Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: The Pulmonary Hypertension Association Registry.

To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR's inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients were more likely to be on publicly-sponsored insurance during the COVID-19 pandemic compared with prior, and did not experience statistically significant delays in access to medications, increased emergency room visits or nights in the hospital, or worsening of mental health metrics. Patients on publicly-sponsored insurance had higher healthcare utilization and worse objective measures of disease severity compared with privately insured individuals irrespective of the COVID-19 pandemic. The relatively small impact of the COVID-19 pandemic on pulmonary hypertension-related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers. Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse, consistent with prior studies highlighting outcomes in this population. We speculate that previously established care relationships may lessen the impact of an acute event, such as a pandemic, on patients with chronic illness.

ICT usage in aphasia rehabilitation-beliefs, biases, and influencing factors from the perspectives of speech and language therapists

Background: The use of digital technology is promoted as an efficient route for the delivery of intensive speech and language therapy in aphasia rehabilitation. Research has begun to explore the views of people with aphasia (PwA) in relation to Information and Communication Technology (ICT) usage in the management of aphasia but there is less consideration of the prescribers' views, i.e., speech and language therapists (SLTs). Aim(s): We aimed to explore SLTs' views of ICT use in aphasia management and identify factors that influence their decisions to accept and integrate ICT in aphasia rehabilitation. In addition, we considered the findings in the context of the Unified Theory of Acceptance and Use of Technology (Venkatesh, Morris, Davis & Davis, 2003). Methods & Procedures: Speech and language therapists (n = 15) from a range of clinical and geographical settings in the Republic of Ireland were invited to participate in one of four focus groups. Focus group discussions were facilitated by an SLT researcher and were audio-recorded and transcribed. Analysis was completed following Braun and Clarke's six phases of thematic analysis (Braun and Clarke, 2006). Outcomes & Results: Four key themes were identified;i. Infrastructure, Resources, and Support, ii. SLT beliefs, biases and influencers, iii. Function & Fit, and iv. ICT and Living Successfully with Aphasia. The SLTs discussed a wide range of factors that influence their decisions to introduce ICT in aphasia rehabilitation, which related to the person with aphasia, the SLT, the broad rehabilitation environment, and the ICT programme features. In addition, several barriers and facilitators associated with ICT-delivered aphasia rehabilitation were highlighted. Conclusion(s): This research highlights a range of issues for SLTs in relation to the use of ICT in aphasia rehabilitation within an Irish context. The potential benefits of using ICT devices in rehabilitation and in functional everyday communication were discussed. However, SLTs also identified many barriers that prevent easy implementation of this mode of rehabilitation.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

COVID-19 stressors and symptoms of anxiety and depression in a community sample of children and adolescents.

BACKGROUND: The COVID-19 public health crisis has created abrupt and unparalleled disruptions to the daily lives of children and adolescents across the world, placing them at significant risk for developing symptoms of anxiety and depression. METHOD: The current study used two data collection periods to determine which types of COVID-19-related stressors were associated with the greatest risk of anxiety and depression symptoms in a community sample of children and adolescents in the United States (U.S.) from May-August 2020 (T1) to February-April 2021 (T2). Seventy-nine youth (ages 10-17; M = 13.41, SD = 2.10; 54.4% female) completed a battery of online standardized questionnaires about COVID-19 stress and psychiatric symptoms at T1 and 56 of these also participated at T2. RESULTS: The majority of children and adolescents reported experiencing the COVID-19-related stressors in multiple domains including daily routines, interpersonal relationships, education, finances, and health. A substantial proportion of the sample reported clinical levels of depression and anxiety symptoms at both T1 and T2. Multiple linear regression analyses revealed that, controlling for T1 anxiety and depression symptoms, T2 interpersonal stressors were significantly associated with elevated depression and anxiety scores at T2. CONCLUSIONS: The findings highlight the salience of social connection for children and adolescents, and may also underscore the risk associated with lockdown restrictions, social distancing, and school closures during the pandemic.

Enhanced Patient-Centricity: How the Biopharmaceutical Industry Is Optimizing Patient Care through AI/ML/DL.

