ABSTRACT
Purpose of Study: Telemedicine has become a common option for healthcare delivery in the post-COVID-19 era. There are advantages, but the barriers to care for children with medical complexity (CMC) and marginalized populations have not been well-described. This study assessed parental perception of telemedicine in the care of their children. Methods Used: A REDcap survey was distributed to parents of hospitalized patients close to discharge to examine their attitudes regarding outpatient telemedicine with a focus on the post-discharge follow-up visit. Summary of Results: A total of 78 parents responded to our survey. A majority (58%) identified themselves as an ethnic minority. About 47% of parents completed college or postgraduate education;the rest had a high school diploma or some college education. Half (50%) of the parents reported a family income of <$100,000. Of the 78, 50% had used telemedicine previously, and a majority (76%) preferred in-person visits. Of those who belonged to a minority population, 80% preferred in-person visits after hospital discharge. Fifty-seven of the parents answered further questions about telemedicine and their child's medical complexity. Of these 57, 53% had a CMC, requiring specialized care and only 20% agreed or strongly agreed that it was difficult to take their child to in-person visits. Fifty-three out of the 78 parents provided a free text response about their thoughts on telemedicine visits. Common themes about advantages of in-person visits were a) preference for a physician's physical exam b) in-person visits were more personal and facilitated clearer communication and c) in-person visits provided more accurate? care compared to telemedicine (See Figure). Internet or computer access as a barrier was only mentioned by 3 parents. The main advantage of telemedicine mentioned was convenience. Conclusion(s): Our study shows that most parents prefer in-person visits, especially after hospital discharge. Our results may not apply to other populations as most of our patients were medically complex and belonged to a minority population. To increase parental support of telemedicine, techniques to improve family confidence in visual assessment and communication are required. Larger studies are needed to identify the needs of patients and families with a focus on the child's medical needs.
ABSTRACT
In response to the growing interest in the health of natural resource-dependent communities, numerous methods have been used to monitor community well-being. However, many existing approaches lack the ability to compare well-being metrics across space and over time while maintaining community voices and perspectives in their own well-being assessment. This manuscript describes the development and implementation of a virtual methodological approach to gathering both quantitative and qualitative data about community well-being in natural resource contexts. We demonstrate application of the approach with commercial fishing communities in relation to long-term socioeconomic monitoring of the California marine protected area network. The approach involved conducting focus groups with commercial fishing “community-experts” in eighteen major California ports. Due to pandemic conditions at the time of data collection, focus groups were held online over Zoom, but the method could also be conducted in-person when health and safety protocols allow. The focus groups were guided by a well-being assessment tool, which included quantitative questions where fishing community-experts were asked to rate their port along environmental, economic, and social aspects of community well-being. An open-ended qualitative discussion followed the rating exercise for each question, after which participants were asked to re-rate the question to produce deliberative, consensus-based ratings. We describe considerations of and insights from the implementation of this approach. Future researchers and practitioners may want to consider the benefits of this approach based on two factors: (1) the mixed-methods focus groups provided a means to develop quantitative well-being metrics comparable across communities and time and introduced rich qualitative information about the context of and conditions in communities across a large spatial area;and (2) the virtual format of the focus group led to lower research costs, offered greater flexibility in scheduling, and received positive feedback from participants who communicated the benefits of being able to participate in the research experience from the comfort and convenience of their own homes. Even as COVID-19 restrictions are lifted, researchers and practitioners may want to consider keeping virtual engagement approaches as a tool in their methodological toolbox, which can open up new avenues for connection and understanding. © 2022 by the Society for Applied Anthropology.
ABSTRACT
A 53–year–old woman was admitted for chest pain for over two weeks, fever, dry cough, fatigue and myalgia. Chest pain increased in supine position and inspiration. Nasopharyngeal swab was positive for SARS–CoV–2 RT–PCR assay. Admission ECG displayed mild ST–segment elevation (0,5 mm) in inferolateral leads and echocardiogram showed normal left ventricular volume, mildly decreased left ventricular EF (52%) and no regional wall motion abnormalities. Blood tests exhibited elevated values of high–sensitivity troponin I (818 pg/mL), proBNP (19.190 pg/mL), CRP (42 mg/dL), D–Dimer test (1090 ng/mL) and WBC (13000/uL, N 89%, L 7%). IL–6 resulted slightly increased (18 ng/mL). ECG after 24 hours showed T wave inversion in inferolateral leads. Coronary CT angiography revealed normal epicardial arteries. A new echocardiogram, after five days, showed infero–basal hypokinesia, improved global EF (57%) and minimal pericardial effusion. Aspirin and fondaparinoux were started. Myopericarditis was suspected and high dose steroids were administered. After a few days, symptoms improved and ECG, echocardiographic abnormalities and troponin levels were normalized. At 6 weeks follow–up the patient was asymptomatic, ECG and echocardiogram were both normal. Instead cardiac MRI showed signs of endothelial injury: presence of interstitial oedema in the inferoapical and anteroseptal wall (STIR–T2–weighted), without late gadolinium enhancement. We measured blood levels of endothelial dysfunction markers: soluble ICAM–1, VCAM–1 and von Willebrand factor (vWF). They all resulted elevated as compared to a laboratory pool of normal serum (535 ng/ml, 265 ng/ml, and 1659 ng/ml, respectively). Our case was suggestive of myopericarditis related to Sars–Cov–2, but echocardiogram and MRI did not show signs of myocarditis permanent damage. However MRI showed interstitial oedema and hyperemia, typical signs of endothelial injury. Moreover we found high levels of soluble endothelial adhesion molecules, vWF, ICAM–1 and VCAM–1, likely expression of the microcirculatory endothelial dysfunction due to myocardial endothelialitis. In conclusion, our case report suggests that, in COVID–19, acute myocardial injury associated with clinical and investigational signs of myocarditis can be due to myocardial endothelialitis rather than true myocarditis and that an early management with anti–inflammatory drugs (steroids) can be particularly beneficial in patients with unexplained elevated cardiac troponin.