North Thames multi-centre service evaluation: Ethical considerations during COVID-19

Objectives During the COVID-19 pandemic, healthcare resources including staff were diverted from paediatric services to support COVID-positive adult patients. Hospital visiting restrictions and reductions in face-to-face paediatric care were also enforced. We investigated the impact of service changes during the first wave of the pandemic on children and young people (CYP), to inform recommendations for maintaining their care during future pandemics. Design A multi-centre service evaluation was performed through a survey of consultant paediatricians working within the North Thames Paediatric Network, a group of paediatric services in London. We investigated six areas: redeployment, visiting restrictions, patient safety, vulnerable children, virtual care and ethical issues. Results Survey responses were received from 47 paediatricians across six National Health Service Trusts. Children's right to health was largely believed to be compromised by the prioritisation of adults during the pandemic (81%; n = 33). Sub-optimal paediatric care due to redeployment (61%; n = 28) and the impact of visiting restrictions on CYP's mental health (79%; n = 37) were reported. Decreased hospital attendances of CYP were associated with parental fear of COVID-19 infection-risks (96%; n = 45) and government ‘stay at home’ advice (89%; n = 42). Reductions in face-to-face care were noted to have disadvantaged those with complex needs, disabilities and safeguarding concerns. Conclusion Consultant paediatricians perceived that paediatric care was compromised during the first wave of the pandemic, resulting in harm to children. This harm must be minimised in subsequent pandemics. Recommendations for future practice which were developed from our findings are provided, including maintaining face-to-face care for vulnerable children.

Download Full-text

The Impact of an Online Mindfulness Program on Self-Compassion, Prosocial Behavior, and Trait Mindfulness

10.31234/osf.io/umqxf ◽

2021 ◽

Author(s):

Neil Bailey ◽

Whitney Comte ◽

Richard Chambers ◽

Larissa Bartlett ◽

Sherelle Connaughton ◽

...

Keyword(s):

Prosocial Behavior ◽

Longitudinal Design ◽

Mindfulness Practice ◽

Trait Mindfulness ◽

Face To Face ◽

Self Compassion ◽

Prosocial Attitudes ◽

Survey Responses ◽

The Impact

Online mindfulness programs have gained traction in recent years due to their increased accessibility and feasibility compared to face-to-face programs. Although much research has demonstrated that face-to-face mindfulness programs can increase trait mindfulness, self-compassion and prosocial attitudes, fewer studies have explored these outcomes in online mindfulness programs. Additionally, the relative importance of formal and informal facets of mindfulness practice (i.e., practicing formal sitting meditation or practicing informally by bringing more awareness to daily activities) has not been extensively examined in either face-to-face or online contexts. This study aimed to test whether participating in a free 4-week online mindfulness program improved trait mindfulness, self-compassion and prosocial behavior, and whether improvements were related to self-reported quality and quantity of mindfulness practice. Using a longitudinal design, a total of 209 matched pre- and post-program survey responses were analysed. Results suggested that participation in the mindfulness program improved participants’ levels of trait mindfulness, self-compassion and prosociality (all p < 0.01). Exploratory analysis indicated the mindfulness program had a significantly greater impact upon prosociality scores for males (p < 0.05). Results also suggested that there was an association between the quality of formal mindfulness practice in the last week of the program and improvements in self-compassion and trait mindfulness (p < 0.01), but this relationship was not present for prosociality, nor for the quality of informal practice or quantity of formal practice. Lastly, exploratory mediation analysis suggested the association between quality of formal practice and self-compassion was mediated by changes in trait mindfulness (p < 0.05). These results suggest participating in an online mindfulness program can lead to improved trait mindfulness, self-compassion, and prosociality. Our results also indicate that practice quality is related to improved trait mindfulness, and that the changes to trait mindfulness mediate improved self-compassion.

Download Full-text

Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2

10.1101/2021.03.13.21253500 ◽

2021 ◽

Cited By ~ 2

Author(s):

Alex F Martin ◽

Sarah Denford ◽

Nicola Love ◽

Derren Ready ◽

Isabel Oliver ◽

...

Keyword(s):

Pilot Study ◽

Minority Groups ◽

Service Evaluation ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Negative Test ◽

Survey Responses ◽

The Impact ◽

Close Contacts

AbstractBackgroundIn December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10-14 days. In this study, we evaluated acceptability of and engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results.MethodsWe conducted a service evaluation of a pilot study, involving an online cross-sectional survey offered to adult (> 18 years) contacts of confirmed COVID-19 cases who were invited to participate in seven days of daily testing instead of isolation. We used a comparison group of contacts who were not offered testing and performed self-isolation. Herein, we examine survey responses from a subset of those who took part in the pilot study and who responded to the evaluation questionnaire.ResultsAcceptability of daily testing was lower among survey respondents who were not offered the option of having it and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant demographic group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts.ConclusionsOur data suggest that daily testing is potentially acceptable, and may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, much of the population has been vaccinated and restrictions on activity have been reduced.