Technologies utilizing cutting-edge methodologies, including artificial intelligence (AI), machine learning (ML) and deep learning (DL), present powerful opportunities to help evaluate, predict, and improve patient outcomes by drawing insights from real-world data (RWD) generated during medical care. They played a role during and following the Coronavirus Disease 2019 (COVID-19) pandemic by helping protect healthcare providers, prioritize care for vulnerable populations, predict disease trends, and find optimal therapies. Potential applications across therapeutic areas include diagnosis, disease management and patient journey mapping. Use of fit-for-purpose datasets for ML models is seeing growth and may potentially help additional enterprises develop AI strategies. However, biopharmaceutical companies often face specific challenges, including multi-setting data, system interoperability, data governance, and patient privacy requirements. There remains a need for evolving regulatory frameworks, operating models, and data governance to enable further developments and additional research. We explore recent literature and examine the hurdles faced by researchers in the biopharmaceutical industry to fully realize the promise of AI/ML/DL for patient-centric purposes.

Post-vaccination Central Nervous System Inflammation at a Tertiary Neuroimmunology Clinic: Impact of Influenza, SARS-CoV-2, and Other Vaccines

Objective: We aim to determine the prevalence and clinical characteristics of iatrogenic CNS inflammation associated with vaccinations at a tertiary neuroimmunology clinic and compare the frequency of these events before and after the COVID-19 pandemic. Background: Various vaccines are implicated in rare demyelinating events. Although influenza is the most commonly-implicated vaccine, an increasing number of CNS inflammatory events are linked to SARS-CoV-2 vaccines. Design/Methods: We analyzed consecutive patients seen over 4 years (2017-2021) at a tertiary neuroimmunology clinic who were screened for iatrogenic CNS inflammation secondary to vaccinations. In patients with suspected iatrogenic events, the Naranjo Adverse Drug Reaction Probability Scale was used to score the probability of vaccine-related events as doubtful, possible, probable, or definite. Results: In total, 419 patients were seen over 4 years and were screened. Eleven cases were identified, and the total prevalence was 2.6% (82% female, average age 56+/- 18 years). Most events (10, 91%) were scored as probable. The following disease phenotypes were identified: multiple sclerosis relapse (6, 55%), optic neuritis (1, 9%), monophasic MOGAD (1, 9%), transverse myelitis relapse (1, 9%), seropositive NMOSD (1, 9%), and autoimmune encephalitis (1, 9%). The vaccines included influenza (n=4), SARS-CoV-2 mRNA (n=3), swine flu (n=1), and HPV (n=1). Two patients were exposed simultaneously to multiple vaccines (tetanus, MMR, and VZV;tetanus, hepatitis A, and meningococcal vaccines). Spontaneous resolution occurred in 36% of events, complete response to corticosteroids/immunotherapy in 46%, partial response in 9%, and unresponsiveness in 9%. Finally, 8 patients (73%) had relapsing disease and 3 patients (27%) had monophasic disease. Conclusions: Post-vaccination iatrogenic CNS inflammation is a rare but distinct neuroimmunological disease spectrum mostly involving spontaneous recovery or responsiveness to corticosteroids. We did not identify an excess of SARS-CoV-2 vaccine-related events. The rare occurrence and predominantly favorable prognosis suggest the benefit of vaccination outweighs the neurological risks, especially during the COVID-19 pandemic.

Interrogating the ‘White-Leaning’ Thesis of White–Asian Multiracials

The study of multiracial people in the United States has typically focused on the experiences of Black–White racially-mixed individuals. In this article, we review and analyze the theoretical and evidence base for the White-leaning characterization of Asian–White multiracials. Historically, Asian Americans have been positioned as a “racial middle” group in relation to White and Black Americans. In line with this perceived racial position, Asian–White multiracials have been generally characterized as being more White than Black–White multiracials, as well as “leaning White” in terms of self-identification. While there is growing recognition of the variability of experiences among Black–White multiracials, the depiction of Asian multiracials as White-leaning—though based on limited empirical evidence—continues to be prominent, revealing the tendency to view Asian–White individuals through a “White racial frame.” The racial identifications and experiences of Asian–White multiracials are far more complex than such a view suggests. We argue for the need to advance studies on Asian mixed-race people to accurately capture their racial positioning within a system of White supremacy, including the diversity of their identifications, political views, and racialized experiences.

Coping with COVID-19 stress: Associations with depression and anxiety in a diverse sample of U.S. adults.

