What is the impact of long-term COVID-19 on workers in healthcare settings? A rapid systematic review of current evidence.

Long COVID is a devastating, long-term, debilitating illness which disproportionately affects healthcare workers, due to the nature of their work. There is currently limited evidence specific to healthcare workers about the experience of living with Long COVID, or its prevalence, pattern of recovery or impact on healthcare. Our objective was to assess the effects of Long COVID among healthcare workers and its impact on health status, working lives, personal circumstances, and use of health service resources. We conducted a systematic rapid review according to current methodological standards and reported it in adherence to the PRISMA 2020 and ENTREQ statements. We searched relevant electronic databases and identified 3770 articles of which two studies providing qualitative evidence and 28 survey studies providing quantitative evidence were eligible. Thematic analysis of the two qualitative studies identified five themes: uncertainty about symptoms, difficulty accessing services, importance of being listened to and supported, patient versus professional identity and suggestions to improve communication and services for people with Long COVID. Common long-term symptoms in the survey studies included fatigue, headache, loss of taste and/or smell, breathlessness, dyspnoea, difficulty concentrating, depression and anxiety. Healthcare workers struggled with their dual identity (patient/doctor) and felt dismissed or not taken seriously by their doctors. Our findings are in line with those in the literature showing that there are barriers to healthcare professionals accessing healthcare and highlighting the challenges of receiving care due to their professional role. A more representative approach in Long COVID research is needed to reflect the diverse nature of healthcare staff and their occupations. This rapid review was conducted using robust methods with the codicil that the pace of research into Long COVID may mean relevant evidence was not identifie

What is the impact of long term COVID-19 on workers in healthcare settings? A rapid review of current evidence. [Protocol]

The objective of this systematic rapid review is to assess the effects of long COVID among healthcare workers and its impact on their self-reported health status, professional working lives, personal circumstances and use of health services. A range of clinical and social science databases will be searched, including MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, and ASSIA. Eligible studies will be those assessing i) the experiences and views of healthcare workers with symptoms of long COVID as well as ii) the impact of long COVID symptoms on health status, working performance, personal circumstances and use of healthcare resources. The eligible population will be healthcare workers with symptoms of long COVID. All clinical and non-clinical staff will be eligible for inclusion, for example, cleaners, domestic staff, receptionists, estate workers

What do we mean by 'older adults' persistent pain self-management'? A concept analysis.

Background: No standard definition exists for the concept “persistent pain self-management” or how it should be defined in relation to older adults. Poorly defined concepts can result in misunderstandings in the clinical setting and can hinder research through difficulties identifying or measuring the concept. Objective: To ascertain attributes, referents, antecedents, and consequences of the concept older adults' persistent pain self-management and develop a theoretical definition. Design: Rodgers evolutionary model of concept analysis was used to systematically analyze articles from the academic and grey literature (N = 45). Data were extracted using standardized extraction forms and analyzed using thematic analysis. Findings: This concept was discussed in three ways: as an intervention, in reference to everyday behaviors, and as an outcome. Five defining attributes were identified: multidimensional process, personal development, active individuals, symptom response, and symptom control. Patients' perceived need and ability to manage pain with support from others is necessary for pain self-management to occur. Numerous physical, psychological, and social health consequences were identified. A theoretical definition is discussed. Conclusions: Our findings have clarified existing use and understanding regarding the concept of older adults' persistent pain self-management. We have identified three areas for future development: refinement of the attributes of this concept within the context of older adults, an exploration of how providers can overcome difficulties supporting older adults' persistent pain self-management, and a clarification of the overall theoretical framework of older adults' persistent pain self-management

No backstage: the relentless emotional management of acute nursing through the COVID-19 pandemic.