Download Full-text

‘It feels it’s wasting whatever time I’ve got left’: A qualitative study of living with treatable but not curable cancer during the COVID-19 pandemic

Palliative Medicine ◽

10.1177/02692163211049497 ◽

2021 ◽

pp. 026921632110494

Author(s):

Eloise Radcliffe ◽

Aysha Khan ◽

David Wright ◽

Richard Berman ◽

Sara Demain ◽

...

Keyword(s):

Qualitative Study ◽

Self Management ◽

Emotional Wellbeing ◽

Complex Needs ◽

Face To Face ◽

Life Threatening ◽

Informal Carers ◽

Living With Cancer ◽

The Impact ◽

Risk Reducing

Background: People living with cancer that is treatable but not curable have complex needs, often managing health at home, supported by those close to them. Challenges are likely to be exacerbated during the COVID-19 pandemic and the risk-reducing measures introduced in response. The impact of COVID-19 on those living with incurable, life-threatening conditions is little understood. Aim: To investigate the experiences and identify the impact of the COVID-19 pandemic for people living with treatable not curable cancer and their informal carers. Design: Qualitative semi-structured phone interviews were conducted with 21 patients living with cancer that is treatable but not curable and 14 carers. Setting/ participants: Participants were part of a larger longitudinal qualitative study (ENABLE) on supported self-management for people living with cancer that is treatable but not curable. Results: The COVID-19 pandemic magnified uncertainty and anxiety and led to loss of opportunities to do things important to patients in the limited time they have left to live. Lack of face-to-face contact with loved ones had a significant impact on patients’ and carers’ emotional wellbeing. Carers experienced increased responsibilities but less access to formal and informal support and respite. While changes to treatment led to some concern about longer-term impact on health, most patients felt well-supported by healthcare teams. Conclusion: The study provides rich insights into the nature of challenges, uncertainty and lost opportunities resulting from the COVID-19 pandemic for patients and carers living with cancer that is treatable but not curable, which has wider resonance for people living with other life-limiting conditions.

Download Full-text

Linking Twitter and Survey Data: The Impact of Survey Mode and Demographics on Consent Rates Across Three UK Studies

Social Science Computer Review ◽

10.1177/0894439319828011 ◽

2019 ◽

Vol 38 (5) ◽

pp. 517-532 ◽

Cited By ~ 5

Author(s):

Tarek Al Baghal ◽

Luke Sloan ◽

Curtis Jessop ◽

Matthew L. Williams ◽

Pete Burnap

Keyword(s):

Survey Data ◽

Data Linkage ◽

Survey Mode ◽

Face To Face ◽

Unit Nonresponse ◽

Twitter Data ◽

Survey Responses ◽

The Impact ◽

Large Representative ◽

Do So

In light of issues such as increasing unit nonresponse in surveys, several studies argue that social media sources such as Twitter can be used as a viable alternative. However, there are also a number of shortcomings with Twitter data such as questions about its representativeness of the wider population and the inability to validate whose data you are collecting. A useful way forward could be to combine survey and Twitter data to supplement and improve both. To do so, consent within a survey is first needed. This study explores the consent decisions in three large representative surveys of the adult British population to link Twitter data to survey responses and the impact that demographics and survey mode have on these outcomes. Findings suggest that consent rates for data linkage are relatively low, and this is in part mediated by mode, where face-to-face surveys have higher consent rates than web versions. These findings are important to understand the potential for linking Twitter and survey data but also to the consent literature generally.

