Developing services for long Covid: lessons from a study of wounded healers

AbstractPersistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following Covid 19 infection. No formal guidelines exist in the United Kingdom for treating ‘long Covid’ patients and services are sporadic and variable, although additional funding is promised for their development.In this study narrative interviews and focus groups are used to explore the lived experience of 43 healthcare professionals with long Covid. These individuals see the healthcare system from both professional and patient perspectives thus represent an important wealth of expertise to inform service design.We present a set of co-designed quality standards highlighting equity and ease of access, minimal patient care burden, clinical responsibility, a multidisciplinary and evidence-based approach, and patient involvement and apply these to propose a potential care pathway model that could be adapted and translated to improve care of long Covid patients.Summary boxWhat is known?▪Persistent symptoms (“long Covid”) occur after Covid-19 in 10-20% of sufferers▪Services to manage and rehabilitate patients with long Covid are not yet optimal▪UK healthcare workers experience at least a threefold greater risk of Covid-19 infection and face significant occupational exposure▪Healthcare workers with long Covid can offer important insights into service design and developmentWhat is the question?▪What are the experiences of healthcare workers with long Covid and what are the implications from these for service development?What was found▪Healthcare workers experienced a confusing novel condition that imposed high levels of uncertainty and a significant personal and professional impact.▪Using professional contacts, patient- and professional Mindlines, support groups and Communities of Practice all helped to minimize this uncertainty and high quality therapeutic relationships were essential to cope with it.▪Many experienced a lack of compassion during interactions with the healthcare system and were frustrated by challenges accessing, or absence of, appropriate services.▪Suggestions for improvement included an integrated, multi-disciplinary assessment and rehabilitation service; a set of clinical quality standards; and co-created research and service development.What is the implication for practice now?▪This study supports and extends the principles outlined in recently-developed NHS long Covid quality standards and will inform and support design of dedicated long Covid services.

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Prevalence of SARS-CoV-2 infection among asymptomatic healthcare workers in greater Houston: a cross-sectional analysis of surveillance data from a large healthcare system

10.1101/2020.05.21.20107581 ◽

2020 ◽

Cited By ~ 3

Author(s):

Farhaan S. Vahidy ◽

H. Dirk Sostman ◽

David W. Bernard ◽

Marc L. Boom ◽

Ashley L. Drews ◽

...

Keyword(s):

Reverse Transcriptase ◽

Healthcare System ◽

Healthcare Workers ◽

Direct Care ◽

List Type ◽

Rt Pcr ◽

Chain Reaction ◽

Cross Sectional ◽

Sectional Analysis ◽

Pcr Test

ABSTRACTObjectiveTo determine the prevalence of SARS-CoV-2 infection among asymptomatic COVID-19 facing and non-COVID-19 facing Healthcare Workers (HCWs), with varying job categories across different hospitals.DesignCross-sectional analysis of a healthcare system surveillance program that included asymptomatic clinical (COVID-19 facing and non-COVID-19 facing), and non-clinical HCWs. A convenience sample of asymptomatic community residents (CR) was also tested. Proportions and 95% confidence Intervals (CI) of SARS-CoV-2 positive HCWs are reported. Proportional trend across HCW categories was tested using Chi Square trend test. Logistic regression model-based likelihood estimates of SARS-CoV-2 prevalence among HCWs with varying job functions and across different hospitals are reported as adjusted odds ratios (aOR) and CI.SettingHealthcare system comprising one tertiary care academic medical center and six large community hospitals across Greater Houston and a community sample.Participants2,872 self-reported asymptomatic adult (> 18 years) HCWs and CRs.ExposureClinical HCWs in COVID-19 and non-COVID-19 units, non-Clinical HCWs, and CRs. Job categories of Nursing, Providers, Allied Health, Support, and Administration / Research. Seven hospitals in the healthcare system.Main OutcomesPositive reverse transcriptase polymerized chain reaction (RT-PCR) test for SARS-CoV-2ResultsAmong 2,872 asymptomatic HCWs and CRs, 3.9% (CI: 3.2 – 4.7) tested positive for SARS-CoV-2. Mean (SD) age was 40.9 (11.7) years and 73% were females. Among COVID-19 facing HCWs 5.4% (CI: 4.5 – 6.5) were positive, whereas 0.6% (CI: 0.2 – 1.7%) of non COVID-19 facing HCWs and none of the non-clinical HCWs or CRs were positive (Ptrend < 0.001). Among COVID-19 facing HCWs, SARS-CoV-2 positivity was similar for all job categories (p = 0.74). However, significant differences in positivity were observed across hospitals.Conclusions and RelevanceAsymptomatic HCWs with COVID-19 patient exposure had a higher rate of SARS-CoV-2 positive testing than those not routinely exposed to COVID-19 patients and those not engaged in patient care. Among HCWs with routine COVID-19 exposure, all job types had relatively similar infection rates. These data can inform hospital surveillance and infection control practices for patient-facing job classifications and suggest that general environmental exposure within hospitals is not a significant source of asymptomatic SARS-CoV-2 infection.What is already known on this topicA sizeable proportion of individuals who contract the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can remain largely asymptomatic.Though such individuals may not develop symptoms, they continue to shed enough viral particles to trigger positive reverse transcriptase polymerized chain reaction (RT PCR) test for SARS-CoV-2Prior reports on proportion of asymptomatic SARS-CoV-2 individuals are highly variable with positivity ranging across < 1% to 36%Asymptomatic SARS-CoV-2 infection among healthcare workers is specifically critical to understandWhat this study addsThis study demonstrates that overall rate of SARS-CoV-2 infection among asymptomatic healthcare workers in a large healthcare system of a metropolitan city in the United States was 3.9%The rate of SARS-CoV-2 infection among healthcare workers who provided direct care to COVID-19 patients was 5.4% whereas it was 0.6% among those healthcare workers who did not provide direct care to COVID-19 patientsThere was no difference in SARS-CoV-2 positivity rate for different job categories of healthcare workers who provided direct care to COVID-19 patients

