Mass food challenges in a vacant COVID-19 stepdown facility: Exceptional opportunity provides a model for the future.

BACKGROUND: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi-elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short-term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll-out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards. METHODS: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established. RESULTS: After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. CONCLUSIONS: Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality-of-life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy-in-even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.

Effect of an Online Hypnosis Intervention in Reducing Migraine Symptoms: A Randomized Controlled Trial.

This study examined the development and effect of an online hypnosis program for the treatment of migraines. Forty-three participants were randomly assigned to a wait-list control or a treatment group. The treatment group received hypnosis mp3s developed for the study. Pain catastrophizing (PCS), headache disability (HDI), migraine frequency, duration, severity, and medication usage were measured. There was a 48% reduction in mean HDI score in the treatment group and 2% reduction in the control group. There was a 60% reduction in mean PCS score in the treatment group. There were no significant between-group differences in the proportion of subjects experiencing decreased frequency or severity of migraines. There was a significant between-group difference in the change in migraine duration. This study demonstrated that a hypnosis intervention delivered online was effective in reducing headache symptoms in migraine sufferers.

Systematic Review of the Effectiveness of Hypnosis for the Management of Headache.

Migraine is a complex neurological condition that causes a range of symptoms, the most common of which is a severe headache. The aim of this systematic review of the literature is to determine the efficacy of hypnosis in the treatment of migraine. A systematic search of 4 scientific databases was conducted using the primary search terms migraine, headache, hypnosis, and hypnotherapy. A total of 8 studies were identified that examined hypnotic techniques either alone or in combination with other nonpharmaceutical techniques, such as visual imagery, relaxation, and pain-displacement techniques. This study demonstrates that hypnotherapy and relaxation techniques are effective in reducing short- and long-term headache activity in migraine sufferers.

Relative effects of demand and control on task-related cardiovascular reactivity, task perceptions, performance accuracy, and mood.

The hypothesis that work control has beneficial effects on well-being is the basis of the widely applied, yet inconsistently supported, Job Demand Control (JDC) Model [Karasek, R.A., 1979. Job demands, job decision latitude and mental strain: Implications for job redesign. Adm. Sci. Q. 24, 285-308.; Karasek, R., Theorell, T., 1990. Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books, Oxford]. The model was tested in an experiment (N=60) using a cognitive stressor paradigm that sought to prevent confounding between demand and control. High-demand was found to be associated with deleterious effects on physiological, subjective, and performance outcomes. In contrast, few main effects were found for control. Evidence for the buffer interpretation of the JDC Model was limited to a significant demand-control interaction for performance accuracy, whereas substantial support was found for the strain interpretation of the model [van der Doef, M., Maes, S., 1998. The job demand-control(-support) model and physical health outcomes: A review of the strain and buffer hypotheses. Psychol. Health 13, 909-936., van der Doef, M., Maes, S., 1999. The Job Demand-Control(-Support) model and psychological well-being: A review of 20 years of empirical research. Work Stress 13, 87-114]. Manipulation checks revealed that objective control altered perceptions of control but not perceptions of demand. It is suggested that beneficial effects of work-related control are unlikely to occur in the absence of reductions in perceived demand. Thus, contrary to the propositions of Karasek and colleagues, demand and control do not appear to be independent factors.