Download Full-text

COVID-19 pandemic impact on psychotropic prescribing for adults with intellectual disability: an observational study in English specialist community services

BJPsych Open ◽

10.1192/bjo.2021.1064 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Danial Naqvi ◽

Bhathika Perera ◽

Sarah Mitchell ◽

Rory Sheehan ◽

Rohit Shankar

Keyword(s):

Mental Illness ◽

Intellectual Disability ◽

Care Delivery ◽

Service Evaluation ◽

Community Services ◽

Prescribing Patterns ◽

Chi Square ◽

Face To Face ◽

Psychological Comorbidities ◽

The Impact

Background Coronavirus disease 2019 (COVID-19) has had a disproportionate impact on people with intellectual disability (PwID). PwID are at higher risk of mental illness and receive psychotropic prescribing ‘off licence' also, to manage distress behaviour. The lockdown and reduction of multidisciplinary face-to-face appointments had an impact on care delivery, the recourse possibly being psychotropic prescribing. It is imperative to comprehend the influence the pandemic had on psychotropic prescribing patterns to enable future planning. Aims The aim was to understand the impact of the pandemic by comparing psychotropic prescribing patterns during the England lockdown with the prescribing patterns before lockdown in specialist urban and rural psychiatric services for PwID. Method Data was collected from Cornwall (rural) and London (urban) intellectual disability services in England as a service evaluation project to rationalise psychotropic prescribing. PwID in both services open across January 2020 to January 2021 were included. Baseline patient demographics including age, gender, ethnicity, intellectual disability level and neurodevelopmental and psychological comorbidities were collected. Baseline psychotropic prescribing and subsequent % change for each psychotropic group for the two services was compared using Pearson's chi-square and z-statistic (two tailed) with significance taken at P < 0.05. Results The two centres London (n = 113) and Cornwall (n = 97) were largely comparable but for baseline differences in terms of presence of severe mental illness (37 v. 86, P < 0.001), challenging behaviour (44 v. 57, P < 0.05) and attention-deficit hyperactivity disorder (37 v. 3, P < 0.001). There was an overall increase in psychotropic prescribing during lockdown in urban as compared with rural settings (11% v. 2%). Conclusions The pandemic caused an increase in psychotropic prescribing associated with lockdown severity and urban settings. Team structures could have played a role.

Download Full-text

Patient Perception of remote, digital NHS healthcare during the COVID-19 pandemic: a UK-wide survey (Preprint)

10.2196/preprints.22629 ◽

2020 ◽

Author(s):

Rehan Symonds ◽

John Tredinnick-Rowe ◽

Sebastian Stevens ◽

Oliver Sleeman

Keyword(s):

Healthcare Services ◽

Patient Perception ◽

User Preference ◽

Free Text ◽

Remote Consultation ◽

Face To Face ◽

Remote Healthcare ◽

The Uk ◽

Survey Responses ◽

The Impact

BACKGROUND During the early spring of 2020, the use of remote healthcare services in the UK saw a dramatic increase in usage as services transitioned away from face-to-face delivery due to the risk of contracting COVID-19. While by far the largest shift was to telephone access which has been studied in recent years pre-COVID (Campbell, 2014), we wanted to determine the impact on patients of any shift to digital access (via an online consultation using a webcam, laptop, mobile phone application). We therefore commissioned a UK-wide representative survey of patient use and attitudes towards digital remote healthcare during the peak of the 2020 COVID-19 Pandemic in the UK. This report predominantly focuses on primary care as it accounts for 300 million NHS patient contacts each year. OBJECTIVE To rapidly assess patient attitudes towards the use of digital healthcare methods during the COVID-19 pandemic via a representative UK-wide survey. METHODS 2,138 survey responses were analysed against the respondents’ protected characteristics, social status, working status, location (UK region), social media usage and number of children (if any) in their household. Inferential statistics were used to compare these variables and survey responses. The survey consisted of three questions. 2,129 free text responses were thematically analysed from the survey, using an inductive, rapid coding method. RESULTS Initially, 14 themes arose from the data. These were collapsed into 7 parent themes with a smaller number of subtopics. These themes represent patient concern and experience of digital, remote healthcare, (1) Remote healthcare is a lesser service, (2) Useful but only for certain conditions, (3) No preference between face-to-face and remote healthcare. (4) Ease of Access to remote healthcare, (5) Speed of Access to Remote Healthcare. (6) Safety Concerns and Remote Healthcare, and (7) Remote healthcare is better than face-to-face. In summary, current patient perception of remote healthcare is that it is a lesser service, compared to face-to-face delivery. Quantitative results indicate 26% of respondents had used a digital, remote consultation. Users were more likely to be females and in a higher social grade. The largest correlation (Cramer’s V 0.51) between variables was across patients who did not see the benefits of digital, remote consultation but who were willing to use it for safety reasons due to the COVID-19 pandemic. CONCLUSIONS Patient preference for using digital, remote healthcare comes with a series of caveats that practitioners and commissioners should be aware of as the active engagement of patients in remote working appears to be more complex than simple measures of technical ability. The survey data intimates issues around willingness, trust, user-preference and more basic behavioural traits that may not have been factored into the delivery of digital care so far. In short, capacity to act is not well equated to willingness or free will of individuals, least of all acceptance of digital, remote healthcare in any universal form. Our data indicates the need for a psychology-based understanding of the frictions and enablers to remote healthcare, rather than a more narrow assessment of technical capacity if we are to drive behaviour change and help shape effective policy. CLINICALTRIAL n/a

