Neurologists’ perceptions of utilising tele-neurology to practice remotely during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic enforced an almost complete switch from face-to-face clinical work to tele-neurology. This study explores neurologists’ perceptions of telephone and videophone remote consultations.MethodsSemi-structured interviews were conducted with neurologists and a GP with a specialist interest (n = 22). Interviews were conducted remotely via Zoom®, audio-recorded, transcribed verbatim and analysed using the principles of thematic analysis.ResultsFour main themes emerged: ‘unknown unknowns (risks/uncertainties)’, ‘better service’, ‘challenges’, and ‘beyond the pandemic’. Thematic saturation was achieved by interview 19. Participants highlighted a number of benefits of remote consultations but over 80% also complained of a reduction in work satisfaction.ConclusionThe sudden introduction of tele-neurology is unlikely to be fully reversed when pandemic-related restrictions have been lifted. However, this study confirms tele-neurology cannot completely replace face-to-face consultations. Some patient groups and consultation types require direct contact. Moreover, significant administrative and infrastructural investment will be required to develop the full potential of tele-neurology.Practice implicationsTele-medicine is capable of improving access and efficiency of specialist neurology services, but limited by lack of non-verbal communication and technical problems. It could enhance service provision with sufficient infrastructural and administrative investment, but may reduce neurologists’ job statisfaction.     

Peripheral neuropathies during the COVID-19 pandemic: is there a relation?

Immunologic Research -     

Cancer survivor’s perspectives on the major challenge in the transition to survivorship

ObjectivesTo understand cancer survivors’ perspectives regarding the major challenge in transitioning from cancer treatment to follow-up care. Identification of major issues should inform survivorship care and help reduce suffering.MethodsA national survey was conducted to identify experiences with follow-up for cancer survivors one to three years post-treatment. The survey included open-ended questions for respondents to add topics of importance and details that offer deeper insight into their experiences. This publication presents analysis of the open-ended question about the major challenge faced by adult cancer population.ResultsOf 13,534 unique adult survey respondents, 8706 respondents identified major challenges. Of those reporting challenges, 4727 (54.3 %) named a single challenge but 3979 (45.7 %) identified more than one. In total, 15,351 challenges were identified. Responses to open-ended questions are summarized under significant themes: major concerns are often more than singular issues; recovery and fear of recurrence; and information needs.Conclusions and practice implicationsResults indicate significant numbers of adult survivors have multiple concerns about physical, emotional, and practical issues but are not receiving assistance and/or appropriate information to help manage these concerns. It is important to determine how health care can be proactive in identifying and addressing needs of survivors.     

Patients’ and oncologists’ views on how oncologists may best address patients’ emotions during consultations: An interview study

Objective

This qualitative study examines patients’ and oncologists’ views on how to best address emotions during consultations, and explores oncologists’ opinions on their own communication and on strategies to improve oncologists’ response to patients’ emotions.

Patients’ and professionals’ perspective of non-in-person visits in hereditary cancer: predictors and impact of the COVID-19 pandemic

PurposeTo identify predictors of patient acceptance of non-in-person cancer genetic visits before and after the COVID-19 pandemic and assess the preferences of health-care professionals.MethodsProspective multicenter cohort study (N = 578, 1 February 2018–20 April 2019) and recontacted during the COVID-19 lockdown in April 2020. Health-care professionals participated in May 2020. Association of personality traits and clinical factors with acceptance was assessed with multivariate analysis.ResultsBefore COVID-19, videoconference was more accepted than telephone-based visits (28% vs. 16% pretest, 30% vs. 19% post-test). Predictors for telephone visits were age (pretest, odds ratio [OR] 10-year increment = 0.79; post-test OR 10Y = 0.78); disclosure of panel testing (OR = 0.60), positive results (OR = 0.52), low conscientiousness group (OR = 2.87), and post-test level of uncertainty (OR = 0.93). Predictors for videoconference were age (pretest, OR 10Y = 0.73; post-test, OR 10Y = 0.75), educational level (pretest: OR = 1.61), low neuroticism (pretest, OR = 1.72), and post-test level of uncertainty (OR = 0.96). Patients’ reported acceptance for non-in-person visits after COVID-19 increased to 92% for the pretest and 85% for the post-test. Health-care professionals only preferred non-in-person visits for disclosure of negative results (83%).ConclusionThese new delivery models need to recognize challenges associated with age and the psychological characteristics of the population and embrace health-care professionals’ preferences.     

