Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care

Unmasking the Impact: Exploring the Role of Masks in Trauma-Informed Care Communication

INTRODUCTION

The COVID pandemic has necessitated mask-wearing by inpatient providers; however, the impact of masks on the acute care surgeon-patient relationship is unknown. We hypothesized that mask-wearing, while necessary, has a negative impact by acting as a barrier to communication, empathy, and trust between patients and surgeons.

METHODS

A cross-sectional study was performed by administering a written survey in English or Spanish to trauma, emergency general surgery, burn, and surgical critical care inpatients aged ≥18 y at a University Level 1 Trauma Center between January 2023 and June 2023. Patients were asked seven questions about their perception of mask effect on interactions with their surgery providers. Responses were scored on a five-point Likert scale and binarized for multivariable logistic regression.

RESULTS

There were 188 patients who completed the survey. The patients were 68% male, 44% Hispanic, and 17% Spanish speaking, with a median age of 45-54 y. A third of patients agreed that surgeon mask-wearing made it harder to understand the details of their surgical procedure and made them less comfortable in giving consent. Twenty three percent agreed that it was harder to trust their provider; increasing age was associated with lower levels of trust, odds ratio 1.36 (confidence interval 1.10-1.71, P = 0.006). Findings were consistent among patients of different sex, race/ethnicity, language, and pre-COVID hospital experience.

CONCLUSIONS

Mask-wearing, while important, has a negative impact on the patient-surgeon relationship in trauma and acute care surgery. Providers must be conscious of this effect while wearing masks and strive to optimize communication with patients to ensure high-quality trauma-informed care.

Reading language of the eyes in female depression

Aberrations in non-verbal social cognition have been reported to coincide with major depressive disorder. Yet little is known about the role of the eyes. To fill this gap, the present study explores whether and, if so, how reading language of the eyes is altered in depression. For this purpose, patients and person-by-person matched typically developing individuals were administered the Emotions in Masked Faces task and Reading the Mind in the Eyes Test, modified, both of which contained a comparable amount of visual information available. For achieving group homogeneity, we set a focus on females as major depressive disorder displays a gender-specific profile. The findings show that facial masks selectively affect inferring emotions: recognition of sadness and anger are more heavily compromised in major depressive disorder as compared with typically developing controls, whereas the recognition of fear, happiness, and neutral expressions remains unhindered. Disgust, the forgotten emotion of psychiatry, is the least recognizable emotion in both groups. On the Reading the Mind in the Eyes Test patients exhibit lower accuracy on positive expressions than their typically developing peers, but do not differ on negative items. In both depressive and typically developing individuals, the ability to recognize emotions behind a mask and performance on the Reading the Mind in the Eyes Test are linked to each other in processing speed, but not recognition accuracy. The outcome provides a blueprint for understanding the complexities of reading language of the eyes within and beyond the COVID-19 pandemic.

Behind the mask: What the eyes can't tell: Facial emotion recognition in a sample of Italian health care students

Wearing a facemask remains a pivotal strategy to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection even after vaccination, but one of the possible costs of this protection is that it may interfere with the ability to read emotion in facial expressions. We explored the extent to which it may be more difficult for participants to read emotions in faces when faces are covered with masks than when they are not, and whether participants' empathy, attachment style, and patient-centred orientation would affect their performance. Medical and nursing students (N = 429) were administered either a masked or unmasked set of 24 adult faces depicting anger, sadness, fear, or happiness. Participants also completed self-report measures of empathy, patient-centredness, and attachment style. As predicted, participants made more errors to the masked than the unmasked faces with the exception of the identification of fear. Of note, when participants missed happiness, they were most likely to see it as sadness, and when they missed anger, they were most likely to see it as happiness. A multiple linear regression analysis showed that more errors identifying emotions in faces was associated with faces being masked as opposed to unmasked, lower scores on the empathy fantasy scale, and higher scores on the fearful attachment style. The findings suggest that wearing facemasks is associated with a variety of negative outcomes that might interfere with the building of positive relationships between health care workers and patients. Those who teach student health care workers would benefit from bringing this finding into their curriculum and training.

Pattern and Perception of Impact of Wearing Face Masks on Communication Among Health Care Workers During COVID-19 pandemic: An Observational Study

To assess the impact of wearing masks (KN95, surgical, cloth mask) due to COVID-19 pandemic on interpersonal communication among health care workers and with patients. The present observational study was conducted in tertiary care centre and also included participants from various other health care facilities from all over India over a period of one year from March 2022 to March 2023. 203 health care workers consented to participate in the study. The study was done as an online survey using the questionnaire which was adapted into a Google form consisting of a 15 closed set questions. Participants rated the question using a binary forced choice as either YES or NO. The mean age of participants consenting to the study was 30.9 ± 6.3 SD years,with male predominance (%). Among the choice of use of face mask, 76.35% used surgical mask, 14.77% used KN95 and 8.86% used cloth masks. 15 questions were divided in 5 categories; analysis showed that majority of questions had an affirmative "yes" response. This results of this study indicated that the sudden change in the existing communication situation due to use of face masks in the clinical setup affected interpersonal communication among healthcare workers and with patients, which may also have a bearing on both patient and clinician well being and could have a significant economic impact on health care systems globally. These results provide information about the clinical strain introduced from use of face masks in healthcare settings. Overall, results showed that in healthcare settings, there is increased cognitive load and listening effort for patients and health care providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss.

The impact of the COVID-19 pandemic on academic performance: a comparative analysis of face-to face and online assessment

Introduction

Survey studies yield mixed results on the influence of the COVID-19 pandemic on academic performance, with limited direct evidence available.

Methodology

Using the academic platform from the Italian university system, a large-scale archival study involving 30,731 students and 829 examiners encompassing a total of 246,416 exams (oral tests only) to scrutinize the influence of the COVID-19 pandemic on the likelihood of passing exams was conducted. Examination data were collected both in face-to-face and online formats during the pandemic. In the pre-pandemic period, only face-to-face data were accessible.

Results

In face-to-face examination, we observed a lower probability of passing exams during the pandemic as opposed to pre-pandemic periods. Notably, during the pandemic we found an increased chance of passing exams conducted through online platforms compared to face-to-face assessments.

Discussion and conclusions

These findings provide the first direct evidence of an adverse impact of the COVID-19 pandemic on academic performance. Furthermore, the results align with prior survey studies underscoring that using telematics platforms to evaluate students' performance increases the probability of exam success. This research significantly contributes to ongoing efforts aimed to comprehend how lockdowns and the widespread use of online platforms impact academic assessment processes.

