Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation.

OBJECTIVE: The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH. METHOD: A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL). RESULTS: Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities. CONCLUSIONS: Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.

Pivoting to Video Telehealth for Delivery of HIV Care During COVID-19: A Brief Report

Background: The rapid spread of the SARS-CoV-2 pandemic obstructed human subjects research, including our own randomized hybrid type 2 effectiveness–implementation trial comparing multidisciplinary HIV care delivered by video telehealth to home (VTH) versus in-person delivery. Methods: Given the Veteran Health Administration's extensive telehealth infrastructure and our team's expertise in personalized implementation of virtual treatments (PIVOT), we shifted our focus to meet the immediate needs of our primary study site (implementation). Our implementation team began training the interdisciplinary infectious diseases clinical team in VTH after declaration of the pandemic in March 2020. We pivoted from a randomized clinical trial recruitment and supported modifications in clinic processes by introducing patients to VTH through personalized telephone calls and mailed brochures to inform them of telehealth options during the pandemic. Adaptations were made to provider locations, with some providers delivering care remotely from home and others delivering virtual care from the clinic. We also modified the external and internal facilitator roles to allow external facilitators to provide one-on-one training, troubleshooting assistance, and delivery of necessary equipment. Results: Within 6 weeks of the emergency declaration of the pandemic, 100% of providers (n = 27) had conducted at least one appointment, with 24.1% (n = 124) of unique patients using VTH. Despite challenges, we capitalized on temporary mandates to assist providers in delivering care virtually. Given our successes, we encourage researchers to be flexible and seek alternative approaches to preserve research efforts in extenuating circumstances. RCT registration: NCT04055207 at clinicaltrials.gov

Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study

Background The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education. Methods We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings;senior residents;interns;and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn. Results Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms;use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001). Conclusion Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics. Disclosures Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)