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Hand surgery during the COVID-19 pandemic: Clinical care best practices.

ABSTRACT: We aimed to evaluate the effectiveness of a single institution's hand surgery clinical care guidelines at preventing the transmission of COVID-19. This is an anonymous survey study distributed to all employees within the division of hand surgery at a single quaternary-care academic medical facility. The primary outcome measure was the result of their employee surveillance and/or symptom initiated COVID-19 antibody (prior transmission) or polymerase chain reaction test (active infection) after institution of a COVID-19 exposure and transmission mitigating clinical care protocol. Employees were also asked multiple questions regarding their perceived and actual risk of exposure to COVID-19 while performing their clinical duties. Fifty-five of 69 (79.7%) hand clinic personnel employed during the COVID-19 surge from March 23, 2020 to May 18, 2020 (therapist: 15/19; consulting physicians: 11/16, nurses: 10/11; hand surgery residents: 6/6; hand surgery fellows: 4/5; physician assistant/nurse practitioners: 4/7; clinical desk operations specialists 3/4) responded to the survey. Forty-two employees were tested and all were negative for COVID-19 antibodies (42/42). Seventeen (17/55, 30.9%) employees had a known exposure to COVID-19 of which 13 of the 17 (76.5%) were from patients. Ten of these 17 (58.8%) employees were tested for COVID-19 antibodies and were negative. Twenty four of the 55 (43.6%) respondents felt they were at high risk for transmission of COVID-19. These data support ongoing care of emergent and urgent hand surgery patients during the COVID-19 surge and safe operation of an elective hand surgery practice amidst the ongoing pandemic through a multimodal approach.

SUBMITTER: Bartoletta JJ

PROVIDER: S-EPMC8166454 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:In response to the COVID-19 pandemic, many postgraduate medical education lectures and conferences have been moved to a virtual platform. Questions remain regarding the effectiveness of virtual education, what types of educational offerings can be transitioned to a virtual format, and what types of curricula should still take place in person. This study surveyed trainees from the United States who participated in a single institution's hand surgery virtual flipped classroom curriculum of 6 week-long modules. Demographics, premodule and postmodule achieved levels of learning based on Bloom's taxonomy, technology usage, and preferences were surveyed. Of the 65 participants, 41 (63.1%) responded to the survey. Trainees included hand surgery fellows (27/41 [65.9%]), orthopedic surgery residents (11/41[26.8%]), and plastic surgery residents (3/41 [7.3%]). On average, most trainees read, viewed, and participated in more than half of the articles (28/41 [68.3%]), electronic videos (31/41 [75.6%]), and conferences (35/41 [85.4%]) per week. The median level of achieved learning increased from "I can apply" to "I can analyze" for all modules. Self-directed learning was preferred for basic facts and knowledge (26/41 [63.4%]) and faculty-directed learning was preferred to review and practice advanced concepts (34/41 [82.9%]). The participants perceived benefits of the virtual curriculum to include increased scheduling flexibility (8/41[19.5%]), expert opinions (7/41 [17.1%]), and diversity of educational formats (3/41 [7.3%]). The perceived drawbacks included decreased interaction (8/41 [19.5%]), technical difficulties (6/41 [14.6%]), excessive detail (3/41 [7.3%]), and single-institution bias (2/41 [4.9%]). The flipped virtual classroom model is an effective and preferred method of instruction for trainees. Trainees achieved a higher level of learning following the completion of each week-long module. Considerations for the implementation of a virtual curriculum include content quality, quantity, and reducing single-institution bias. The implementation of virtual learning can enhance hand surgery education for the modern learner.

Project description:Background COVID-19 pandemic school shutdowns impacted child food security. Resilient school meal programs are imperative to cope and persist through shocks and stressors. Objective To explore unforeseen positive outcomes and determine best practices during the COVID-19 pandemic for child nutrition directors in Mississippi (MS), Louisiana (LA), and West Virginia (WV). Study Design, Setting, Participants A semi-structured focus group discussion guide was developed based on the resilience capacity model (RCM). Four focus group discussions with child nutrition directors (n = 16) from MS, LA, and WV were conducted to elicit directors’ perceptions of encouraging outcomes during the COVID-19 pandemic and best practices for building resilient school meal programs. Measurable Outcome/Analysis The discussion guide was tested for content validation by subject experts and face validation by testing the guide in one focus group discussion session. The primary researcher developed a codebook based on the conceptual RCM. Two researchers independently reviewed and coded transcripts to assess interrater reliability. Predominant themes were identified using an inductive and deductive content analysis approach. Results Encouraging outcomes included acknowledgment of school nutrition staff as essential workers and recognition of child nutrition programs as important for child food security. Best practices recommended by child nutrition directors include effective communication and networking among all personnel from policymakers to staff involved in food preparation and distribution, revision of standard operating procedures to include disaster/pandemic related mitigation strategies, taking initiatives to improve school meal provision process, and emergency management training for everyone involved in school meal provision process. Director recommendations included: in-class food distribution, increased food storage, preparation, and distribution equipment, and developing a best practices policy document for each state with a comprehensive plan for emergency management situations. Conclusions Future emergency school nutrition policies should encourage efficient communication, revision of existing standard operating procedures, and implement training for all school nutrition personnel. Funding Achieving Equity Investment Grant 2021 (University of Mississippi)

Project description:Objective To explore the perspectives of lactation support providers delivering breastfeeding education via in-person and telehealth consultations and assess the impact of COVID-19 on the provision of breastfeeding education. Design Qualitative descriptive study using purposive sampling. Setting Massachusetts-based lactation support providers who provided in-person and/or telehealth consultations in various practice settings (e.g., inpatient; outpatient; private practice; and the Special Supplemental Nutrition Program for Women, Infants, and Children). Participants Fourteen Massachusetts-based lactation support providers, ages 36 to 68 years. Measurements Participants completed an online demographic and employment characteristics survey and virtual key informant interviews, from which six main themes were defined. Results The six main themes included Common Questions Asked by Clients, Prenatal and Postpartum Consultation Topics, Facilitators for Telehealth Versus In-Person Consultations, Barriers for Telehealth Versus In-Person Consultations, Best Practices, and COVID-19 Adaptations. From participant interviews, common subthemes emerged. The primary adaptation due to COVID-19 was shifting to telehealth. Content in lactation consultations was similar via in-person and telehealth sessions. Typical content areas included breast pumping and mother’s milk supply. A notable difference was the lack of physical examinations for women and newborns in telehealth sessions. Scheduling flexibility was a key facilitator of telehealth consultations, whereas the inability to provide hands-on assistance and chaotic home environments were common barriers. In-person facilitators included weighing newborns to assess feeding success and insurance billing coverage, whereas unsupportive family members were noted as a barrier. Diversity, equity, and inclusion-related barriers (e.g., language barriers, lack of reflective diversity, lack of stable Internet access) were observed in both settings. Best practices for in-person and telehealth consultations included meeting mothers where they are and focusing on mothers’ goals. Conclusion Practice adaptations adopted during the pandemic and best practice recommendations may be useful for lactation support providers and other health care professionals caring for breastfeeding dyads. Practice adaptations adopted during the pandemic and best practice recommendations may be useful for lactation support providers and other health care professionals caring for breastfeeding dyads.

Project description:IntroductionPrior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics.Methods and analysisWe will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis.Ethics and disseminationFormal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.

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Hand surgery during the COVID-19 pandemic: Clinical care best practices.

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