COVID-19 Pandemic Adversely Affects the Provision of Desired Newborn Circumcision: Perinatal Physician Perspectives

Over half of boys in the United States undergo circumcision, which has its greatest health benefits and lowest risks when performed during the newborn period under local anesthesia. The COVID-19 pandemic has affected delivery of patient care in many ways and likely also influenced the provision of newborn circumcisions. Prior to the pandemic, we planned to conduct a qualitative study to ascertain physician perspectives on providing newborn circumcision care. The interviews incidentally coincided with the onset of the pandemic and thus, pandemic-related changes emerged as a theme. We elected to analyze this theme in greater detail. Semi-structured interviews were conducted with perinatal physicians in a large urban city from 4/2020 to 7/2020. Physicians that perform or counsel regarding newborn circumcision and physicians with knowledge of or responsibility for hospital policies were eligible. Interviews were transcribed verbatim and qualitative coding was performed. Twenty-three physicians from 11 local hospitals participated. Despite no specific COVID-19 related questions in the interview guide, nearly half of physicians identified that the pandemic affected delivery of newborn circumcision care with 8 pandemic-related sub-themes. The commonest sub-themes included COVID-19 related changes in: (1) workflow processes, (2) staffing and availability of circumcision proceduralists, and (3) procedural settings. In summary, this qualitative study revealed unanticipated COVID-19 pandemic-related changes with primarily adverse effects on the provision of desired newborn circumcisions. Some of these changes may become permanent resulting in broad implications for policy makers that will likely need to adapt and redesign the processes and systems for the delivery of newborn circumcision care.

Care and compassion at time of pandemic: an ICU field experience in Italy

After the COVID-19 pandemic outbreak in March 2020, the majority of hospital policies have followed guidelines aimed to prevent the virus transmission and the families’ entry was denied in all hospital wards and intensive care units (ICU). Despite being necessary, such restrictions have been experienced with discomfort and sufferings by the general ICU staff of Treviso Hospital (Italy) and by families of patients. Therefore, from April 2020, a step-by-step project was developed to reactivate contact with COVID-19 patients’ families. The several requests and appeals of intensive care communities and organizations, both nationally and internationally, motivated the Treviso hospital initiative, leading to a model that might be potentially useful to other intensive care units worldwide.

Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital

Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies.Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015–2016. In Longhua, the standardized annual CS rate was around 35% in 2008–2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.

Factors of feasibility: an interview study of physicians’ experiences of expanded access to investigational drugs in three countries

Seriously ill patients who have exhausted all approved treatment regimens and who cannot be enrolled in clinical trials may resort to expanded access programmes in order to gain access to unapproved, investigational drugs. It seems that in some countries, expanded access to investigational drugs is offered in clinical practice on a more routine basis than in other countries. This study is the first to investigate the experiences of physicians with expanded access to investigational drugs in different healthcare systems, with a focus on factors that facilitate or hinder expanded access. Semi-structured interviews (n = 36) were carried out with medical specialists in the Netherlands (n = 14), Turkey (n = 9) and the United States of America (n = 13), and analysed thematically. This study identifies five sets of factors pointed out by physicians that determine the degree to which expanded access to investigational drugs is deemed feasible in clinical practice: the suitability of investigational treatments, the application process, hospital policies, support by pharmaceutical companies, and funding and reimbursement arrangements. Based on the interviews conducted, we conclude that, while legally allowed and technically possible, expanded access is not always feasible for—and not always considered an option by—treating physicians. This is mainly due to lack of familiarity with expanded access, the extensive time and effort required for the application process, willingness or ability of pharmaceutical companies to supply the drugs, and funding issues.