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Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

10.1101/2020.04.11.20062133 ◽

2020 ◽

Cited By ~ 13

Author(s):

Jasmine M Gardner ◽

Lander Willem ◽

Wouter Van Der Wijngaart ◽

Shina Caroline Lynn Kamerlin ◽

Nele Brusselaers ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

Healthcare System ◽

Healthcare Workers ◽

Health Interventions ◽

Parameter Estimates ◽

List Type ◽

Public Health Interventions ◽

Social Distancing ◽

Health Measures

AbstractObjectivesDuring March 2020, the COVID-19 pandemic has rapidly spread globally, and non-pharmaceutical interventions are being used to reduce both the load on the healthcare system as well as overall mortality.DesignIndividual-based transmission modelling using Swedish demographic and Geographical Information System data and conservative COVID-19 epidemiological parameters.SettingSwedenParticipantsA model to simulate all 10.09 million Swedish residents.Interventions5 different non-pharmaceutical public-health interventions including the mitigation strategy of the Swedish government as of 10 April; isolation of the entire household of confirmed cases; closure of schools and non-essential businesses with or without strict social distancing; and strict social distancing with closure of schools and non-essential businesses.Main outcome measuresEstimated acute care and intensive care hospitalisations, COVID-19 attributable deaths, and infections among healthcare workers from 10 April until 29 June.FindingsOur model for Sweden shows that, under conservative epidemiological parameter estimates, the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000). The most stringent public-health measures examined are predicted to reduce mortality by approximately three-fold. Intensive-care load at the peak could be reduced by over two-fold with a shorter period at peak pandemic capacity.ConclusionsOur results predict that, under conservative epidemiological parameter estimates, current measures in Sweden will result in at least 40-fold over-subscription of pre-pandemic Swedish intensive care capacity, with 15.8 percent of Swedish healthcare workers unable to work at the pandemic peak. Modifications to ICU admission criteria from international norms would further increase mortality.What is already known?-The COVID-19 pandemic has spread rapidly in Europe and globally since March 2020.-Mitigation and suppression methods have been suggested to slow down or halt the spread of the COVID-19 pandemic. Most European countries have enacted strict suppression measures including lockdown, school closures, enforced social distancing; while Sweden has chosen a different strategy of milder mitigation as of today (10 April 2020).-Different national policy decisions have been justified by socio-geographic differences among countries. Such differences as well as the tempo and stringency of public-health interventions are likely to affect the impact on each country’s mortality and healthcare system.What this study adds?-Individual-based modelling of COVID-19 spread using Swedish demographics and conservative epidemiological assumptions indicates that the peak of the number of hospitalised patients with COVID-19 can be expected in early May under the current strategy, shifted earlier and attenuated with more stringent public health measures.-Healthcare needs are expected to substantially exceed pre-pandemic capacity even if the most aggressive interventions considered were implemented in the coming weeks. In particular the need for intensive care unit beds will be at least 40-fold greater than the pre-pandemic capacity if the current strategy is maintained, and at least 10-fold greater if strategies approximating the most stringent in Europe are introduced by 10 April.-Our model predicts that, using median infection-fatality-rate estimates, at least 96,000 deaths would occur by 1 July without mitigation. Current policies reduce this number by approximately 15%, while even more aggressive social distancing measures, such as adding household isolation or mandated social distancing can reduce this number by more than 50%.