The COVID-19 pandemic disordered the routine delivery of health care. We explored nurses' experiences of working in COVID and non-COVID facing roles, focusing on staff in the acute sector of one Scottish health board. The study covered the period between April and July 2021, and was conducted through twenty in-depth interviews. Interactions between patients, family members and nurses changed due to inflection control measures. Staff experienced a range of conflicting emotions, e.g. fear of infection and transmission but a strong sense professional duty to contribute to the pandemic effort. Nurses were dissatisfied with the care they provided and experienced moral dilemmas, distress and injury from the emotional labour caused not only by working under the infection control measures, but also by the virulence and uncertainty of this new disease. We draw on earlier works - Goffman's (1967) presentation of self, Hochschild's (1983) work on emotional labour, and Bolton and Boyd's (2003) work furthering emotional labour - to illustrate that the usual rules and routines of interaction between patients, family and staff were abandoned. Nurses were able to mask their distress and injury, but were often unable to effectively deliver the correct emotional response due to infection control measures, such as protective clothing (PPE) and social distancing. The 'backstage' spaces, important for dealing with the emotion of front stage performances, were missing for those in COVID-facing roles. The isolating work, and the removal of spaces for the donning and doffing of PPE, resulted in limited or no opportunity for humour and the enacting of collective care. Their private space offered little reprieve with the constant media attention on infection levels, death and nursing 'heroes'

Is there evidence for aetiologically distinct subgroups of idiopathic congenital talipes equinovarus? A case-only study and pedigree analysis.

Idiopathic congenital talipes equinovarus (CTEV) is a common developmental foot disorder, the aetiology of which remains largely unknown. Some aspects of the epidemiology suggest the possibility of aetiologically distinct subgroups. Previous studies consider CTEV as a homogenous entity, which may conceal risk factors in particular subgroups. We investigate evidence for aetiologically distinct subgroups of CTEV. Parents of 785 probands completed a postal questionnaire. Family pedigrees were compiled by telephone. Case-only analysis was used to investigate interactions between risk factors and sex of the proband, CTEV laterality and CTEV family history. The male:female ratio was 2.3:1, 58% of probands were affected bilaterally and 11% had a first-second degree family history. There were modest interactions between family history and twin births (multivariate case - only odds ratio [ORca]=3.87, 95%CI 1.19–12.62); family history and maternal use of folic acid supplements in early pregnancy (ORca=0.62, 95%CI 0.38–1.01); and between sex of the proband and maternal alcohol consumption during pregnancy (female, positive history and alcohol consumed: ORca=0.33, 95%CI 0.12–0.89). Previous reports of an interaction between maternal smoking and family history were not confirmed. Relatives of female probands were affected more often than relatives of male probands. These results provide tentative evidence for aetiologically distinct CTEV subgroups. They support the "Carter effect", suggesting CTEV develops though a multifactorial threshold model with females requiring a higher risk factor "load", and suggest areas where future aetiological investigation might focus. Large multi-centre studies are needed to further advance understanding of this common condition

Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates:a controlled interrupted time series analysis

Background: Opioids can be effective analgesics, but long-term use may be associated with harms. In 2013, the first national, comprehensive, evidence-based pain management guideline was published, from the Scottish Intercollegiate Guideline Network (SIGN 136: Management of Chronic Pain) with key recommendations on analgesic prescribing. This study aimed to examine the potential impact on national opioid prescribing rates in Scotland. Methods: Trends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as a comparison drug. Results: After a positive prescribing trend pre-publication, the timing of SIGN 136 publication was associated with a negative change in the trend of opioid prescribing rates (−2.82 items per 1000 population per quarter [PTPPQ]; P < 0.01). By Q2 2020, the relative reduction in the opioid prescribing rate was −20.67% (95% CI: −23.61, −17.76). This persisted after correcting for gabapentinoid prescribing and was mainly driven by the reduction in weak opioids, whereas strong opioid prescribing rates continued to rise. Gabapentinoid prescribing showed a significant rise in level (8.00 items per 1000 population; P = 0.01) and trend (0.27 items PTPPQ; P = 0.01) following SIGN 136 publication. Conclusions: The publication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute

An epidemiological study of neuropathic pain symptoms in Canadian adults

The reported prevalence of neuropathic pain ranges from 6.9% to 10%; however the only Canadian study reported 17.9%. The objective of this study was to describe the epidemiology of neuropathic pain in Canada. A cross-sectional survey was conducted in a random sample of Canadian adults. The response rate was 21.1% (1504/7134). Likely or possible neuropathic pain was defined using a neuropathic pain-related diagnosis and a positive outcome on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) or the Douleur Neuropathique 4 (DN4) Questions. The prevalence of likely neuropathic pain was 1.9% (S-LANSS) and 3.4% (DN4) and that of possible neuropathic pain was 5.8% (S-LANSS) and 8.1% (DN4). Neuropathic pain was highest in economically disadvantaged males. There is a significant burden of neuropathic pain in Canada. The low response rate and a slightly older and less educated sample than the Canadian population may have led to an overestimate of neuropathic pain. Population prevalence varies by screening tool used, indicating more work is needed to develop reliable measures. Population level screening targeted towards high risk groups should improve the sensitivity and specificity of screening, while clinical examination of those with positive screening results will further refine the estimate of prevalence

Lived experience of long COVID in health workers in Scotland (LoCH study).

This is the final project report for project COV/LTE/20/32 ("Lived Experience of Long-Term COVID-19 on NHS Workers in Health Care Settings in Scotland: a Longitudinal Mixed Methods Study"). The Long COVID in health workers (LoCH) study investigated the lived experience of the longer term effects of COVID-19 (long COVID) on professional and ancillary staff employed in the NHS across Scotland. These staff were asked about: their symptoms of long COVID; health and wellbeing; use of healthcare and self management strategies; working in the NHS; and personal and household finances. The report outlines the methodology and results of the study, and identifies key findings and potential impacts

An investigation of health and social care students' and recent graduates' clinical placement and professional practice experiences and coping strategies during the Wave 1 COVID-19 pandemic period.

During the first COVID-19 pandemic wave in 2020, nursing, midwifery, pharmacy, allied health and social work professional students from Robert Gordon University (RGU) were encouraged to undertake extended, paid clinical placements, or enter professional practice earlier than planned. This unparalleled policy intervention was introduced to address concerns that the NHS would be overwhelmed by the ongoing pandemic. Other policy measures implemented at that time included closing down or scaling back routine health and social care, and rapid redeployment of health and social care staff to areas considered business critical e.g. intensive care. Therefore, students entered a health and social care system in a state of significant flux, exposing those individuals to increased risk of unintentional, psychosocial harm. This mixed methods study sought: (1) to investigate the lived experiences and coping strategies of RGU health care and social work students during the Wave 1 COVID-19 pandemic period; and (2) to explore the role and acceptability of online group technologies and other forms of support, which were helpful in building individual resilience and supporting health and wellbeing during this time

An investigation of health and social care students' and recent graduates' clinical placement and professional practice experiences and coping strategies during the Wave 1 COVID-19 pandemic period: supplementary report.

During the first COVID-19 pandemic wave in 2020, nursing, midwifery, pharmacy, allied health and social work professional students from Robert Gordon University (RGU) were encouraged to undertake extended, paid clinical placements, or enter professional practice earlier than planned. This unparalleled policy intervention was introduced to address concerns that the NHS would be overwhelmed by the ongoing pandemic. Other policy measures implemented at that time included closing down or scaling back routine health and social care, and rapid redeployment of health and social care staff to areas considered business critical e.g. intensive care. Therefore, students entered a health and social care system in a state of significant flux, exposing those individuals to increased risk of unintentional, psychosocial harm. This mixed methods study sought: (1) to investigate the lived experiences and coping strategies of RGU health care and social work students during the Wave 1 COVID-19 pandemic period; and (2) to explore the role and acceptability of online group technologies and other forms of support, which were helpful in building individual resilience and supporting health and wellbeing during this time. This report contains supplementary appendices for the main report, which can be found on OpenAIR: https://rgu-repository.worktribe.com/output/176445