ABSTRACT
Objective The COVID-19 pandemic requires a nimble approach to building trust between healthcare providers and community. Crowdsourcing is one community-engaged approach that may be effective at engaging marginalised communities to identify ways to build trust. This early-stage innovation report assesses the effectiveness of using a crowdsourcing contest to elicit community ideas on how to build trust between healthcare providers and community about COVID-19 and promote community engagement about vaccines. Methods This mixed-methods study conducted a qualitative assessment of crowdsourcing contest entries and evaluated online community engagement via social media analytics (reach, video views, engagement). Themes from contest entries informed the development of community leader video interviews. Qualitative data from contest entries were digitally transcribed and analysed using axial coding. Results Contest participants (n=19) were European Americans (n=10), African Americans (n=8, 87%) and American Indians (n=1), the majority of whom identified as women (n=18) and were 18-80 years old. Contest entry recommendations included: (1) partner with community stakeholders and providers, (2) improve access to credible information from trusted sources, (3) use multiple channels of communication, and (4) use clear and plain language. Conclusion Crowdsourcing contests coupled with public education are beneficial community engagement tools to identify new ways to promote trust between medical professionals and diverse community members about COVID-19. Crowdsourcing contests also provide opportunity for partnership and critical dialogue between healthcare professionals and community leaders.Copyright © 2023 BMJ Publishing Group. All rights reserved.
ABSTRACT
Background: Compared to their non-caregiving peers, caregivers of persons with dementia (PWD) endure higher psychological distress, social isolation and increased morbidity and disability. Stress and isolation experienced by caregivers during the COVID-19 pandemic have added to caregiver burden and worsened health. The objective of this study was to obtain a greater understanding of the health and needs of informal caregivers of PWD during the COVID-19 pandemic. Method(s): Using a cross-sectional questionnaire, we attained demographic data, characteristics of caregiving during the COVID-19 pandemic, mental health status, COVID-19 testing and illness, and protective measures taken to prevent infection with COVID-19 among caregivers of PWD. From March 2021 to August 2021, respondents were recruited through the Maya Angelou Center for Health Equity's Alzheimer's disease (AD) registry. Descriptive statistics (frequency and proportions) of demographic, caregiving, health, and COVID-19 related data for caregivers of PWD was conducted using SAS software version 9.4. Result(s): A total of 274 caregivers of PWD participated in the study. More than half of caregivers were women (56.57%), and approximately 73% of caregivers were married. The racial composition of the majority of caregivers included African American (44.16%), Non-Hispanic White (26.64%), and Native American (20.44%). Most caregivers were providing care for parents (59.86%) or a partner (21.17%). Nearly 46% of caregivers reported experiencing stress, but not being burnt out. Almost 47% of caregivers reported high psychological distress during the COVID-19 pandemic. In addition to caregiving stressors due to the COVID-19 pandemic, caregivers also experienced behavioral changes in their household;more than half of caregivers experienced increased interpersonal conflict with loved ones, friends, or co-workers. The top 3 needs reported during the COVID-19 pandemic included support with caregiving, medical care, and food. Conclusion(s): Approximately half of caregivers of PWD experienced stress and psychological distress during the COVID-19 pandemic. In addition to the stress of caregiving, caregivers lacked support for necessary medical services and social needs. The data collected from caregivers during the COVID-19 pandemic will be used to develop recommendations to support informal caregivers during emergency situations. Copyright © 2022 the Alzheimer's Association.
ABSTRACT
INTRODUCTION: Esophageal-pericardial fistulas are rare complications which can arise from many different pathologies, such as ulcerations, diverticulum, foreign bodies, carcinomas, radiofrequency atrial ablation, or prior surgeries. It may be difficult to recognize due to vague symptoms such as pain, fever, nausea, hematemesis, dysphagia, or odynophagia. Even when promptly recognized, the mortality rate is often around 80%. CASE DESCRIPTION/METHODS: A 61 year old female with a past medical history significant for RA, hypothyroidism, bariatric surgery, gastrectomy with gastric pouch, gastric and esophageal ulcers presented to the ED for an evaluation of altered mental status. During a long hospital stay, which included intubation and a short ICU stay, she was found to have pneumopericardium on a routine chest X-ray. A CT chest without contrast was done to confirm. The pneumopericardium was not causing any hemodynamic instability and therefore was treated conservatively with IV antibiotics. A repeat CT was performed the following morning which showed resolving pneumopericardium and therefore no surgery was indicated. Initially the pneumopericardium was believed to be from a fistula from the trachea to the pericardium, presumed due to intubation, however, a barium swallow was performed and showed a fistula formation between the esophagus and pericardium. No surgery was indicated and the patient was on appropriate GI prophylaxis. The patient was placed on TPN until a PEG could be initiated. She remained stable and was discharged to a long term care facility with a plan for follow up EGD in 8 weeks. The patient has not yet followed up due to the COVID-19 pandemic. DISCUSSION: Here we presented a case of an esophageal-pericardial fistula with unknown origin. We presume in our patient, the fistula developed over time due to her long standing GERD, prolonged NSAID use, and known esophageal ulcers. Esophageal-pericardial fistulas are associated with a high morbidity and mortality, and making an early diagnosis is crucial. Patients with pericardial fistulas often complain of chest pain or abdominal pain but can have a wide range of more non-specific symptoms including dyspnea, fever, cough, and even sputum production. It is important to have a high index of suspicion and avoid a delay in the diagnosis, especially if there are risk factors present. This case highlights an example of a patient with a highly fatal diagnosis, who remained hemodynamically stable and relatively asymptomatic during her hospital course. (Figure Presented).