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COVID-19 Vaccine Intention among Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey

Vaccines ◽

10.3390/vaccines9080835 ◽

2021 ◽

Vol 9 (8) ◽

pp. 835

Author(s):

Mohammed Noushad ◽

Mohammad Zakaria Nassani ◽

Anas B. Alsalhani ◽

Pradeep Koppolu ◽

Fayez Hussain Niazi ◽

...

Keyword(s):

Saudi Arabia ◽

Healthcare System ◽

Healthcare Workers ◽

Vaccine Coverage ◽

Vaccination Campaign ◽

Herd Immunity ◽

Positive Sign ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Public Health Strategies

The COVID-19 pandemic has caused largescale morbidity and mortality and a tremendous burden on the healthcare system. Healthcare workers (HCWs) require adequate protection to avoid onward transmission and minimize burden on the healthcare system. Moreover, HCWs can also influence the general public into accepting the COVID-19 vaccine. Therefore, determining COVID-19 vaccine intention among HCWs is of paramount importance to plan tailor-made public health strategies to maximize vaccine coverage. A structured questionnaire was administered in February and March 2021 among HCWs in Saudi Arabia using convenience sampling, proceeding the launch of the vaccination campaign. HCWs from all administrative regions of Saudi Arabia were included in the study. In total, 674 out of 1124 HCWs responded and completed the survey (response rate 59.9%). About 65 percent of the HCWs intended to get vaccinated. The intention to vaccinate was significantly higher among HCWs 50 years of age or older, Saudi nationals and those who followed the updates about COVID-19 vaccines (p < 0.05). The high percentage (26 percent) of those who were undecided in getting vaccinated is a positive sign. As the vaccination campaign gathers pace, the attitude is expected to change over time. Emphasis should be on planning healthcare strategies to convince the undecided HCWs into accepting the vaccine in order to achieve the coverage required to achieve herd immunity.

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International consensus on quality standards for brain health-focused care in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458518809326 ◽

2018 ◽

Vol 25 (13) ◽

pp. 1809-1818 ◽

Cited By ~ 13

Author(s):

Jeremy Hobart ◽

Amy Bowen ◽

George Pepper ◽

Harriet Crofts ◽

Lucy Eberhard ◽

...

Keyword(s):

Multiple Sclerosis ◽

Treatment Effectiveness ◽

Care Pathway ◽

Disease Onset ◽

Quality Standards ◽

Cell Loss ◽

Service Evaluation ◽

Brain Health ◽

International Consensus ◽

Time Frames

Background: Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset. The MS community has endorsed a management strategy of prompt diagnosis, timely intervention and regular proactive monitoring of treatment effectiveness and disease activity to improve outcomes in people with MS. Objectives: We sought to develop internationally applicable quality standards for timely, brain health–focused MS care. Methods: A panel of MS specialist neurologists participated in an iterative, online, modified Delphi process to define ‘core’, ‘achievable’ and ‘aspirational’ time frames reflecting minimum, good and high care standards, respectively. A multidisciplinary Reviewing Group (MS nurses, people with MS, allied healthcare professionals) provided insights ensuring recommendations reflected perspectives from multiple stakeholders. Results: Twenty-one MS neurologists from 19 countries reached consensus on most core (25/27), achievable (25/27) and aspirational (22/27) time frames at the end of five rounds. Agreed standards cover six aspects of the care pathway: symptom onset, referral and diagnosis, treatment decisions, lifestyle, disease monitoring and managing new symptoms. Conclusion: These quality standards for core, achievable and aspirational care provide MS teams with a three-level framework for service evaluation, benchmarking and improvement. They have the potential to produce a profound change in the care of people with MS.

