ABSTRACT
Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.
ABSTRACT
The COVID-19 pandemic accelerated a widespread shift to telehealth among mental health professionals to prioritize both providers' and clients' safety. Telehealth is likely here to stay; however, there is limited practical guidance for clinicians about how to make decisions regarding who should proceed with care via telehealth versus in-person. There also is virtually no data on the effectiveness of hybrid approaches to care; yet this can be an attractive option with potential clinical benefit. This paper provides practice-informed guidance to support shared clinical decision-making between clinicians and families to decide whether to engage in therapy services in-person or via telehealth. We specifically focus on decision-making guidance relevant for youth with anxiety or related disorders, given the unique implications of telehealth for these youth. Guided by the three-legged stool of evidence-based practice, we discuss how clinicians can use principles of shared decision-making to inform clinical recommendations about treatment modality.
ABSTRACT
While teledermatology has been a feature of some dermatology services for some time, the COVID-19 pandemic has led to both a deterioration in waiting lists for routine patients, and the use of distance consultation as a means of providing and improving access for such patients. The majority of teledermatology platforms rely on general practitioner (GP)-submitted information and images, and most data suggest that these systems result in around 50% of patients avoiding hospital attendance through the implementation of management plans suggested by hospital-based consultants (Mehrtens SH, Shall L, Halpern SM. A 14 year review of a UK teledermatology service: experience of over 40,000 teleconsultations. Clin Exp Dermatol 2019;44: 874-81). We now report the use of an online platform (Virtual LucyTM) using patient-provided information via a structured questionnaire, and patient images uploaded following clear online guidance, reinforced by call centre interaction. The data are derived from funded National Health Service (NHS) work: there was no specific funding for its generation. In total, 3500 patients from two hospital trusts with routine waiting list pressures were invited to use the system as an alternative to eventual hospital attendance. After secure registration, they completed dermatology and general health questionnaires based on conventional medical history taking, as well as a Dermatology Life Quality Index and then uploaded one or more images as appropriate. The patient data were reviewed by a consultant and a self-populated report provided to the patient, GP and trust within 72 h. Forty-eight per cent of patients were discharged to their GP with reassurance or a management plan. Patients requiring hospital attendance were signposted to appropriate clinics (e.g. isotretinoin, phototherapy, patch testing) or to surgical clinics for biopsy or excision. Hospital trust-based consultants were able to access the platform to view images prior to any surgery. Of patients directed to hospital clinics, 32% were reclassified as being urgent - waiting list duration was the main determinant of the need for reclassification. Of all images, 0.5% were unsatisfactory, and those patients were contacted through the platform to ask for a replacement image with specific advice. One per cent of patients were contacted by clinical staff by telephone or video to clarify or expand on the information given, and approximately 1% of patients used the platform to ask for additional treatment details. There were no patient complaints, and GP and hospital staff issues related to logistics were increasingly uncommon as iterative development of the system and support processes occurred. Teledermatology using patient-derived information and images gives similar outcomes to those seen in published conventional teledermatology, puts fewer demands on clinical staff, is popular with patients and has a significant benefit to the NHS.
ABSTRACT
The COVID-19 pandemic accelerated a widespread shift to telehealth among mental health professionals to prioritize both providers' and clients' safety. Telehealth is likely here to stay;however, there is limited practical guidance for clinicians about how to make decisions regarding who should proceed with care via telehealth versus in-person. There also is virtually no data on the effectiveness of hybrid approaches to care;yet this can be an attractive option with potential clinical benefit. This paper provides practice-informed guidance to support shared clinical decision-making between clinicians and families to decide whether to engage in therapy services in-person or via telehealth. We specifically focus on decision-making guidance relevant for youth with anxiety or related disorders, given the unique implications of telehealth for these youth. Guided by the three-legged stool of evidence-based practice, we discuss how clinicians can use principles of shared decision-making to inform clinical recommendations about treatment modality.
ABSTRACT
Objectives: This study was designed to test the feasibility of running a trial to compare the effectiveness of a combined weight management and physical function programme for patients with knee osteoarthritis ARMED (Arthritis Rehabilitation through the Management of Exercise and Diet) with usual care ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise). The COVID-19 pandemic interruption allowed additional measurement of the qualitative 'lived in' experiences of this patient group during the pandemic and also their appetite for virtual health. Participants: Thirty-two patients with knee osteoarthritis were recruited from a combined primary/secondary care waiting list and were allocated to either a six-week intervention group (ARMED) or to the six-week usual care ESCAPE pain group (Enabling Self-management and Coping with Arthritic Pain using Exercise) group. Results: The intervention programme was interrupted after three weeks by COVID-19. Fifteen patients were reassessed after the first stage. The average attendance was 92% with 6 patients attending all sessions, 5 attending 5/6, 1 attending 4/6 and 2 attending 3/6. One subject dropped out and 15/16 patients completed all outcome measurements. All patients completed the KOOS knee score and the Short Warwick-Edinburgh Mental Well Being Scale to evaluate anxiety and depression. There was a statistically significant improvement in pain, activities of daily living, quality of life and mental health and well-being scores from time one to time 2. The mean weight, BMI and waist measurements were reduced also from time one to time 2, but these failed to reach significance. The semi-structured interviews provided rich information on enablers and barriers to coping in lockdown, benefits of the ARMED programme to increasing physical activity and weight management and enablers and barriers to redesigning the programme for online delivery. Conclusions: Evaluation of preliminary data from this feasibility study supports the three-week intervention combining education, exercise and weight management in this patient group even during a pandemic. Based on the results of the qualitative interviews, we have now redesigned our programme to present it virtually. We hope to present the results of our virtual feasibility study later in 2021. ©
ABSTRACT
The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.