Thoracic Myelopathy in a Teenager Caused by Stage IV Hodgkin's Lymphoma.

We report the case of a 19-year-old Native American woman who presented with bilateral lower extremity weakness due to spinal cord compression from late-stage Hodgkin's lymphoma. Hodgkin's lymphoma rarely has an initial presentation of spinal cord compression, except in cases of late-stage disease. The patient partially attributed her delayed pursuit of care to the difficulty of scheduling an appointment during the coronavirus (COVID-19) pandemic. The COVID-19 pandemic has impacted access to care and the potential for early detection of disease, as seen in this patient. Additionally, Native Americans on South Dakota Reservations face unique challenges that affect access to healthcare and health outcomes.

Accounting for Research Induced Environmental Impacts Using Life Cycle Assessment

Since the 1970's the number of scientific publications with sustainability as a keyword has increased from 1 in 1975 to 13,628 in 2019. Research, like all human endeavors, has impacts on the environment due to the activities required to generate the supporting data (i.e., use of vehicles, resources, and materials). Researchers have a responsibility to minimize their impacts as part of their work and to make environmentally responsible decisions. A life-cycle approach is currently the best-developed means of assessing the impact of a group or organization. This article presents a case study of organizational life cycle assessment (O-LCA) of a research project. The objectives of this study were to (i) estimate the impact of the project, focusing on travel. (ii) Use a post hoc approach to determine impact reduction opportunities. (iii) Apply O-LCA as a decision-making tool in project management of research and (iv) profile the environmental impact of the project using public data (manufacturers figures) and proprietary datasets. The results of this study indicate that the greatest impact arising from the project was due to commuting followed by conference and training attendance, fieldwork and meetings. Scenarios modeling, alternative vehicle use, flexible working arrangements and stakeholder events highlighted the reduction potential that could have been implemented as part of the project. O-LCA proved to be an appropriate tool for assessing the impact of a research group and that it has the potential to inform decisions and management of academic projects and events. It should be noted that the ability of research groups or personnel to bring about change might be limited, typically due to their placement within a larger organization (e.g., a higher education institute). The recent COVID-19 pandemic, has hastened the shift to remote working practices for many organizations. Recent surveys indicate that more than 80% of respondents would like to work remotely, at least some of the time, after the pandemic. This modal shift in working practices offers an immediate opportunity for environmental relief. It is recommended that O-LCA be incorporated into groups and organizations to support their decision-making practices to foster responsible and sustainable research. Copyright © 2021 Cooney, Tahar, Kennedy and Clifford.

PROVIDING LOW-BARRIER MEDICATIONS FOR ADDICTION TREATMENT VIA A TELEMEDICINE CALL LINE TO PEOPLE EXPERIENCING HOMELESSNESS IN LOS ANGELES, COUNTY