“It seems like COVID-19 now is the only disease present on Earth”: living with a rare or undiagnosed disease during the COVID-19 pandemic

PurposePatients with rare and undiagnosed diseases (RUDs) face significant health challenges, which may be exacerbated during the COVID-19 pandemic. The goal of this study was to identify specific impacts of the pandemic on RUD patients, and targets for improving support and health-care access.MethodsWe conducted an online survey of RUD patients and their family members from 21 April to 8 June 2020, recruited from 76 Facebook groups for RUDs. Questions assessed patient characteristics and impacts of the pandemic on RUD diagnosis and management.ResultsRespondents (n = 413), including 274 RUD patients and 139 family members, were predominantly female and white, though income varied. Impacts of the pandemic included (1) barriers to accessing essential health care, (2) specific impacts of restrictive COVID-19 visitation policies on ability to advocate in health-care settings, (3) uncertainty and fear regarding COVID-19 risk, (4) exacerbated physical and mental health challenges, (5) magnified impacts of reduced educational and therapeutic services, and (6) unexpected positive changes due to the pandemic.ConclusionThere are specific, serious challenges affecting RUD patients and families during the COVID-19 pandemic. There is an urgent need to develop approaches to mitigate these challenges both during and beyond the pandemic.     

What doubts,concerns and fears about COVID-19 emerged during the first wave of the pandemic?

ObjectivesThe control of the COVID-19 pandemic depends strongly on effective communication, which must be grounded on the population’s perceptions and knowledge. We aimed to analyse the doubts, concerns and fears expressed by the Portuguese population about COVID-19.MethodsWe performed a content analysis of 293 questions submitted to online, radio, newspaper and TV channel forums during the first month of the pandemic in Portugal.ResultsMost questions contained doubts (n = 230), especially on how to prevent person-to-person transmission (n = 40) and how to proceed in case of symptoms (n = 37). Concerns and fears were also very commonly expressed (n = 144), mostly about which persons could be considered vulnerable (n = 53) and how to prevent transmission during daily life or normal activities (n = 37).ConclusionAs the pandemic evolved and suppression measures were put in place, doubts moved to concerns of vulnerability, quarantine and social isolation, and to doubts about transmission, transmission prevention, and on how to proceed in case of symptoms.Practice implicationsThese results may inform future communication strategies for a more adequate response in the next phases of the COVID-19 pandemic, as well as in future pandemics.     

The COVID-19 anxiety syndrome and selective attentional bias towards COVID-19-related stimuli in UK residents during the 2020–2021 pandemic

The psychological and social effects of the COVID-19 pandemic are pervasive, and there is potential for a long-lasting impact on mental health. In the current study, we sought to provide, in a representative sample of UK residents during the third COVID-19 lockdown in February 2021, further evidence for the validation of the COVID-19 anxiety syndrome construct. We did this by evaluating the COVID-19 anxiety syndrome against measures of personality, health anxiety and COVID-19 anxiety in predicting levels of generalized anxiety and depression and by examining whether increased health anxiety and COVID-19 psychological distress (COVID-19 anxiety and COVID-19 anxiety syndrome) scores were associated with increased attentional bias to COVID-19-related stimuli. A series of correlation analyses revealed that neuroticism, health anxiety, COVID-19 anxiety and COVID-19 anxiety syndrome scores were positively and significantly correlated with generalized anxiety and depression scores and that the perseveration component of the COVID-19 anxiety syndrome predicted generalized anxiety and depression scores independently of age, gender, conscientiousness, openness, health anxiety and COVID-19 anxiety. Furthermore, results indicated that only the total COVID-19 anxiety syndrome score and the scores on the avoidance and perseveration components were positively and significantly correlated with attentional bias indices. More specifically, the general attentional bias index was only shown to be positively and significantly correlated with the total COVID-19 anxiety syndrome score and its perseveration component, while slowed disengagement was only shown to be negatively and significantly correlated with the total COVID-19 anxiety syndrome score and its avoidance component. The implications of these findings are discussed.     

Role of the humoral immune response during COVID-19: guilty or not guilty?

Systemic and mucosal humoral immune responses are crucial to fight respiratory viral infections in the current pandemic of COVID-19 caused by the SARS-CoV-2 virus. During SARS-CoV-2 infection, the dynamics of systemic and mucosal antibody infections are affected by patient characteristics, such as age, sex, disease severity, or prior immunity to other human coronaviruses. Patients suffering from severe disease develop higher levels of anti-SARS-CoV-2 antibodies in serum and mucosal tissues than those with mild disease, and these antibodies are detectable for up to a year after symptom onset. In hospitalized patients, the aberrant glycosylation of anti-SARS-CoV-2 antibodies enhances inflammation-associated antibody Fc-dependent effector functions, thereby contributing to COVID-19 pathophysiology. Current vaccines elicit robust humoral immune responses, principally in the blood. However, they are less effective against new viral variants, such as Delta and Omicron. This review provides an overview of current knowledge about the humoral immune response to SARS-CoV-2, with a particular focus on the protective and pathological role of humoral immunity in COVID-19 severity. We also discuss the humoral immune response elicited by COVID-19 vaccination and protection against emerging viral variants.     