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Nano Silver Coated Surgical Apparels and Phaco Needles for Safety of Ophthalmic Surgeons in View of COVID-19 Pandemic

The Open Ophthalmology Journal ◽

10.2174/1874364102115010009 ◽

2021 ◽

Vol 15 (1) ◽

pp. 9-12

Author(s):

Santosh Dnyanmote ◽

Jorge Alio ◽

Anuradha Dnyanmote

Keyword(s):

Healthcare System ◽

Healthcare Workers ◽

Respiratory Virus ◽

Hospital Staff ◽

Infected Person ◽

Source Of Infection ◽

Potential Source ◽

Corona Virus ◽

Co Morbidity ◽

Recent Outbreak

Background: In view of the recent outbreak of the pandemic caused by novel corona virus 19 (n-covid) which has thrown the overall healthcare system that has created fear, apprehension and anxiety amongst all surgeons. Ophthalmic surgeons are no exceptions. The new corona virus is a respiratory virus of the Coronoviridae family containing a single strand of RNA which spreads primarily through droplets generated when an infected person coughs or sneezes or through droplets of saliva or discharge from the nose. A person can get infected by the virus if the person is within 1 meter of a person with COVID 19 or by touching contaminated surface and then touching eyes, nose or mouth. Methods: Standard recommendations to prevent the spread of COVID-19 include frequent cleaning of hands using alcohol based hand rubs or soap and water. Covering the nose and mouth with a proper mask, covering skin, eyes, hair, hands and legs with proper apparel is important. Just like elderly members of the society, the healthcare workers who have some co-morbidity are susceptible to COVID-19 invasion. Asymptomatic carriers who may present with senile or pre-senile cataract can be a potential source of infection to other patients, hospital staff, surgeons and others. Conclusion: It is important that all the microsurgical instruments which will be used for phacoemulsification be properly sterilized. The surfaces of these instruments should remain free of contaminants as these instruments will be used multiple times in other patients as well.

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Strengthening public COVID-19 response with private facilities in Kisumu, Kenya

10.1101/2021.08.31.21262891 ◽

2021 ◽

Author(s):

Shannen van Duijn ◽

Hellen C. Barsosio ◽

Mevis Omollo ◽

Emmanuel Milimo ◽

Isdorah A. Odero ◽

...

Keyword(s):

Private Sector ◽

Healthcare Workers ◽

Scale Up ◽

Public Private Partnership ◽

Healthcare Sector ◽

List Type ◽

Private Partnership ◽

Healthcare Facilities ◽

New Findings ◽

The Way

AbstractINTRODUCTIONSARS-CoV-2 testing is one of the options to combat COVID-19 in Kenya. In the first COVID-19 year there was limited tapping of the private sector’s potential to scale up testing in Kenya. In April 2020, we initiated a unique public-private partnership (PPP) project in Kisumu County connecting the private sector to centralized testing supported by the ministry of health (MoH), ‘COVID-Dx’, to accelerate the local response to COVID-19. Within COVID-Dx, we aimed to demonstrate this PPP’s performance as a replicable model for effective public-private collaboration in responding to the COVID-19 pandemic in similar settings.METHODSKEMRI, Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities collaborated in COVID-Dx. COVID-Dx was implemented from June 01, 2020, to March 31, 2021, in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the MoH COVID-19 case definition. Samples were tested at the central laboratory in KEMRI via SARS-CoV-2 RT-PCR. Healthcare workers in participating facilities collected data using the digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboard to all relevant stakeholders. We did descriptive statistical analyses using Stata 16 to inform project processes.RESULTSNine facilities participated in the project. A total of 4,324 PCR tests for SARS-CoV-2 were done, with 425 positives. We noted differences in positivity rates between the facilities. Healthcare workers were the largest group tested in the project, 1009, representing 43% of the Kisumu healthcare workforce.CONCLUSIONCOVID-Dx can serve as a model for PPPs scale-up testing, especially LMICs, and digitizing the MoH case report form improved reporting efficiency, demonstrating that digital is the way forward. The COVID-Dx PPP has led to another collaboration with Kisumu County aimed towards extending the COVID-Dx model to other counties.SUMMARY BOXWhat is already known?In sub-Saharan Africa, COVID-19 responses are mainly rolled out through the public healthcare sector, even though the private sector plays a significant role in health service deliveryThe challenge is to combine private and public efforts in healthcare delivery in a mutually supportive and collaborative manner, especially during large outbreaks such as COVID-19.What are the new findings?The development of a public-private partnership (COVID-Dx) at the start of a global pandemic - COVID-19 – is challenging, but PPPs are essential for epidemic preparedness.The development of a digital app with a corresponding dashboard, ensures transparency and efficiency. It has shown to enable data-driven decision-making and provides insight into how to prioritize funding streams.What do the new findings imply?This PPP model is replicable and can serve as an example of PPPs for epidemic preparedness in similar settings in LMICs.Digital is the way going forward when combatting large outbreaks in the future, especially in LMICs

