Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.

CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.

Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.

To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.

Trauma plays an important role in the development of psychosis, but no studies have investigated whether a trauma-focused therapy could prevent psychosis.

This study aimed to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to prevent psychosis in people with an at-risk mental state (ARMS), using eye-movement desensitisation and reprocessing therapy (EMDR).

This started as a mixed-method randomised study comparing EMDR to treatment as usual but, as a result of low participant recruitment, was changed to a single-arm feasibility study. The proposed primary outcome for an RCT was transition to psychosis at 12-month follow-up. Data on secondary outcomes were also collected. Qualitative interviews were conducted with patients and therapists.

Fourteen participants were recruited from the Early Intervention teams. Most people who expressed an interest in taking part attended an assessment to determine eligibility. All those eligible consented to take part. A total of 64% (7 of 11) of participants who were offered EMDR were followed up at 12 months. Of the 11 participants offered EMDR, one (11%, 95% CI: 0.2%, 48%) transitioned to psychosis. Nine patients and three therapists were interviewed. Participants who completed therapy (n = 4; mean 10.5 sessions) found EMDR helpful, but those who discontinued (n = 6; mean 5.2 sessions) said it had not benefitted them overall. Therapists said EMDR could be effective, although not for all patients.

Future studies recruiting people with an ARMS to an RCT may need to extend recruitment beyond Early Intervention teams. Although some individuals found EMDR helpful, reasons for discontinuing need to be addressed in future studies.

Despite positive findings around the use of eHealth in dementia care, evidence for its efficacy is insufficient to ensure its adoption into routine care. Early involvement of end-users in the design of an implementation plan is a key strategy for promoting translation of findings into practice.

This study aimed to identify the requirements for use of an eHealth intervention to support assessment and decision making for use with people with dementia in care homes, and co-design strategies for its implementation.

A qualitative co-design method was applied through a series of workshops. Participants included family carers of people with dementia, and health and social care practitioners with direct experience of working with people with dementia. The workshops focused on identifying requirements for use and co-developing implementation strategies in response to factors identified to influence implementation. A deductive thematic analytic approach was taken, guided by the key concepts of the Normalisation Process Theory.

Three workshops were conducted from July’21-November’21, attended by 39 participants. Three overarching phases of requirements were identified: 1) incentivising adoption of eHealth; 2) enabling operation of an eHealth intervention; 3) sustaining use of eHealth. Initial adoption requires promotion of the interventions benefits to engage stakeholders, and its alignment with national recommendations for good quality dementia care. Operationalising eHealth involves ensuring its compatibility with current care home processes and technology, provision of sufficient training and support from ‘champions’. To sustain its use, ongoing monitoring of the implementation plan and provision of feedback to allow stakeholders to appraise its effects is required.

Implementing eHealth across a complex system of care homes is a multifaceted process. Using the key requirements identified in the workshops, we have developed a multi-strategy plan centered around three phases of implementation, to promote uptake of eHealth to support assessment and decision making for people with dementia in care homes. This is strengthened through collaborating with end-users to increases its value, credibility and real-world relevance. The theoretically informed strategies target mechanisms previously demonstrated to shape the implementation process and outcomes, ready for testing in care homes.

To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection.

Case–control study.

This study analyzed data collected in May–December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon.

Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed.

HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase– polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression.

Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37–2.26).

These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.

The ‘MRCPsych Course’ (Membership of the Royal College of Psychiatrists) is provided to all core trainees in psychiatry in Wales by the School of Psychiatry, Health Education and Improvement Wales (HEIW), now delivered online since the start of the COVID-19 pandemic. The aims of the HEIW MRCPsych course are: to prepare core trainees for the MRCPsych exams and to set a ‘robust platform’ for speciality training at the higher level in psychiatry. We undertook a quality assurance of the 2020/21 academic year to see how content and delivery of the course were serving these aims and make recommendations for improvement.

Over the course of one academic year we triangulated trainee feedback, lecturer feedback and peer review. Trainee and trainer feedback forms were sent out following every session. We developed standards and criteria for peer review and reviewed 10% of sessions. We conducted focus groups with trainees using mentimeter to structure a real time, anonymous interaction with parallel verbal and written discussions using a virtual meeting.

Trainee feedback forms were received for 31 lectures from an average of 11 trainees per session. 14 Lecturer feedback forms were received, and 48 trainees attended the two focus groups. 15 hours of teaching underwent peer review.

Lecture content was universally accurate and up to date and all teachers were fluent and engaging, with almost all incorporating research data, guidelines and inspiration for further learning.

Several lecturer feedback forms requested a curriculum be provided. Some trainees requested a more exam focused approach with more MCQs.

Trainees found online sessions more accessible and convenient. The major downside being that they no longer get to know each other and feel very anonymous, which makes peer support and interaction more difficult.

Interactive engagement was the lowest scored domain overall. Interaction seemed to work best when done as a continuous process from the start and when a variety of techniques were engaged. Trainee's suggestions for increasing interactivity included quizzes, polls, breakout rooms, use of interactive tools, and a general encouragement of cameras and microphones on and active discussion throughout the session.

Speakers had no problems using the technology to deliver an online session, this triangulated with their high confidence and high satisfaction reported by lectures with HEIW practical support. Trainees reported a high satisfaction with the quality of teaching on the course.

Our conclusions have informed changes which are currently being implemented and tested.

To describe the development and implementation of a novel tool designed to enhance nurse–patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience.

An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires.

Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001).

Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.

This study aimed to identify a well-fitting and theoretically justified item-level latent factor structure for the Wechsler Memory Scales (WMS)-IV verbal paired associates (VerbalPA) subtest to facilitate the ease and accuracy of score interpretations for patients with lateralized temporal lobe epilepsy (TLE).

Archival data were used from 250 heterogeneous neurosciences patients who were administered the WMS-IV as part of a standard neuropsychological assessment. Three theoretically motivated models for the latent structure of VerbalPA were tested using confirmatory factor analysis. The first model, based on cognitive principles of semantic processing from hub-and-spoke theory, tested whether performance is related to specific semantic features of target words. The second, motivated by the Cattell–Horn–Carroll (CHC) model of cognitive abilities, investigated whether the associative properties of items influence performance. A third, Hybrid model tested whether performance is related to both semantic and associative properties of items. The best-fitting model was tested for diagnostic group effects contrasting the heterogeneous neuroscience patients with subsets of left and right TLE (n = 51, n = 26, respectively) patients.

The Hybrid model was found to have the best fit. Patients with left TLE scored significantly less well than the heterogeneous neurosciences sample on selected semantic factor scores, although the effect size was small.

Future editions of the WMS may consider implementing a semantic scoring structure for the VerbalPA to facilitate test score interpretation. Additionally, these results suggest that principles of hub-and-spoke theory may be integrated into CHC cognitive ability taxonomy.

There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.

This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.

We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.

The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.

The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.