Protection, freedom, stigma: a critical discourse analysis of face masks in the first wave of the COVID-19 pandemic and implications for medical education

Background

The COVID-19 pandemic has spotlighted the face mask as an intricate object constructed through the uptake of varied and sometimes competing discourses. We investigated how the concept of face mask was discursively deployed during the first phase of the COVID-19 pandemic. By examining the different discourses surrounding the use of face masks in public domain texts, we comment on important educational opportunities for medical education.

Method

We applied critical discourse methodology to look for key phrases related to face masks that can be linked to specific socio-economic and educational practices. We created an archive of 171 English and Mandarin texts spanning the period of February to July 2020 to explore how discourses in Canada related to discourses of mask use in China, where the pandemic was first observed. We analyzed how the uptake of discourses related to masks was rationalized during the first phase of the pandemic and identified practices/processes that were made possible.

Results

While the face mask was initially constructed as personal protective equipment, it quickly became a discursive object for rights and freedoms, an icon for personal expression of political views and social identities, and a symbol of stigma that reinforced illness, deviance, anonymity, or fear.

Conclusion

Discourses related to face masks have been observed in public and institutional responses to the pandemic in the first wave. Finding from this research reinforce the need for medical schools to incorporate a broader socio-political appreciation of the role of masks in healthcare when training for pandemic responses.

Effective communication between nursing professionals and patients after the implementation of mask-wearing requirements in the clinical setting: A cross-sectional study

This study aimed to evaluate staff nurses' perspectives on the use of face masks in effective communication and relationship management skills with patients in the hospital setting. The study surveyed registered nurses (RNs) who work with adult patients in different hospital units. An online survey was completed by RNs who were selected by convenience sampling. RNs' communication with patients was perceived as moderately affected by the use of face masks. Statistically significant differences were found when comparing communication with years of professional experience. Participants who had over 10 years of experience reported having greater difficulty in their communication with patients when using face masks. The effect of provider-patient relationship on effective nurse-patient face-mask communication was statistically significant and negative. This study shows that some participants found face masks used in the clinical setting may affect nurse-patient communication, as well as the nurses' ability to manage their relationships with patients. The findings of this study support the need for targeted research into effective communication strategies when face mask use is needed in the healthcare setting.

COVID-19 Treatments: Then and Now

The coronavirus disease 2019 (COVID-19) pandemic has evolved over the past 3+ years, and strategies to prevent illness and treat infection have changed over time. As COVID-19 transitions from a pandemic to an endemic infection, widespread nonpharmaceutical interventions such as mask mandates and governmental policies requiring social distancing have given way to more selective strategies for risk mitigation. Monoclonal antibody therapies used for disease prevention and treatment lost utility owing to the emergence of resistant viral variants. Oral antiviral medications have become the mainstay of treatment in nonhospitalized individuals, whereas systemic corticosteroids remain the cornerstone of therapy in those requiring supplemental oxygen. Emerging literature also supports the use of additional immune-modulating therapies in select admitted patients. Importantly, the COVID-19 pandemic highlighted both unprecedented research and development of medical interventions while also drawing attention to significant pitfalls in the global response. This review provides a comprehensive update in prevention and management of COVID-19.

Drift-diffusion modeling reveals that masked faces are preconceived as unfriendly

During the COVID-19 pandemic, the use of face masks has become a daily routine. Studies have shown that face masks increase the ambiguity of facial expressions which not only affects (the development of) emotion recognition, but also interferes with social interaction and judgement. To disambiguate facial expressions, we rely on perceptual (stimulus-driven) as well as preconceptual (top-down) processes. However, it is unknown which of these two mechanisms accounts for the misinterpretation of masked expressions. To investigate this, we asked participants (N = 136) to decide whether ambiguous (morphed) facial expressions, with or without a mask, were perceived as friendly or unfriendly. To test for the independent effects of perceptual and preconceptual biases we fitted a drift-diffusion model (DDM) to the behavioral data of each participant. Results show that face masks induce a clear loss of information leading to a slight perceptual bias towards friendly choices, but also a clear preconceptual bias towards unfriendly choices for masked faces. These results suggest that, although face masks can increase the perceptual friendliness of faces, people have the prior preconception to interpret masked faces as unfriendly.

Knowledge, beliefs, and practices related to coronavirus disease 2019 (COVID-19) infection and vaccination in healthcare personnel working at nonacute care facilities

OBJECTIVE

To characterize experiences, beliefs, and perceptions of risk related to coronavirus disease 2019 (COVID-19), infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at nonacute care facilities.

DESIGN

Anonymous survey.

SETTING

Three non-acute-care facilities in St. Louis, Missouri.

PARTICIPANTS

In total, 156 HCP responded to the survey, for a 25.6% participation rate). Among them, 32% had direct patient-care roles.

METHODS

Anonymous surveys were distributed between April-May 2021. Data were collected on demographics, work experience, COVID-19 exposure, knowledge, and beliefs about infection prevention, personal protective equipment (PPE) use, COVID-19 vaccination, and the impact of COVID-19.

RESULTS

Nearly all respondents reported adequate knowledge of how to protect oneself from COVID-19 at work (97%) and had access to adequate PPE supplies (95%). Many HCP reported that wearing a mask or face shield made communication difficult (59%), that they had taken on additional responsibilities due to staff shortages (56%), and that their job became more stressful because of COVID-19 (53%). Moreover, 28% had considered quitting their job. Most respondents (78%) had received at least 1 dose of COVID-19 vaccine. Common reasons for vaccination were a desire to protect family and friends (84%) and a desire to stop the spread of COVID-19 (82%). Potential side effects and/or inadequate vaccine testing were cited as the most common concerns by unvaccinated HCP.

CONCLUSIONS

A significant proportion of HCP reported increased stress and responsibilities at work due to COVID-19. The majority were vaccinated. Improving workplace policies related to mental health resources and sick leave, maintaining access to PPE, and ensuring clear communication of PPE requirements may improve workplace stress and burnout.

Advantages and disadvantages of maintaining the mandatory use of masks in health centers and nursing homes in Spain. How and when is it justified to maintain it?

We address the advantages and disadvantages of maintaining the mandatory use of masks in health centers and nursing homes in the current epidemiological situation in Spain and after the declaration of the World Health Organization on May 5, 2023 of the end of COVID-19 as public health emergency. We advocate for prudence and flexibility, respecting the individual decision to wear a mask and emphasizing the need for its use when symptoms suggestive of a respiratory infection appear, in situations of special vulnerability (such as immunosuppression), or when caring for patients with those infections. At present, given the observed low risk of severe COVID-19 and the low transmission of other respiratory infections, we believe that it is disproportionate to maintain the mandatory use of masks in a general way in health centers and nursing homes. However, this could change depending on the results of epidemiological surveillance and it would be necessary to reconsider returning to the obligation in periods with a high incidence of respiratory infections.

Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic: a mixed methods study

Background

At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020.

Methods

From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol.

Results

One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources.

Discussion

It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.