Finding a Place for Music Therapy Practice in a Hospital Child Development Service

<p>This exegesis examines the beginnings of a music therapy practice at a hospital Child Development Service (CDS) in New Zealand, looking at the issues involved in setting up this practice during a student placement over a period nine months. The research is an exploratory case study (Yin 2009) which aims to identify issues through secondary analysis of clinical documentation, using thematic analysis to code and analyse the clinical data. Five core issues were revealed which included: working with team members, interacting with the children's family, issues in the implementation of the intervention, reflections on the student's experience and working within hospital policies and procedures. A case vignette is used to describe an example of arising issues and important factors when working with team members and family. The results of the study suggest that service development is a complex process, showing the importance of collaboration within the multidisciplinary team and involving family members in sessions. In terms of beginning a new music therapy practice in this specific setting, it was found that music therapy was filling a gap in what the child development team could provide. It was also found that there are several factors to consider when establishing a paid position within the service. It is important to create a balance between working within the medical framework philosophy of the hospital and providing a holistic and an empathetic level of care for the families. The project aims to inform other music therapy practitioners and students beginning or establishing work in new settings.</p>

Finding a Place for Music Therapy Practice in a Hospital Child Development Service

<p>This exegesis examines the beginnings of a music therapy practice at a hospital Child Development Service (CDS) in New Zealand, looking at the issues involved in setting up this practice during a student placement over a period nine months. The research is an exploratory case study (Yin 2009) which aims to identify issues through secondary analysis of clinical documentation, using thematic analysis to code and analyse the clinical data. Five core issues were revealed which included: working with team members, interacting with the children's family, issues in the implementation of the intervention, reflections on the student's experience and working within hospital policies and procedures. A case vignette is used to describe an example of arising issues and important factors when working with team members and family. The results of the study suggest that service development is a complex process, showing the importance of collaboration within the multidisciplinary team and involving family members in sessions. In terms of beginning a new music therapy practice in this specific setting, it was found that music therapy was filling a gap in what the child development team could provide. It was also found that there are several factors to consider when establishing a paid position within the service. It is important to create a balance between working within the medical framework philosophy of the hospital and providing a holistic and an empathetic level of care for the families. The project aims to inform other music therapy practitioners and students beginning or establishing work in new settings.</p>

Determinants Influencing Bed Occupancy Rate (BOR) at Langsa Hospital in the Covid-19 Pandemic

Health facilities with referral status for COVID-19 cases, reported a decrease in non-COVID inpatients, compared to facilities with non-referral status. The decrease in bed utilization (BOR) was very significant in several health facilities including Langsa Hospital 10-15% before 65-75%,. This study aims to study the Determinants of Factors Affecting the Decrease in Bed Utilization (BOR) at Langsa Hospital during the COVID-19 Pandemic Period in 2021. The research approach uses descriptive qualitative data collection techniques through in-depth interviews and informants are determined by purposive sampling of key informants, namely 4 inpatients and 2 supporting informants. The total number of informants is 6 people. The research instrument is the researcher himself and data collection through interviews, documentation and field observations. Data analysis technique with taxonomy. The results of the study, namely the availability of services due to reduced facilities, hospital policies in implementing health care programs, priority to hospitals from patients in independent practice health care services and community stigma regarding the confirmation of COVID-19 status in each patient, were the driving factors for the decrease in BOR at Langsa Hospital in the 2021 COVID-19 pandemic. It is recommended that the Langsa Hospital management coordinate with IPSRS for the availability of facilities, the health promotion section conducts more effective promotion and socialization methods and nursing provides training on effective communication.