Exploring cancer patients’, caregivers’, and clinicians’ utilisation and experiences of telehealth services during COVID-19: A qualitative study

ObjectivesThe COVID-19 pandemic has significantly impacted oncology. With pandemic restrictions limiting close contact between individuals, telehealth (the use of teleconferencing/videoconferencing to conduct real-time medical consultations) has been increasingly utilised. This qualitative study aimed to explore adult cancer patient, caregiver, and clinician (doctor, nurse, allied health) telehealth experiences during COVID-19 in urban and rural Australian settings and identify potential enablers and barriers to sustained telehealth implementation.MethodsEnglish-speaking participants completed semi-structured interviews regarding their telehealth experiences since March 2020. Interviews ceased when data saturation occurred. Iterative thematic analysis was conducted using NVivo 12 Pro.ResultsThirty-four interviews (clinician=14, patient=13, caregiver=7) were conducted from April to August 2021. Analysis generated seven themes relating to telehealth use: 1) Acceptability as a form of consultation, 2) Impacts on healthcare provision, 3) Communication & relationships, 4) Efficient form of consultation, 5) Comfort of conducting telehealth in different environments, 6) Technological barriers and 7) Future preferences.ConclusionsThe rapid uptake of telehealth during the pandemic has mostly been well-received, and telehealth can be appropriately used in oncology.Practice implicationsBarriers including providing appropriate facilities, technology, and telehealth training; and selecting appropriate patients must be addressed to enable sustained telehealth use in future cancer care.     

The impact of the learning environment sudden shifts on students’ performance in the context of the COVID-19 pandemic

IntroductionThis study aims to determine the effect of sudden changes in learning environments on students’ performance, in the context of the COVID-19 pandemic lockdown. We present an analysis of the kinesiology program, focusing on the learning modality changes through the years, and its impact on students’ performance.MethodsWe analyzed three periods over five years. During the Pre-pandemic period (2018-2019), classes had been taught in-person, during the pandemic (2020-2021) classes had been taught online, and during end of lockdown (2022) classes had return to in-person modality. In addition, we also examined the academic performance outcomes by gender during the three periods.ResultsWe found that the academic performance significantly increased in all cohort of career, increasing the average grade from 4.7 ± 0.08 (2018 to 2019, in-person) to 5.15 ± 0.07 during the pandemic period, from 2020 to 2021, when online modality was utilized. Furthermore, when returning to in-person classes in 2022, the academic performance reduced significantly to 4.6 ± 0.17. We also found that gender did not have an influence on academic performance in any of the learning environments presented. However, during clinical internships, we found that gender had a significantly effect on academic performance.ConclusionBased on these results, we conclude that the sudden shift from in-person learning to online learning modality helped improved the learning performance of student, reflecting those results on better students’ performance scores that could be associated with the enhanced efficient use of time.     

“Alexa,Am I pregnant?”: A content analysis of a virtual assistant’s responses to prenatal health questions during the COVID-19 pandemic

ObjectiveTo elucidate whether Amazon’s virtual assistant, Alexa, provides evidence-based support as a supplement to provider-facilitated prenatal care, during the COVID-19 pandemic.MethodsUsing a conceptual content analysis approach, a query of 40 questions, relating to all phases of pregnancy, was collected from Alexa by two independent investigators, using two unique devices, over a one-week period between May 20, 2020 and May 27, 2020. Alexa’s responses were matched to the evidence-based content from the American College of Obstetricians and Gynecologists (ACOG) and reviewed by a Certified Nurse Midwife for completeness and currency.ResultsOf the 40 questions asked of Alexa, it was unable to answer 14 questions (35%). A total of 21 out of the 40 responses (52%) were not evidence-based and three COVID-specific questions (about 1%) were answered incorrectly or insufficiently. Four questions (10%) were answered accurately.ConclusionAlexa was largely unable to provide evidence-based answers to commonly asked pregnancy questions and, in many cases, supplied inaccurate, incomplete, or completely unrelated answers that could further confuse health consumers.Practice ImplicationsEnsuring that mobile health (mhealth) tools, such as Amazon Alexa, are evidence-based and credible in answering common prenatal questions has important implications for this pandemic and future consumer needs.