Study protocol: How does cognitive flexibility relate to other executive functions and learning in healthy young adults?

BACKGROUND

Cognitive flexibility (CF) enables individuals to readily shift from one concept or mode of practice/thoughts to another in response to changes in the environment and feedback, making CF vital to optimise success in obtaining goals. However, how CF relates to other executive functions (e.g., working memory, response inhibition), mental abilities (e.g., creativity, literacy, numeracy, intelligence, structure learning), and social factors (e.g., multilingualism, tolerance of uncertainty, perceived social support, social decision-making) is less well understood. The current study aims to (1) establish the construct validity of CF in relation to other executive function skills and intelligence, and (2) elucidate specific relationships between CF, structure learning, creativity, career decision making and planning, and other life skills.

METHODS

This study will recruit up to 400 healthy Singaporean young adults (age 18-30) to complete a wide range of cognitive tasks and social questionnaires/tasks. The richness of the task/questionnaire battery and within-participant administration enables us to use computational modelling and structural equation modelling to examine connections between the latent constructs of interest.

SIGNIFICANCE AND IMPACT

The current study is the first systematic investigation into the construct validity of CF and its interrelationship with other important cognitive skills such as learning and creativity, within an Asian context. The study will further explore the concept of CF as a non-unitary construct, a novel theoretical proposition in the field. The inclusion of a structure learning paradigm is intended to inform future development of a novel intervention paradigm to enhance CF. Finally, the results of the study will be useful for informing classroom pedagogy and the design of lifelong learning policies and curricula, as part of the wider remit of the Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC).

Universal Masking in Health Care Settings: A Pandemic Strategy Whose Time Has Come and Gone, For Now

During the COVID-19 pandemic in the United States, the use of facemasks has been mandated in all health care settings for individuals older than 2 years, whether present as health care personnel, patients, or visitors. In this commentary, a group of health care epidemiologists, infectious diseases physicians, and researchers argue for the withdrawal of the universal masking policy given the current status of the COVID-19 pandemic.

Empathising with masked targets: limited side effects of face masks on empathy for dynamic, context-rich stimuli

Multiple studies revealed detrimental effects of face masks on communication, including reduced empathic accuracy and enhanced listening effort. Yet, extant research relied on artificial, decontextualised stimuli, which prevented assessing empathy under more ecologically valid conditions. In this preregistered online experiment (N = 272), we used film clips featuring targets reporting autobiographical events to address motivational mechanisms underlying face mask effects on cognitive (empathic accuracy) and emotional facets (emotional congruence, sympathy) of empathy. Surprisingly, targets whose faces were covered by a mask (or a black bar) elicited the same level of empathy motives (affiliation, cognitive effort), and accordingly, the same level of cognitive and emotional empathy compared to targets with uncovered faces. We only found a negative direct effect of face coverings on sympathy. Additional analyses revealed that older (compared to young) adults showed higher empathy, but age did not moderate face mask effects. Our findings speak against strong negative face mask effects on empathy when using dynamic, context-rich stimuli, yet support motivational mechanisms of empathy.

The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County-Central Region, Romania

INTRODUCTION

The COVID-19 pandemic brought a burden and represented a challenge for the Romanian medical system. This study explored the consequences that COVID epidemiological measures had on the quality of the mental health care provided to hospitalized patients in a regional psychiatric hospital in Romania.

MATERIALS AND METHODS

Both patient-level and hospital-level indicators were considered for this comparative retrospective study. On the one hand, we extracted patient-level indicators, such as sociodemographics, diagnosis, admission, and discharge dates for 7026 hospitalized patients (3701 women, average age = 55.14) from hospital records. On the other hand, for the hospital-level indicators, we included indicators referring to the aggregated concept of mental health services, such as case mix index, length of stay, bed occupancy rate and patients' degree of satisfaction. Data extracted covered a period of two years (1 March 2019-28 February 2021) before and during the first year of the COVID-19 pandemic.

RESULTS

We found that, compared to the pre-pandemic period, the pandemic period was marked by a drastic decrease in hospitalized patient admissions, coupled with an increase in emergency-based admissions. Other management indicators, such as the case mix index, the number of cases contracted/performed, and the degree of patient satisfaction, decreased. In contrast, the average length of stay and bed occupancy rate increased.

CONCLUSIONS

The COVID-19 pandemic, especially in the first year, raised multiple difficult issues for the management of psychiatric hospitals. It imposed an application of strict measures designed to face these new and unprecedented challenges. Our findings offer a detailed snapshot of the first year of the COVID-19 pandemic in terms of its impact on mental health services and suggest some future directions. Implications for hospital management are discussed.

The effects of a ‘COVID Nurse Assistant’ application on patient satisfaction in COVID isolation rooms

Introduction: The COVID-19 pandemic has caused a major shift in the healthcare delivery system. With the limited personal protection equipment and a nursing service shortage caused ineffective nursing care delivered to COVID-19 patients. Wearing full personal protective equipment (PPE) hinders nurse-patients communication and inhibiting the achievement of treatment goals. This study aims to examine the effect of a ‘COVID Nurse Assistant’ (CNA) application on patient satisfaction in COVID-19 isolation rooms. Design and Methods: This was a comparative study with an experimental and control group design. The participants were patients confirmed positive with COVID-19 receiving care in an isolation room for at least three days and were fully conscious. The intervention used was accessing health information related to COVID-19 through a mobile-friendly application namely-‘COVID Nurse Assistant’. The instrument used was the Patient Satisfaction Questionnaire (PSQ-18) translated into Bahasa Indonesia. In addition, an independent t-Test was used to perform statistical analysis. Results and Discussions: A total 158 respondents completed the online survey among of 219 eligible patients (72% response rate). The score in the general and financial satisfaction sub-scales reported by patients in the experimental group were significantly different from the control with p-values of 0.032 and 0.018 respectively. However, other subscales were not significantly different between the two groups. Conclusions: The implementation of the CNA online application has noteworthy implications on patient satisfaction. However, further studies examining similar system in different clinical areas would provide better information for the optimal use of technology in patient education.  

