AUTHENTIC CARE AND TEACHER EDUCATION: A Self-Study of Buddhist Compassion from the Pandemic

In this chapter, the authors use self-study methodology to explore the Buddhist notion of compassion as articulated by Japanese educator Daisaku Ikeda and enacted in their teaching during the COVID-19 pandemic. The authors examine how this relational way of knowing, being, and doing brings new perspectives to understandings of and efforts to create care in the classroom. They then discuss specific actions taken to enact care in their teaching and how students reacted to these efforts. The authors then address their own vulnerability and doubt, focusing specifically on the actions taken to foster a sense of belonging and community during the pandemic while remaining mindful of boundaries. They conclude their chapter by considering implications of Buddhist compassion for teacher educators post-pandemic. © 2023 selection and editorial matter, Melanie Shoffner and Angela W. Webb;individual chapters, the contributors.

Interval training in the treatment of chronic effects of COVID-19

BACKGROUND AND PURPOSE: The World Health Organization categorized COVID-19 as a pandemic on March 11th, 2020. Since then, maximizing survival of those infected has been the major focus of many health services. Those who suffered from the virus are now experiencing ongoing symptoms that may last several months or more. These symptoms can include fatigue, pain, muscle atrophy, weakness, and functional impairments. Due to the lack of evidence on the long-term effects of COVID-19 healthcare providers may take into account research from other relevant and more extensively studied respiratory illnesses. The purpose of this case report is to highlight the use of available research from SARS-COV in the rehabilitation of a young, previously healthy patient with severe effects of COVID-19. CASE DESCRIPTION: The patient is a 45-year-old male diagnosed with COVID19 in May 2020. He was diagnosed with a severe case and admitted to the Intensive Care Unit with hypoxemia for 4 days. His past medical history included celiac disease, post-traumatic stress disorder, and two pulmonary embolisms from COVID-19 for which he was prescribed Apixaban. He was evaluated by physical therapy in the Veterans Affairs Telehealth system in September 2020. The patient's chief complaint was fatigue and inability to perform his usual functions. This was demonstrated by the inability to ambulate greater than 2 min without rest breaks. At the time of evaluation his gait speed was >35 m/s highlighting his severely deconditioned state. The patient was treated for 12 visits over 6 months using interval training with a rate of perceived exertion progression three days per week utilizing concepts from high intensity interval training. This intervention was based upon available research on treatments of similar respiratory conditions such as SARS-COV. OUTCOMES: The patient's meaningful functional improvements included the following: patient specific functional scale improved from a range of 0-2 to a range of 8-10, 2-minute step test from 93 to 100 steps, 5 times sit to stand from 15 to 11 seconds, and 6 -minute walk test from 540 m to 600 m. Patient's PROMIS score was also taken 4 months into treatment falling into normal ranges with a T-score of 47.7 for the global physical health score. DISCUSSION: Due to limited available evidence on the treatment of long-term effects of COVID19 clinicians may interpret the best evidence for similar conditions such as SAR-COV. In the absence of evidence for effective treatments in outpatient physical therapy for a patient with novel COVID-19, using evidence from conditions with similar physiological effects seemed to be an effective strategy. Interval training reduces the ventilatory demand of exercise and reduces the sense of breathing effort as sustained traditional aerobic exercise may not be tolerated in this population. This case highlights an approach that warrants further study in this population.

The impact of COVID-19 on diabetes management for adolescents with T1D and their parents

Introduction: For families with type 1 diabetes (T1D), anxiety from the COVID-19 pandemic may be elevated due to potential for increased vulnerability. Objectives: We aimed to describe the impact of the pandemic on adolescents with T1D and their parents. Methods: In a 2-site (Seattle WA, Houston TX USA) clinical trial of a psychosocial intervention targeting stress/resilience, adolescents 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T ≥30) were enrolled with a parent. Using a mixed-methods approach, participants enrolled August 2020-June 2021 completed a survey about the pandemic, including an open-ended question about how COVID impacted T1D management. Survey responses were summarized using frequencies and percentages, and associations between variables were assessed by Chi-squared tests. A1C was extracted from clinical records. Results: Adolescents (n=122) were 56% female, 80% White race, 18% Hispanic, mean A1c = 8.5±2.1%. Parents (n=102) were 79% White, 14% Hispanic, 61% college graduate, 67% reporting annual household income ≥75K USD. 10% of adolescents reported history of COVID-19 infection, 51% had a family member/other important person diagnosed, and 12% had a family member/other important person die from COVID-19 complications. 49% of parents reported loss of job or salary reduction. 29% of adolescents and 33% of parents reported significant struggle to manage T1D during the pandemic (Table 1). Adolescents who reported more difficulty with T1D management were more likely to have A1C ≥ 8%, p<.01. Qualitative themes indicated perceived positive, negative, and neutral effects of the pandemic on: T1D self-care, exercise, food, mental health, telehealth, and motivation. Conclusions: Discussing how the pandemic impacted families' T1D management may be an important focus for clinicians, especially for adolescents with above-target A1C. Strategies to improve resilience for ongoing and future stress may be of value. (Table Presented).

Community and academic partner creation of a community-informed, behavior theory-based music video to encourage stroke preparedness during the COVID-19 pandemic

Background: Black Americans comprise 14% of Michigan's population, but 30% of the COVID-19 cases and 40% of deaths. The accumulating national quantitative data on decreased presentation and increased pre-hospital delay during the pandemic confirmed our Flint, MI community partners' impression of a decline in stroke presentations. Thus, we set out to understand the community's perception of seeking acute stroke care during the pandemic which will inform the development and dissemination of public health messaging in a predominantly Black American community. Method: To honor social distancing orders, we conducted semi-structured interviews based on the Theory of Planned Behavior via HIPAA-approved teleconferencing with community members. Due to the clinical and public health implications of the pandemic, we employed a rapid assessment approach to streamline qualitative data analysis. Results were used to inform the creation of a music video. Lyrics were written by the academic team, set to a soundtrack and sung by a community partner. The music video theme was conceptualized by the academic team and performed by both academic and community partners. Results: We reached thematic saturation after completing 15 semi-structured interviews with Flint, MI community members. Mean duration of interviews was 40 minutes. Eighty percent of participants were Black;median age was 50;74% were women and 47% reported some college or above. There was an unfavorable attitude towards seeking emergent stroke care via ambulance and at the hospital, due to concerns for viral transmission at the hospital, hospital capacity and ability to triage, and quality of care. Community and academic partners co-created a music video with verses addressing the community-identified barriers: “stroke is an emergency all the time, even with COVID-19 / get to the hospital as soon as symptoms start, it's so important to do your part, be Stroke Ready” (https://youtu.be/lKefAiUM2W0) The video reached over 1,200 users on our community-academic partner Stroke Ready Facebook page. Conclusion: We found that community members' attitudes and perceived behavioral control to seek emergent stroke care were impacted during the COVID-19 pandemic. We addressed these barriers in an academic-community partner created music video. Academic and community partnerships facilitated a timely, innovative response to seeking acute stroke care in the setting of the COVID-19 pandemic.