The COVID-19 pandemic has brought unprecedented levels of stress to individuals in the U.S. and throughout the world. These high stress levels place individuals at risk for symptoms of anxiety, depression, and other psychiatric disorders. The current study applies a control-based model of coping to contribute to the development of evidence-based interventions to promote resilience. Data were collected online from April 22 through July 12, 2020. Data from two samples of U. S. community adults who completed an online battery of standardized questionnaires were combined (N = 709). More than a quarter reported moderate to severe levels of depression symptoms, and more than one-fifth reported moderate to severe levels of anxiety symptoms; symptom levels were higher among adults who reported more COVID-19-related stress. As hypothesized, multiple regression analyses indicated that greater use of primary and secondary control coping was associated with lower symptom levels, whereas greater use of disengagement coping was associated with higher symptom levels, above and beyond the association of stress with symptoms. Race and ethnicity emerged as important moderators of these associations, indicating that what constitutes adaptive coping varies according to characteristics of the individual. Implications for public health policy and clinical practice are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02444-6.

New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review.

Noncommunicable diseases (NCDs) place a huge burden on healthcare systems and society as a whole. Relatively early in the coronavirus disease 2019 (COVID-19) pandemic, clinicians became aware that in individuals infected with COVID-19, those with preexisting NCDs such as diabetes mellitus and cardiovascular disease (CVD) were at a greater risk of poor outcomes and mortality than those without. The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years, but with limited success - the proportion of patients adherent and persistent to their medications remains very low. There are many facets to adherence and persistence. Recent evidence suggests that a patient-centric approach is important, and ensuring that a patient is both motivated and empowered is critical to improving adherence/persistence. The COVID-19 pandemic has brought many changes to the way in which patients with NCDs are managed, with telemedicine and ehealth becoming more common. Changes have also occurred in the way in which patients can gain access to medications during the pandemic. The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic. Over the coming months, a huge amount of work will be put into initiatives to promote adherence to COVID-19 vaccination programs. Those at highest risk of severe COVID-19, such as people aged 80 years and older, are likely to receive the vaccine first in some parts of world. Finally, social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID-19, but also access to healthcare, and a patient's adherence and persistence with their treatments.

In vitro diagnostics for the medical dermatologist. Part II: Hypercoagulability tests.

The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.

Exploring the Impact of COVID-19 on Nurse Workload and Quality of Care via Computerized Simulation

COVID-19 is taking a significant toll on front-line healthcare professionals - especially nurses who provide care for patients 24/7. Given the trend for higher acuity levels among the COVID-19 patients and increased infection prevention and control (IPAC) precautions, such as donning and doffing personal protective equipment (PPE), the demands on front-line healthcare professionals have changed. To understand the changes, discrete event simulation (DES) was used to quantify the effects of varying COVID-19 policies on nurse workload and quality of care. We are testing a standard nurse-patient ratio of 1:5 where we vary the number of COVID-19 positive patients in that mix from 1 to 5. Preliminary modeling results show as nurses were assigned to more COVID-19 positive patients, the workload of nurses increased, and quality of care deteriorated. In comparison to the baseline (pre-pandemic) case, distance walked by simulant-nurse, mental workload, direct care time, missed care, missed care delivery time and care task waiting time, increased by up to 40%, 279%, −27%, 132%, 311% and 44%, respectively. The developed approach has implications for design of the healthcare system as a whole, including pandemic planning scenarios. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Healthcare Delivery and Huntington's Disease During the Time of COVID-19.

BACKGROUND: Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington's disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD. OBJECTIVE: The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels. METHODS: This observational study of a clinical HD population during the 'safer-at-home' orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity. RESULTS: Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden. CONCLUSION: A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.

Transitioning to Online Teaching

Given the effects of natural and social crises that disrupt face-to-face education, such as the COVID-19 pandemic, many teachers have been forced to use online tools to provide their students with distance learning. Luckily, with expanding access to online learning technologies, this transition is more possible than it ever has been before. There are many considerations that schools and teachers need to consider when they redesign face-to-face instruction to meet the needs of distance or online learning. This chapter outlines some of the elements of the online learning environment that teachers must address in order to be successful, such as technical professional development, online resources for teacher collaboration, recognition of time and skill constraints, or the “new normal” for education during the coronavirus pandemic, and the role that teacher perceptions and beliefs around technology plays in the classroom. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.