The impact of briefly observing faces in opaque facial masks on emotion recognition and empathic concern

Since the outbreak of SARS-CoV-2 in 2019, there have been global public health initiatives that have advocated for the community use of face masks to reduce spread of the virus. Although the community use of facial coverings has been deemed essential for public health, there have been calls for enquiries to ascertain how face masks may impact non-verbal methods of communication. This study aimed to ascertain how the brief observations of faces in opaque facial coverings could impact facial emotion recognition. It was also an aim to ascertain if there was an association between the levels of empathic concern and facial emotion recognition when viewing masked faces. An opportunity sample of 199 participants, who resided in the United Kingdom, were randomly assigned to briefly observe either masked (n = 102) or unmasked (n = 97) faces. Participants in both conditions were required to view a series of facial expressions, from the Radboud Faces Database, with models conveying the emotional states of anger, disgust, fear, happiness, sadness, and surprised. Each face was presented to participants for a period of 250 ms in the masked and unmasked conditions. A 6 (emotion type) x 2 (masked/unmasked condition) mixed ANOVA revealed that viewing masked faces significantly reduced facial emotion recognition of disgust, fear, happiness, sadness, and surprised. However, there were no differences in the success rate of recognising the emotional state of anger between the masked and unmasked conditions. Furthermore, higher levels of empathic concern were associated with greater success in facially recognising the emotional state of disgust. The results of this study suggest that significant reductions in emotion recognition, when viewing faces in opaque masks, can still be observed when people are exposed to facial stimuli for a brief period of time.

The Healthcare Relationship during the Second Wave of the COVID-19 Pandemic: A Qualitative Study in the Emergency Department of an Italian Hospital

The COVID-19 pandemic had an impact not only on people's lives but also on the healthcare system. This study aimed to investigate the healthcare relationship in the Emergency Department (ED) of a hospital in northern Italy, during the second wave of the COVID-19 pandemic. The participants (N = 43) consisted of 16 nurses, 6 doctors from the hospital ED, and 21 patients who accessed this department. Semi-structured interviews were carried out and a thematic analysis was conducted. The findings suggest that the COVID-19 pandemic brought both positive and negative changes to the healthcare relationship that are linked to changes in the organization of the ED and to participants' various experiences of the pandemic. The changes in this relationship should be monitored because they could have long-term effects on healthcare professionals' wellbeing, treatment outcomes, and the healthcare system. The findings from this study could be used to understand these changes and inform intervention strategies to improve the healthcare relationship.

Impact of Facemasks Use on Interpersonal Communication in a Clinical Setup: A Questionnaire Based Study

Precautionary measures such as physical distancing, wearing a mask, and hand hygiene to suppress virus transmission necessitated a shift in the communication paradigm.The study aimed to check the effects of wearing masks (N95, surgical, and cloth) due to the COVID-19 pandemic on interpersonal communication in audiology-speech-language pathology clinical setup from a clinician perspective. A total of 105 participants, 17 males, and 88 females, in the age range of 19 to 29 years (Mean age = 21.41 years; S.D = 1.6), participated in the study. A questionnaire consisting of 15 close-ended questions grouped into five major categories, Communication Effectiveness (3 questions), Visual Cues (5 questions), Physiological Effect (4 questions), Palliative Effect (1 question), and Environment Effect (2 questions) was framed. Procedure: Participants rated the questions using a binary forced-choice as either Yes or No adapted into a google form. Results showed that most questions in all five categories received an above-average "yes" response. A significant association between questions in communication effectiveness with visual cues and physiological effects was noticed, leading to the conclusion that wearing face masks impacted overall communication by affecting various parameters of speech, majorly, the voice. It was also seen that of all the participants, 60% used N95, 32.4% used cloth, and only 7.6% used surgical face masks. Speech-language pathologists have a significant role in facilitating oral/ verbal communication when such barriers are encountered in clients with communication disorders and fellow professionals with strategies to strengthen oral/ verbal communication.

Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective

OBJECTIVES

This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them.

BACKGROUND

The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience.

METHOD

A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach.

RESULTS

The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness.

CONCLUSIONS

The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.

The role of face masks within in-patient psychotherapy: Results of a survey among inpatients and healthcare professionals

Introduction

Face-to-face medical and psychotherapeutic treatments during the Corona pandemic often involve patients and health care providers wearing face masks. We performed a pilot survey assessing the subjective experience of wearing face masks during psychotherapy sessions regarding (i) feasibility, (ii) psychotherapeutic treatment and (iii) communication, emotion and working alliance in patients and healthcare professionals.

Methods

A total of n = 62 inpatients (RR = 95.4%) and n = 33 healthcare professionals (RR = 86.8%) at an academic department of Psychosomatic Medicine and Psychotherapy participated in this survey anonymously. The items of the questionnaire were created by the interprofessional expert team and were based on existing instruments: (i) the Therapeutic Relationship Questionnaire and (ii) the German translation of Yalom's Questionnaire on Experiencing in Group Psychotherapy.

Results

The majority of patients rate their psychotherapy as highly profitable despite the mask. In individual therapy, face masks seem to have a rather low impact on subjective experience of psychotherapy and the relationship to the psychotherapist. Most patients reported using alternative facial expressions and expressions. In the interactional group therapy, masks were rather hindering. On the healthcare professional side, there were more frequent negative associations of face masks in relation to (i) experiencing connectedness with colleagues, (ii) forming relationships, and (iii) therapeutic treatment.

Discussion

Information should be given to patients about the possible effects of face masks on the recognition of emotions, possible misinterpretations and compensation possibilities through alternative stimuli (e.g., eye area) and they should be encouraged to ask for further information. Especially in group therapy, with patients from other cultural backgrounds and in cases of need for help (e.g., hearing impairment) or complex disorders, appropriate non-verbal gestures and body language should be used to match the intended emotional expression.

Patients' perception of personal protective equipment during the SARS-Cov-2 pandemic

BACKGROUND

Since the outbreak of the coronavirus (SARS-Cov-2), wearing personal protective equipment (PPE) has become necessary. Patients' ability to recognize staff is disrupted impacting on the relationship between healthcare worker and patient.

OBJECTIVE

Assess the patients' perspective of healthcare workers wearing PPE and its effect on communication.

METHODS

Admitted Orthopaedic patients during the first wave of SARS-Cov-2 were surveyed about the experience with staff wearing PPE. In response to feedback, individual badges with large pictures and names were introduced to wear over PPE. Patient views and response to the badges was collected from surveying admitted patients.

RESULTS

Patients encountered staff wearing face masks and felt this was appropriate in the context of the pandemic. 44% responded that they would prefer staff wearing badges with names, roles and pictures more visible. Following the introduction of badges, patients were better able to recognize staff roles and remember names. Hospital staff felt this was a positive change to help improve rapport while wearing PPE.

CONCLUSION

Wearing PPE affects patients' ability to recognize individuals in a fast-paced environment such as an acute hospital. Introducing badges was an intervention based on patient feedback and an important adaptation to sustained PPE use to improve the patient's experience.

Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults

IMPORTANCE

Metabolic and bariatric surgery (MBS) is an effective and safe treatment for obesity and its comorbidities, but less than 50% of those who are eligible and referred for MBS complete the procedure. The patient-physician relationship could be a decisive factor in the decision to complete MBS; however, this relationship has not been explored, particularly among racially and ethnically diverse populations.

