning. It mentions that each hospital has implemented the devices in various ways. It also mentions that partnering with the Rhode Island Medical Society, a group of committed individuals, physicians and non-physicians, a website was created to solicit donations of used tablets.