427. Healthcare Personnel Perceived Benefit of Infection Prevention Strategies during COVID

Background During the COVID-19 pandemic, many infection prevention policy and practice changes were introduced to mitigate hospital transmission. Although each change had evidence-based infection prevention rationale, healthcare personnel (HCP) may have variable perceptions of their relative values. Methods Between October-December 2020, we conducted a voluntary, anonymous, IRB-approved survey of UNC Medical Center HCP regarding their views on personal protective equipment (PPE) and hospital policies designed to prevent COVID acquisition. The survey collected occupational and primary work location data (COVID unit or not) as well as their views on specific infection prevention practices during COVID. Chi squared tests (two tailed) were used to compare differences in the proportions. Results The overall results are displayed (Figure). Among the 694 HCP who responded to the survey, we found HCP were largely (68%) satisfied that the organization was taking all the necessary measures to protect them from COVID-19. A significantly greater proportion (14% more) of HCP (81.7% compared to 67.6%; 95% CI of difference 9.4-18.5%, P&lt; 0.0001) agreed that all PPE was available to them compared to those who were confident that the organization was taking necessary steps for protection, highlighting that safety is more than simply availability of supplies. More than 90% felt that daily screening of patients/visitors and patient/visitor mask requirements were important for protecting them from acquiring COVID in the workplace and that wearing a mask themselves was a key intervention for protecting others. Fewer HCP (72-80%), although still a majority, perceived that eye protection and daily symptom screening for HCP were beneficial. Symptom screening for patients/visitors was perceived by 19% more HCP (90.9% compared to 72.2%; 95% CI of difference 15-23%) to be beneficial than symptom screening of HCP (P&lt; 0.0001). Figure. HCP Perceived Benefit of Infection Prevention Strategies during COVID Conclusion Although infection prevention strategies were implemented based on evidence and in alignment with CDC recommendations, it is important to acknowledge that the perception and acceptance of these recommendations varied among our HCP. Compliance can only be optimized with key interventions when we seek to understand the perceptions of our staff. Disclosures David J. Weber, MD, MPH, PDI (Consultant)

Paediatric tracheostomy: a unique situation in a tertiary children’s hospital in Sabah, Malaysia

<p class="abstract"><strong>Background:</strong> This paper presents our experience in paediatric tracheostomy in a tertiary children’s hospital and to describe the unique multi-racial and multi-ethnic social demographics involved. Moreover, we would like to highlight an unusual social concern in the state of Sabah, Malaysia and its challenges when treating illegal immigrant children.</p><p class="abstract"><strong>Methods:</strong> A retrospective case note review was conducted for all paediatric patients who underwent tracheostomy between January 2014 to December 2018.</p><p class="abstract"><strong>Results:</strong> Seventy-six patients were recruited. Among them thirteen (17.1%) were illegal immigrant children. The commonest indication for tracheostomy was for prolonged assisted ventilation (60.5%), followed by upper airway obstruction (38.2%) and bronchial toileting (1.3%).</p><p class="abstract"><strong>Conclusions: </strong>This study reflects the current trend in regards to the indication for paediatric tracheostomy. The challenges in treating illegal immigrant children need to be considered on a case by case basis encompassing the family’s economic situation, hospital policies and the child well-being.</p>

He Tamariki Kokoti Tau: Families of Indigenous Infants Talk about Their Experiences of Preterm Birth and Neonatal Intensive Care

Māori (Indigenous peoples of Aotearoa New Zealand) bear an unequal burden of poor perinatal health outcomes, including preterm birth. An infant arriving preterm disrupts the birth imaginary of whānau (family collectives) and situates them in a foreign health environment that may not be culturally safe and nurturing. A cross-sectional interpretative phenomenological analysis of first interviews with 19 whānau participating in a Kaupapa Māori (by, with, for Māori) qualitative longitudinal study of preterm birth identified themes from their experiences and the meanings they attributed to them. Preterm birth was an emotional roller coaster, with the birth imaginary and anticipated roles disrupted as health practitioners took over the care of their infants. Whānau expressed the desire to be close to their infants, holding them, loving them, nurturing them, and emplacing them within whakapapa (genealogy, continual layering of foundations) networks. When health practitioners or hospital policies inhibited this intimacy by isolating, excluding, or discriminating, whānau were frustrated. Being familiar with hospital routines, staff, peers, infant cares, and being wrapped in wider whānau support were key for whānau coping. Whakawhanaungatanga (processes of establishing relationships) create safe spaces for whānau to be themselves. This quietens the ‘storm’ and returns whānau to a sense of calm, through the reclamation of their environment.