OBJECTIVE

To examine the association between patient-reported satisfaction with their patient-physician relationship and MBS completion by self-reported racial and ethnic group.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included 408 patients who were referred to a bariatric surgeon or obesity medicine program between July 24, 2019, and May 19, 2022.

EXPOSURE

Patient satisfaction with their physician was measured by 7 dimensions (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physician, and accessibility and convenience) using the Patient Satisfaction Questionnaire Short Form.

MAIN OUTCOMES AND MEASURES

Completion status for MBS (yes or no).

RESULTS

A total of 408 patients (mean [SD] age, 47.3 [11.6] years; among 366 with data available, 317 [86.6%] women and 49 [13.4%] men) were included in the study. Of 363 patients with data available on race and ethnicity, 66 were Hispanic/Latinx (18.2%), 136 (37.5%) were non-Hispanic Black, 146 (40.2%) were non-Hispanic White, and 15 (4.1%) were other race or ethnicity. A total of 124 patients (30.4%) completed MBS. Overall, the mean (SD) patient satisfaction score was significantly greater in MBS completers vs noncompleters (3.86 [0.56] vs 3.61 [0.64]; P < .001). Multivariable logistic regression analysis showed technical quality was the most significant factor for MBS completion (adjusted odds ratio [aOR], 1.99 [95% CI, 1.24-3.19]), followed by communication (aOR, 1.78 [95% CI, 1.16-2.72]) and accessibility and convenience (aOR, 1.61 [95% CI, 1.03-2.53]). The interaction between racial and ethnic groups and patient satisfaction was not significant (eg, mean [SD] score for Hispanic/Latinx completers, 3.95 [0.55] vs 3.77 [0.60] for non-Hispanic White completers; P = .46 for interaction).

CONCLUSIONS AND RELEVANCE

These findings suggest that there is an association between patient satisfaction with the patient-physician relationship and the decision to complete MBS regardless of race and ethnicity. These findings have important implications for strategies to improve the proportion of qualified patients who complete MBS to achieve improved health outcomes.

The Eyes Have It: Psychotherapy in the Era of Masks

Nonverbal communication is integral to the success of psychotherapy and facial expression is an important component of nonverbal communication. The SARS CoV-2 pandemic has caused alterations in how psychotherapy services are provided. In this paper, potential issues that may arise from conducting psychotherapy when both the patient and therapist are wearing masks are explored. These include higher likelihood of misidentifying facial expression, especially when expression is incongruent with body language, and when the lower face is more important for correct identification of emotion. These issues may be particularly problematic for patient populations for whom emotion recognition may be a problem at baseline, or for those more prone to biases in emotional recognition. Suggestions are made for therapists to consider when seeing patients in-person when masks are necessary.

Communicating and reading emotion with masked faces in the Covid era: A short review of the literature

Face masks have proven to be key to slowing down the SARS-Cov2 virus spread in the COVID-19 pandemic context. However, wearing face masks is not devoid of "side-effects", at both the physical and psychosocial levels. In particular, masks hinder emotion reading from facial expressions as they hide a significant part of the face. This disturbs both holistic and featural processing of facial expressions and, therefore, impairs emotion recognition, and influences many aspects of human social behavior. Communication in general is disrupted by face masks, as they modify the wearer's voice and prevent the audience from using lip reading or other non-verbal cues for speech comprehension. Individuals suffering from psychiatric conditions with impairment of communication, are at higher risk of distress because masks increase their difficulties to read emotions from faces. The identification and acknowledgement of these "side-effects" on communication are necessary because they warrant further work on adaptive solutions that will help foster the use of face masks by the greatest number.

Care in the time of COVID: An interpretative phenomenological analysis of the impact of COVID-19 control measures on post-partum mothers' experiences of pregnancy, birth and the health system

Background

Findings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system.

Methods

This study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association's social media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis.

Results

Mothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience.

Conclusion

This study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures.

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection

OBJECTIVE

To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic.

METHODS

The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed.

RESULTS

Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs.

CONCLUSION

PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.

Adult Age Differences in Using Information From the Eyes and Mouth to Make Decisions About Others' Emotions

OBJECTIVES

Older adults are often less accurate than younger counterparts at identifying emotions such as anger, sadness, and fear from faces. They also look less at the eyes and more at the mouth during emotion perception. The current studies advance understanding of the nature of these age effects on emotional processing.

METHODS

Younger and older participants identified emotions from pictures of eyes or mouths (Experiment 1) and incongruent mouth-eyes emotion combinations (Experiment 2). In Experiment 3, participants categorized emotions from pictures in which face masks covered the mouth region.

RESULTS

Older adults were worse than young at identifying anger and sadness from eyes, but better at identifying the same emotions from the mouth region (Experiment 1) and they were more likely than young to use information from the mouth to classify anger, fear, and disgust (Experiment 2). In Experiment 3, face masks impaired perception of anger, sadness, and fear more for older compared to younger adults.

DISCUSSION

These studies indicate that older people are more able than young to interpret emotional information from the mouth, they are more biased to use information from the mouth, and suffer more difficulty in emotion perception when the mouth is covered with a face mask. This has implications for social communication in different age groups.

Masking care: A qualitative investigation of the impact of face masks on the experience of stroke rehabilitation from the perspective of staff and service users with communication difficulties

BACKGROUND

Face mask use has become widespread as a means of reducing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Research suggests face coverings can impact speech discrimination, therapeutic alliance and the interpretation of non-verbal cues. However, there is little research into the impact of face masks on people with communication difficulties (pwCD) post-stroke.

AIMS

To explore the perspectives of service users and staff on a stroke rehabilitation unit in order to understand the impact of staff wearing face masks on the experience of rehabilitation for pwCD. Strategies that might improve the experience of rehabilitation for pwCD were also explored.

METHODS & PROCEDURES

Semi-structured interviews and a focus group were conducted with six pwCD and five health professionals (HPs) on a stroke rehabilitation unit. The data were analysed using reflexive thematic analysis.

OUTCOMES & RESULTS

Four main interacting themes were identified from the data: (1) face masks as a barrier to effective communication; (2) face masks as a barrier to human connection and therapeutic relationships; (3) the impact of face masks on an individual is influenced by multiple internal and external factors; and (4) there is a need for service provision to evolve to meet pwCD's needs when using face masks.

CONCLUSIONS & IMPLICATIONS

Findings shed light on how face masks can act as a barrier for pwCD within the rehabilitative process, and emphasize that each individual with communication difficulties is likely to be affected to a differing extent, as a result of multiple interacting factors. HPs are encouraged to consider the individual holistically, tailor strategies and adapt to each individual's needs. Further research is required to understand how to optimize rehabilitation outcomes when face masks are used.