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Service Design

Industrial Engineering ◽

10.4018/978-1-4666-1945-6.ch014 ◽

2012 ◽

pp. 211-222

Author(s):

Satu Miettinen

Keyword(s):

Design Process ◽

Design Thinking ◽

Service Design ◽

Design Methods ◽

Point Of View ◽

Human Interaction ◽

Service Development ◽

Service Needs ◽

New Ideas ◽

Tourism Service

Service design is establishing itself as a method for developing services and service business. Service needs, new ideas and ways to utilise technology are encountered when the customer and the end user participate in the design process. This chapter focuses on service design methods and the process of how service design can help in innovating customer-orientated service concepts for e-tourism. Service design connects the areas of cultural, social and human interaction. Use of design methods acts as a link between the different views in the service design process. Service design is an emerging field where the terminology and methods are still developing. Mager (2009) has pointed out that the need for service design is evident, as economic development has changed dramatically during the last four decades from manufacturing to provision of information and services. Service design looks at service development from the designer’s point of view. Design thinking has the ability to create concepts, solutions and future service experiences for users.

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35 Online randomised controlled trial to improve clinical estimates of survival (ORACLES): study design

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.35 ◽

2018 ◽

Vol 8 (3) ◽

pp. 373.1-373 ◽

Cited By ~ 1

Author(s):

Linda Oostendorp ◽

Nicola White ◽

Priscilla Harries ◽

Sarah Yardley ◽

Christopher Tomlinson ◽

...

Keyword(s):

Palliative Care ◽

Medical Students ◽

Randomised Controlled Trial ◽

Care Pathway ◽

Low Cost ◽

Controlled Trial ◽

Online Training ◽

List Type ◽

More Care ◽

Randomised Controlled

IntroductionClinicians often struggle to recognise whether palliative care patients are imminently dying.1 2 A previous study identified the factors that expert palliative care doctors (with demonstrated prognostic skills) had used to judge the probability of patients dying within 72 hours.Aim and methodsTo evaluate whether an online training resource can teach medical students to formulate survival estimates for palliative care patients that are more similar to experts’ estimates. In this online randomised controlled trial we will recruit 128 students in the penultimate/final year of medical school. Participants are asked to review three series of vignettes describing patients referred to palliative care and provide estimates (0%–100%) about the probability that patients will die within 72 hours. After the first series of vignettes students in the intervention arm are given access to the training resource showing how experts weighted the various symptoms/signs. Participants are asked to complete a second series of vignettes and then a third series after two weeks to assess if any effect has been maintained.ResultsStudents’ survival estimates will be correlated with experts’ estimates to determine the baseline level of agreement and any changes following the intervention. The primary outcome will be the survival estimates provided in the second series of vignettes. Secondary outcomes include the estimates provided at the follow-up the weighting of symptoms/signs and levels of discrimination and consistency.ConclusionThis study will provide evidence about whether a brief low-cost online training resource can influence how medical students make prognostic decisions in an experimental setting.References. Neuberger J. More care less pathway: A review of the liverpool care pathway.Department of Health2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf [Accessed: 30thMay 2018]. White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?PLoS One25 August 2016;11(8):e0161407. Available from: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0161407&type=printable [Accessed: 30th May 2018]

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Healthcare workers’ legal liability and immunity during the COVID-19 pandemic

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.449 ◽

2020 ◽

pp. 1-8

Author(s):

Nasser Hammad Al-Azri

Keyword(s):

Public Good ◽

Healthcare System ◽

Disaster Response ◽

Healthcare Workers ◽

Healthcare Professionals ◽

Legal Liability ◽

Working Environment ◽

The Public ◽

Healthcare Workforce ◽

Healthcare Practice

Abstract The COVID-19 pandemic is the most unprecedented crisis facing modern healthcare governance in a century. Many healthcare activities are attracting scrutiny from ethical and legal perspectives. Therefore, healthcare professionals are concerned about legal ambiguity regarding legal liability and immunity in their areas of practice. Law is a key response activity that promotes a sense of safety and security among healthcare workers. This article describes why it is important formally to address issues of altered operations in healthcare practice during emergencies. Furthermore, this article provides suggestions regarding solutions to the issue of legal liability during disasters. Implementing ethical and legal clarity during disaster response is a necessity for a strong healthcare system at every level from international to local in order to achieve a stable healthcare workforce operating for the public good within a safe and secure working environment.

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