ABSTRACT
Background: During the COVID-19 pandemic, HIV care providers urgently adopted telemedicine as an alternative to routine in-person person visits to ensure continuity of care. We examined how introducing televisits at a community and an academic outpatient HIV clinic during the COVID-19 pandemic affected technical quality of care for persons with HIV (PWH). Methods: The study included all non-pregnant adult PWH who had at least two visits for HIV care in the 18 months prior to 3/13/2020 at the Howard Brown Health Centers (HB) and Northwestern University Infectious Disease Center (NU-IDC) and in Chicago, Illinois. HIV care quality indicators (described in Table) were calculated using data extracted from electronic medical records during 4 different time periods: 1. pre-pandemic (1/1/19-3/1/2020), 2. early pandemic (7/1/2019-9/1/2020), 3. mid-pandemic (1/1/2020-3/1/2021), and 4. current (7/1/2020-9/1/2021). Measures were compared between intervals 2-4 and interval 1 (pre-pandemic) using generalized linear mixed models to estimate differences in indicators across intervals within each site while controlling for multiple observations of individuals. Differences by age group, race, and sex at birth were also compared. Results: 6,447 PWH were included in the analysis. The proportion of televisits peaked between April-June 2020 (71-75% at HB 53-89% at NU-IDC) then declined by July-September (33-35%at HB, 10-15% at NU). Changes in quality care measures are shown in Table 1. There were significant declines in care utilization and disease monitoring measures in intervals 2,3 &4 compared to interval 1. The largest declines were observed in STI screening. Measures of HIV virologic suppression, BP control, and HbA1C <7% (in both persons with and without diabetes) were stable with no significant differences noted in these measures between interval 4 and 1. Similar trends were observed across all age, race and sex subgroups. Conclusion: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and disease monitoring decreased compared to pre-pandemic levels. Despite these reductions, proportions with virologic, BP, and glycemic control remained stable among PWH. The effect of televisits as well as other patient factors on HIV quality indicators and their changes over time during COVID-19 need to be further examined.
ABSTRACT
Nephrology nurses face health and wellness challenges due to significant work-related stressors. This survey, conducted online between July 24 and August 17, 2020, assessed the psychological well-being of nephrology nurses in the United States during the COVID-19 pandemic (n = 393). Respondents reported feeling burned out from work (62%), symptoms of anxiety (47% with Generalized Anxiety Disorder-7 [GAD-7] scores ≥ 5), and major depressive episodes (16% with Patient Health Questionnaire-2 [PHQ-2] scores ≥ 3). Fifty-six percent (56%) of survey respondents reported caring for COVID-19 patients, and 62% were somewhat or very worried about COVID-19. Factors, including high workload, age, race, and the COVID-19 pandemic, may partially explain the high proportion of nephrology nurses who reported symptoms of burnout, anxiety, and depression. Copyright© by the American Nephrology Nurses Association.
ABSTRACT
Purpose: This paper aims to draw on Seamon’s(2012a, 2012b, 2014, 2015, 2018) theories on the “processes of place attachment” to understand the influence of place attachment on community leadership and the management of four towns in the Barossa region of South Australia. Design/methodology/approach: The research methodology combines photo-elicitation, participant observation and in-depth interviews with 12 community leaders across four town groups. Scannell and Gifford’s(2010) tripartite model for place attachment is used to segment qualitative interview data to understand the nature of place attachment of community leaders. This was followed by thematic analysis using Seamon’s(2012a, 2014, 2018) six processes of place attachment to understand how the dynamics of place attachment as a series of processes interact to influence community leadership and place-based action. Findings: The research revealed that community leaders in the Barossa region regularly confront a tension between the “Being” and “Becoming” of Place. It also suggests that place attachment for new residents is accelerated by engaging multiple place attachment processes;these can be measured using the research methodology in this study. The result is a tipping point where place leadership from new residents can accelerate towards the “Being of Place” showing a tendency towards protectionist behaviour commonly seen amongst long-term residents. Research limitations/implications: Testing the findings in this paper in other rural regions and other cultural contexts will add further insight and validation of these findings. It is recommended that future research could further develop this approach through engaging multiple place-based community groups in the same town and across different locations to understand the pattern language of communities with more accuracy. Practical implications: This study has enabled a deeper understanding of place-based community groups and their motivations to protect the status quo or promote change in the development and management of the place. Each community requires a tailored approach to place management and development to activate community resources and partnerships successfully. This research also provides knowledge on how to accelerate place attachment for new residents to improve their sense of belonging, value and purpose by engaging programs that engage all six place attachment processes. Social implications: The research reveals that place relations are dynamic, complex and often political. Rural towns display a pattern language for how they engage networks and resources that government needs to understand to engage community stewardship of place – its social, environmental and economic setting. This research offers a method to better understand the pattern language of place attachment that drives community leadership and place management to help communities sustain themselves and adapt to change. Originality/value: The research explores the inter-relationship between the place attachment of community leaders and their response to change from different types of community impacts such as bushfires or the COVID-19 pandemic. Understanding these processes is valuable in informing place management partnerships between community, business and government. © 2021, Emerald Publishing Limited.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic increasingly encountered in the clinical setting. It typically manifests as a respiratory illness, although cardiac involvement is common and portends a worse prognosis. We present the case of a 56-year-old male admitted with COVID-19 fulminant myocarditis and cardiogenic shock. We discuss important aspects of the multidisciplinary and interventional care involved in treating cardiogenic shock as well as the likely mechanisms of, and potential treatment for, COVID-19 myocarditis. The various pathways of myocardial injury, including direct viral damage, macrophage activation, and lymphocytic infiltration, are outlined in detail in addition to associated pathology such as cytokine release syndrome. COVID-19 is a complex and multisystem disease process; in addition to supportive care, specific consideration should be given to the underlying mechanism of injury for each patient.