WHAT THIS PAPER ADDS

What is already known on the subject There is evidence face masks can affect speech discrimination, therapeutic alliance and interpretation of non-verbal cues. The existing literature predominantly considers people with hearing impairments, mental health needs or the general public. The potential for face masks to impact pwCD post-stroke is high, given pre-existing communication barriers and evidence of increased social isolation. What this paper adds to existing knowledge This study is the first of its kind to explore how face mask use by HPs impacts the experience of rehabilitation for pwCD post-stroke. The authors consider the need to tailor compensatory strategies to each individual and adapt them to meet service users' needs. What are the potential or actual clinical implications of this work? HPs should monitor closely the impact of face mask use on pwCD with whom they are working, and consider what adaptations to delivery are required. It would be helpful for clinicians to have a discussion with pwCD post-stroke to understand the impact of face mask use on them personally and what strategies they would find most helpful within rehabilitation. Additional training by speech and language therapists on supporting effective communication and successful interaction with pwCD may be indicated in the context of face mask use.

Adults With Hearing Loss Demonstrate Resilience During COVID-19 Pandemic: Applications for Postpandemic Services

BACKGROUND

The COVID-19 pandemic has produced unique challenges for persons with hearing loss. There is a unique concern that adults with hearing loss may be more susceptible to isolation than adults with normal hearing.

PURPOSE

This study explored the impact of the COVID-19 pandemic on the well-being of older adults with and without hearing loss.

RESEARCH DESIGN

This was a longitudinal study with pre-COVID-19 and six mid-COVID-19 interviews, spanning from March 1, 2020, to October 31, 2020.

STUDY SAMPLE

The study enrolled 12 participants with hearing aids and 12 with cochlear implants aged 55-80 years that were compared to 18 age-matched adults with hearing within normal limits.

DATA COLLECTION AND ANALYSIS

Surveys were completed to evaluate the impact of time alone and loneliness, social contact, depression, and the impact of masks on hearing. A mixed-effects statistical model was used to analyze each question.

RESULTS

Participants commonly reported stress and anxiety during monthly video calls. Adults with varying degrees of hearing loss reported decreased social interaction and increased stress during the pandemic, similar to the rates observed by participants with healthy hearing. Face coverings were commonly reported to affect the intelligibility of conversational speech. Participants with hearing loss found satisfactory methods for maintaining social connection during the pandemic that they hope will continue once restrictions ease fully.

CONCLUSIONS

Participants from the hearing loss groups in this study were frustrated by challenges posed by facial masks and were resilient in their ability to cope with COVID-19 and found the use of technology to be helpful. Audiologists are encouraged to use these successful electronic means of connecting with their patients even after restrictions are fully lifted.

The Effects of Face Masks on the Doctor-Patient Relationship in Orthopaedics

BACKGROUND

Since the onset of the COVID-19 pandemic, the widespread use of face masks has grown exponentially. There is limited data highlighting the patient perception of face mask use during this pandemic, specifically in orthopaedic clinics. The purpose of this study was to determine the patient's perception of the implementation of face masks in the orthopaedic clinic during a period of mask mandates and if this change impacted the success of their interactions with physicians. The secondary aim includes measures of patient satisfaction such as the ability to understand conversation and communicate effectively with the physician.

METHODS

Participants were recruited on the day of their appointment at our institution's orthopaedic clinic and provided with instructions via email. The online, anonymous survey included the CARE questionnaire - a tool to examine patient satisfaction by assessing perception of empathy and was conducted using Qualtrics.

RESULTS

Does patient preference to have their physician wear a face mask impact the success of their interactions with physicians? Overall, the use of face masks by physicians did not negatively impact patient encounters. CARE scores for patients who preferred masks (37.2) were similar to those who preferred their physician did not wear a mask (37.5). Is patient satisfaction affected by the use of face masks in the orthopaedic clinic? Patients who preferred that their doctor wear a face mask stated that it had no negative impact on the effect of communication or conversation with the physician. Other factors such as how well the patients knew the physician and patient gender had a greater impact on the CARE score than masks did.

CONCLUSION

Our study determined that the preference of face masks by patients does not impact the success of their interactions with physicians using the CARE score. The findings of this study are valuable in informing orthopaedic physicians about patient attitudes towards mask use and could influence decision making for not only the COVID-19 pandemic, but also future infectious outbreaks that may arise. Level of Evidence: III.

At the heart of the COVID-19 crisis: Perceived concerns of changes in long-term cancer care in French women with cancer

Objective

In the COVID‐19 crisis context, the main objective of the study is to investigate factors associated with perceived concerns of change in long‐term cancer care in patients currently under treatment.

Methods

A French population‐based cross‐sectional study was performed using an online questionnaire in April 2020. All persons currently receiving cancer treatment and belonging to the Seintinelles Association (https://www.seintinelles.com) were included in this present analysis. Individual sociodemographic characteristics, medical status and information regarding cancer care were collected. Multivariate binomial logistic regression analysis was performed.

Results

We included 298 women in the analysis. Younger participants (OR = 0.96 [0.94–0.99]), the need to visit healthcare facilities to receive treatment (OR = 2.93 [1.16–8.52]), deterioration in the quality of communication with the medical team since the beginning of the COVID‐19 crisis (OR = 3.24 [1.61–7.02]) and being cared for by a university hospital or a public hospital (OR = 2.19 [1.16–4.23] versus comprehensive cancer centre) were associated with a perceived fear of change in long‐term cancer care.

Conclusion

To address patients' concerns regarding changes in their long‐term cancer care, medical teams should consider the patients' own perceptions of the situation and provide clear, appropriate, precise information on cancer care, especially in the centres mostly affected by the COVID‐19 crisis.

The contribution of respiratory and hearing protection use to psychological distress in the workplace: a scoping review

OBJECTIVE

Workers from various industries use personal protective equipment (PPE) including masks, respirators, and hearing protection to reduce their exposures to workplace hazards. Many studies have evaluated the physiological impacts of PPE use, but few have assessed the psychological impacts. The aim of the present study was to carry out a scoping review to compile existing evidence and determine the extent of knowledge on workplace mask, respirator or hearing protection use as a psychosocial hazard (stressor) that could result in a stress response and potentially lead to psychological injury.

METHODS

The scoping review followed recognized methods and was conducted using Ovid Emcare, PubMed, Sage Journals, ScienceDirect, Scopus, SpringerLink, Google Scholar and preprint databases (OSF Preprints and medRxiv). Articles on the stressors associated with the use of masks, respirators, and hearing protection were included. The extracted data included author(s) name, year of publication, title of article, study design, population data, stressors assessed, and key findings.

RESULTS

We retrieved 650 articles after removal of duplicates, of which 26 were deemed eligible for inclusion for review. Identified factors associated with PPE use that could potentially create a stress response were identified: communication impacts, physical impacts, psychological illness symptoms, cognitive impacts, and perceived PPE-related impacts. Evidence for respirators suggest that there may be psychological injury associated with their use. However, hearing protection appears to have a protective effect in reducing psychological symptoms such as anxiety, depression, and aggression.