Download Full-text

Increasing Screening Follow-Up for Vulnerable Children: A Partnership with School Nurses

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081572 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1572 ◽

Cited By ~ 4

Author(s):

Eunice Rodriguez ◽

Ashini Srivastava ◽

Melinda Landau

Keyword(s):

Low Income ◽

School Nurses ◽

School Age Children ◽

Full Time ◽

Vision Screening ◽

Minority Children ◽

Vulnerable Children ◽

Survey Responses ◽

The Impact

Approximately 20% of school-age children have a vision problem. Screening is an effective way to detect visual impairments, although only if adequate follow-up is available. Here, we evaluate the impact of hiring full-time nurses in four underserved schools on the likelihood of increasing follow-up for treatment after vision screening. First, we compared descriptive screening follow-up data from the intervention schools with that of five matched schools with part-time nurses in San Jose, California, from 2008 to 2012. The intervention schools had around 2800 low-income, minority children each year, and the five comparison schools had around 3445. Secondly, we conducted a qualitative analysis of open-ended survey responses from 129 teachers in the nine participating schools. In the final year, 96% of the students screened and referred for possible vision problems in schools with full-time nurses were followed up and examined by a health care provider. Yet, only 67% of students screened in comparison schools were examined. Teachers in schools with full-time nurses reported that follow-up of vision problems and getting glasses for students was the most beneficial activity performed by the nurses. School nurses can effectively increase medical care coordination and follow-up of vision screening in low-income communities.

Download Full-text

An innovative approach to teaching bioethics in management of healthcare

Nursing Ethics ◽

10.1177/0969733014558967 ◽

2014 ◽

Vol 23 (2) ◽

pp. 167-175 ◽

Cited By ~ 5

Author(s):

Silviya Aleksandrova-Yankulovska

Keyword(s):

Ethical Issues ◽

Death And Dying ◽

Innovative Approach ◽

Ethical Considerations ◽

Educational Approach ◽

The North ◽

Bioethical Issues ◽

Approach To Teaching ◽

In The Beginning ◽

Medical University

Background: Bioethical courses were introduced in the curricula in medical universities in Bulgaria in 1990s. In the beginning, the courses were mainly theoretical, and systematic case analyses and discussions of movies were introduced later on. The benefits of using films to teach ethics have been previously analyzed in the literature; however, to our knowledge such studies in Bulgaria are yet lacking. Objective: The aim of this study was to survey the opinions of students and analyze the results from the application of movies in bioethics teaching in a medical university in the north of Bulgaria. Methodology: A survey was carried out among 92 students in the management of healthcare. Two movies were used, and separate protocols for film discussion were developed. Ethical considerations: The study was conducted anonymously and with students’ free informed consent. Results and discussion: The students distinguished in total 21 different dilemmas and concepts in the first movie. The ethical dilemmas were classified into five groups: general ethical issues, deontological issues, special ethical issues, principles of bioethics, and theories of ethics. The second movie focused students’ attention on the issues of death and dying. In total, 18 elements of palliative care were described by the students. The range of different categories was a positive indicator of an increased ethical sensitivity. The students evaluated the movies’ discussions as a generally positive educational approach. They perceived the experience as contributing to their better understanding of bioethical issues. Conclusion: The innovative approach was well accepted by the students. The introduction of movies in the courses of bioethics had the potential to provide vivid illustrations of bioethical issues and to contribute to the exploration of specific theses and arguments. The presentation and discussion should be preceded by accumulation of theoretical knowledge. The future of effective bioethics education lays in the interactive involvement of students.

Download Full-text

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽

10.1027/0227-5910/a000025 ◽

2010 ◽

Vol 31 (5) ◽

pp. 238-246 ◽

Cited By ~ 9

Author(s):

Paul W. C. Wong ◽

Wincy S. C. Chan ◽

Philip S. L. Beh ◽

Fiona W. S. Yau ◽

Paul S. F. Yip ◽

...

Keyword(s):

Ethical Issues ◽

Research Participation ◽

Self Report ◽

Initial Contact ◽

Psychological Autopsy ◽

Autopsy Study ◽

The People ◽

And Control ◽

The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Download Full-text