CONCLUSIONS

Mask or respirator use may lead to an increase in work-related stress. Whereas hearing protection may have protective effects against psychological symptoms and improves speech intelligibility. More research is needed to better understand potential psychosocial impacts of mask, respirator and/or hearing protection use.

Tracheostomy care and communication during COVID-19: Global interprofessional perspectives

Objective

Investigate healthcare providers, caregivers, and patient perspectives on tracheostomy care barriers during COVID-19.

Study design

Cross-sectional anonymous survey

Setting

Global Tracheostomy Collaborative Learning Community

Methods

A 17-item questionnaire was electronically distributed, assessing demographic and occupational data; challenges in ten domains of tracheostomy care; and perceptions regarding knowledge and preparedness for navigating the COVID-19 pandemic.

Results

Respondents (n = 115) were from 20 countries, consisting of patients/caregivers (10.4%) and healthcare professionals (87.0%), including primarily otolaryngologists (20.9%), nurses (24.3%), speech-language pathologists (18.3%), respiratory therapists (11.3%), and other physicians (12.2%). The most common tracheostomy care problem was inability to communicate (33.9%), followed by mucus plugging and wound care. Need for information on how to manage cuffs and initiate speech trials was rated highly by most respondents, along with other technical and knowledge areas. Access to care and disposable supplies were also prominent concerns, reflecting competition between community needs for routine tracheostomy supplies and shortages in intensive care units. Integrated teamwork was reported in 40 to 67% of respondents, depending on geography. Forty percent of respondents reported concern regarding personal protective equipment (PPE), and 70% emphasized proper PPE use.

Conclusion

While safety concerns, centering on personal protective equipment and pandemic resources are prominent concerns in COVID-19 tracheostomy care, patient-centered concerns must also be prioritized. Communication and speech, adequate supplies, and care standards are critical considerations in tracheostomy. Stakeholders in tracheostomy care can partner to identify creative solutions for delays in restoring communication, supply disruptions, and reduced access to tracheostomy care in both inpatient and community settings.

Transformation of Outpatient Psychiatry

Provision of psychiatric services during the pandemic required flexibility, innovation, and collaboration. Going forward, telepsychiatry will offer accessible and effective treatment options. Increased collaboration with multidisciplinary providers, a critical component of effective treatment during the pandemic, should augment future treatment relationships. Large practice organizations continue to develop and disseminate best practices, and providers and institutions must continuously adapt and improve services. An increased focus on the utility of novel and innovative technology's role in psychiatry has emerged during the pandemic, and although openness to innovation will be critical, as will adherence to use of scientifically validated tools and procedures.

Impact of Face Masks on Speech Acoustics and Vocal Effort in Healthcare Professionals

OBJECTIVES/HYPOTHESIS

We investigated speech acoustics and self-reported vocal symptoms in mask-wearing healthcare professionals. We hypothesized that there would be an attenuation of spectral energies and increase in vocal effort during masked speech compared to unmasked speech.

STUDY DESIGN

Within and between subject quasi-experimental design.

METHODS

We prospectively enrolled 21 healthcare providers (13 cisgender female, 8 cisgender male; M = 32.9 years; SD = 7.9 years) and assessed acoustics and perceptual measures with and without a face mask in place. Measurements included: 1) acoustic Vowel Articulation Index (VAI); 2) cepstral and spectral acoustic measures; 3) traditional vocal measures (e.g., fundamental frequency, intensity); 4) relative fundamental frequency (RFF); and 5) self-reported ratings of vocal effort and dyspnea.

RESULTS

During masked speech, there was a significant reduction in VAI, high-frequency information (>4 kHz), and RFF offset 10, as well as a significant increase in cepstral peak prominence and perceived vocal effort. Further analysis showed that high-frequency attenuation was more pronounced when wearing an N95 mask compared to a simple mask.

CONCLUSIONS

Face masks pose an additional barrier to effective communication that primarily impacts spectral characteristics, vowel space measures, and vocal effort. Future work should evaluate how long-term mask use impacts vocal health and may contribute to vocal problems.

LEVEL OF EVIDENCE

3 Laryngoscope, 132:391-397, 2022.

Reiki practitioners' perceptions of the impact of the COVID-19 pandemic on the experience, practice and future of Reiki

OBJECTIVES

This study examined the impact of the COVID-19 pandemic on the experience, practice and future of Reiki in the UK, including the personal impact of the pandemic on practitioners and their work, practitioner perceptions of the future of the profession and Reiki delivery, and practitioner experiences and views of distant Reiki in comparison to hands on or near the body treatments.

METHOD

A qualitative study using semi-structured interviews was carried out with 10 Reiki practitioners. Interviews were recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Three themes were identified: adapting and growing with the challenges of COVID-19, Reiki for individual and community resilience, and moving from the mainstream hands on to lesser known distant Reiki.

CONCLUSION

While the COVID-19 pandemic personally impacted Reiki practitioners, they focused on turning adversity into opportunity, to overcome a sense of disconnectedness and social isolation, by providing social support and promoting individual and community resilience. Practitioners focused on self-care, personal development and reaching out to the community. Personal Protective Equipment was perceived as necessary for infection control but a potential barrier to the client's experience of Reiki. They saw value in adapting their practice as part of the future of the profession by utilising new technology and distant Reiki healing, but were clear this could not replace in person contact.

A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study

BACKGROUND

The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies.

OBJECTIVE

This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT).

METHODS

A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures.

RESULTS

The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication.

CONCLUSIONS

These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality-particularly for studies involving high-risk or rare cohorts-and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance.

Surgeons' non-transparent facemasks challenge the physician-patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients

Background and purpose - Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician-patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons' facemask impacts patients' perception of the physician-patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods - All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor-patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results - A non-transparent facemask led to more restrictions in the physician-patient communication and a worse understanding of what the surgeon said. Patients' understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5-10] vs. transparent: 10 [IQR 9-10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3-7] vs. transparent: 9 [IQR 9-10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation - Surgeons' non-transparent facemasks pose a new communication barrier that can negatively affect the physician-patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician-patient communication and patients' understanding of what the surgeon said seem to be negatively affected.

Telehealth and food insecurity screenings: challenges and lessons learned

Food insecurity remains a persistent problem in the United States and affected 35.2 million Americans in 2019. In the wake of COVID-19, food insecurity has increased in many communities. Given that food insecurity exacerbates poor health or health conditions, screening of food insecurity within medical settings is frequently identified within the literature as an important first step in effectively addressing this social concern and improving the health outcomes of patients. However, health care providers often do not screen for food insecurity for a variety of reasons. In this article review, we discuss the challenges associated with incorporating food insecurity screenings within the medical model and how the COVID-19 pandemic has exacerbated these challenges. Specifically, the COVID-19 pandemic has substantially increased the delivery of health care services via telehealth, making screening for food insecurity even more difficult via remote videoconferencing. We examine the strengths and weaknesses of telehealth and their implications for food insecurity screenings. We discuss how these implications might inform future research regarding the use of telehealth as a means of screening patients for social determinants of health in the COVID-19 era. Given that the use of telehealth is not expected to back to pre-pandemic levels, it is important to understand how to best screen for social determinants of health via videoconferencing.

COVID-19 and psychiatric disorders: The impact of face masks in emotion recognition face masks and emotion recognition in psychiatry

Since the outbreak of the COVID-19 pandemic, reading facial expressions has become more complex due to face masks covering the lower part of people's faces. A history of psychiatric illness has been associated with higher rates of complications, hospitalization, and mortality due to COVID-19. Psychiatric patients have well-documented difficulties reading emotions from facial expressions; accordingly, this study assesses how using face masks, such as those worn for preventing COVID-19 transmission, impacts the emotion recognition skills of patients with psychiatric disorders. To this end, the current study asked patients with bipolar disorder, major depressive disorder, schizophrenia, and healthy individuals to identify facial emotions on face images with and without facial masks. Results demonstrate that the emotion recognition skills of all participants were negatively influenced by face masks. Moreover, the main insight of the study is that the impairment is crucially significant when patients with major depressive disorder and schizophrenia had to identify happiness at a low-intensity level. These findings have important implications for satisfactory social relationships and well-being. If emotions with positive valence are hardly understood by specific psychiatric patients, there is an even greater requirement for doctor-patient interactions in public primary care.

Nurses experience of caring for patients with COVID-19: A phenomenological study

INTRODUCTION

COVID-19 has impacted all dimensions of life and imposed serious threat on humankind.

BACKGROUND

In Jordan, understanding how nurses experienced providing care for patients with COVID-19 offers a framework of knowledge about similar situations within the context of Arabic culture.

AIM

To explore nurses' experience with providing hands-on care to patients with active COVID-19 infection in an Arabic society.

METHODS

A descriptive phenomenological study interviewed 10 nurses through a purposive sampling approach until data saturation was reached. The research site was hospital designated to receive patients with active COVID-19 infection. Semi-structured interviews were used to collect the data.

FINDINGS

Three themes were generated from the data: the impact of the COVID-19 outbreak on nurses' health; unfamiliar work and social environments; and conforming to professional standards.

DISCUSSION

There are specific risks to the physical and mental wellbeing of nurses who provide hands-on care to patients with COVID-19 in an Arabic society.

IMPLICATION FOR NURSING AND HEALTH POLICY

Health care institutions should consider establishing programs that promote nurses' wellbeing and support their productivity in a crisis. A danger pay allowance should be considered for nurses during extraordinary circumstances, such as pandemics.

Effects of face masks on the appearance of emotional expressions and invariant characteristics

Faces convey a lot of information about a person. However, the usage of face masks occludes important parts of the face. There is already information that face masks alter the processing of variable characteristics such as emotional expressions and the identity of a person. To investigate whether masks influenced the processing of facial information, we compared ratings of full faces and those covered by face masks. 196 participants completed one of two parallel versions of the experiment. The data demonstrated varying effects of face masks on various characteristics. First, we showed that the perceived intensity of emotional expressions was reduced when the face was covered by face masks. This can be regarded as conceptual replication and extension of the impairing effects of face masks on the recognition of emotional expressions. Next, by analyzing valence and arousal ratings, the data illustrated that emotional expressions were regressed toward neutrality for masked faces relative to no-masked faces. This effect was grossly pronounced for happy facial expressions, less for neutral expressions, and absent for sad expressions. The sex of masked faces was also less accurately identified. Finally, masked faces looked older and less attractive. Post hoc correlational analyses revealed correlation coefficient differences between no-masked and masked faces. The differences occurred in some characteristic pairs (e.g., Age and Attractiveness, Age and Trustworthiness) but not in others. This suggested that the ratings for some characteristics could be influenced by the presence of face masks. Similarly, the ratings of some characteristics could also be influenced by other characteristics, irrespective of face masks. We speculate that the amount of information available on a face could drive our perception of others during social communication. Future directions for research were discussed.

“What Is Hidden behind the Mask?” Facial Emotion Recognition at the Time of COVID-19 Pandemic in Cognitively Normal Multiple Sclerosis Patients

Social cognition deficits have been described in people with multiple sclerosis (PwMS), even in absence of a global cognitive impairment, affecting predominantly the ability to adequately process emotions from human faces. The COVID-19 pandemic has forced people to wear face masks that might interfere with facial emotion recognition. Therefore, in the present study, we aimed at investigating the ability of emotion recognition in PwMS from faces wearing masks. We enrolled a total of 42 cognitively normal relapsing–remitting PwMS and a matched group of 20 healthy controls (HCs). Participants underwent a facial emotion recognition task in which they had to recognize from faces wearing or not surgical masks which of the six basic emotions (happiness, anger, fear, sadness, surprise, disgust) was presented. Results showed that face masks negatively affected emotion recognition in all participants (p < 0.001); in particular, PwMS showed a global worse accuracy than HCs (p = 0.005), mainly driven by the “no masked” (p = 0.021) than the “masked” (p = 0.064) condition. Considering individual emotions, PwMS showed a selective impairment in the recognition of fear, compared with HCs, in both the conditions investigated (“masked”: p = 0.023; “no masked”: p = 0.016). Face masks affected negatively also response times (p < 0.001); in particular, PwMS were globally hastier than HCs (p = 0.024), especially in the “masked” condition (p = 0.013). Furthermore, a detailed characterization of the performance of PwMS and HCs in terms of accuracy and response speed was proposed. Results from the present study showed the effect of face masks on the ability to process facial emotions in PwMS, compared with HCs. Healthcare professionals working with PwMS at the time of the COVID-19 outbreak should take into consideration this effect in their clinical practice. Implications in the everyday life of PwMS are also discussed.

The Telepsychiatry Operational Guidelines 2020 in India: a welcome step

The release of the Telepsychiatry Operational Guidelines 2020 in India, during the COVID-19 pandemic, is a relief for both clinicians and patients. These guidelines embark on initiating and executing naive and recently started telepsychiatry services in India. The document is aligned with other ethical regulations, policies, laws and the 2020 Telemedicine Practice Guidelines in India. This paper discusses a few points about the broader applicability of the guideline for the benefit of humankind in the prevailing healthcare crisis. The guidelines may be extrapolated in policy-making for telepsychiatry services in other low- and middle-income countries sharing a similar socioeconomic, cultural and political milieu.