BACKGROUND: Los Angeles County Department of Health Services (LAC DHS) provides medical care for the safety net population of Los Angeles County, including a large population of people experiencing homelessness (PEH). To enhance patients' access to medications for addiction treatment during the COVID19 pandemic, LAC DHS established a telemedicine call line in March 2020 to support patients' access low-barrier medications for addiction treatment. To operationalize the call line, LAC DHS partnered with community organizations already working with PEH to facilitate timely access to medications for addiction treatment on demand. One of the largest community partners partnered with LAC DHS during this time was Community Health Project Los Angeles (CHPLA). Little was previously published regarding the patients who accessed care via CHPLA and how many of these patients remained engaged in medical treatment. We aimed to quantify and characterize the cohort of PEH treated and retained in care during the first 20 months of the operation of the telemedicine call line. METHODS: The telemedicine addiction medications call line was established in March 2020 and was accessible by any DHS affiliated outreach providers to call when they identified a patient interested in receiving a medication for addiction treatment. After each telemedicine visit was completed, CHPLA social workers logged patient information into a secure registry. Registry information was collected from March 2020 to August 2021 including patient demographics and the reason for visit. Information on addiction medications prescribed by the call line providers was also collected. Descriptive statistics were obtained and resulted below. RESULTS: During our study period, 111 of CHPLA's clients experiencing homelessness were served by the LAC DHS telemedicine call line (mean age 39 years, 74% male (N=82), 23% Latinx (N=26), 11% Black (N=10, 60% White (N=67). All PEH were prescribed buprenorphine-naloxone (bup-nx) for opioid use disorder. Insurance covered 87% (N=97) of prescriptions for bupnx. Of the 111 PEH who were prescribed bup-nx, 78% (N=87) obtained their initial prescription. Additional services provided to PEH by CHPLA included referral for case management (N=4), specialty addiction treatment (N=8), and women's health services (N=2). Of the 87 patients that received their initial prescription for bup-nx, 21% (N=18) were interested in and referred to and 6% (N=5) established care with a continuity clinic offering maintenance medications for addiction treatment. CONCLUSIONS: A telemedicine call line can be feasible and effective way to initiate low-barrier medications for addiction treatment to PEH during the COVID-19 pandemic, but low threshold initiation of medications for addiction treatment is itself insufficient to address the patient readiness, the many social determinates of health, and the systemic barriers to continuity clinical services for PEH with substance use disorders.

Engaging graduate students during a pandemic: Critical thinking, creativity, communication, and collaboration in emergency remote learning

This chapter explores the application of multiple technology-driven learning platforms to engage graduatelevel students in emergency remote learning during the COVID-19 pandemic. The authors stress the importance of integrating creativity, communication, collaboration, and critical thinking while teaching and learning at the graduate level. Multiple platforms, technology, and other tools of engagement created a plethora of opportunities for critical thinking, use of various communication styles, various learning styles, and the creative collaboration of students to work together without being together physically in the standard brick and mortar classroom. © 2021 by IGI Global. All rights reserved.

Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services.

INTRODUCTION: The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. METHODS: All acute hospitals in the UK were invited to participate. Data were collected on unit structure, and for patients admitted to acute medicine services over a 24-hour period, with follow-up at 7 days. RESULTS: 158 units participated in SAMBA21, from 156 hospitals. 8973 patients were included. The number of admissions per unit had increased compared to SAMBA19 (Sign test p<0.005). An early warning score was recorded within 30 minutes of hospital arrival in 77.4% of patients. 87.4% of unplanned admissions were seen by a tier 1 clinician within 4 hours of arrival. Overall, the medical team performed the initial clinician assessment for 36.4% of unplanned medical admissions. More than a third of medical admissions had their initial assessment in Same Day Emergency Care (SDEC) in 25.4% of hospitals. 62.1% of unplanned admissions were seen by two other clinical decision makers prior to consultant review. Of those unplanned admissions requiring consultant review, 67.8% were seen within the target time. More than a third of unplanned admissions were discharged the same day in 41.8% of units. CONCLUSION: Performance against the CQIs for acute medicine was maintained in comparison to previous rounds of SAMBA, despite increased admissions. There remains considerable variation in unit structure and performance within acute medical services.

A Qualitative Review of Social Barriers Impeding Retention in HIV Care at a Ryan White Clinic

Background. Ending the HIV Epidemic: A Plan for America aims to decrease new HIV diagnoses 75% by 2025 and 90% by 2030. To achieve this, we identified patients unable to achieve viral suppression with social-behavioral needs deemed 'high-hanging fruit.' Via extensive outreach efforts and creation of shared problem solving, we pursued the goals of rapid and effective treatment leading to viral suppression and prevention of HIV transmission. We (1) exhausted all avenues of outreach to re-engage patients in HIV care and (2) identified personal or social characteristics related to difficulties in visit retention and achieving viral suppression. Methods. Of 446 Ryan White-eligible patients seen in an urban, academic medical center, 46 did not achieve and/or maintain viral suppression, and qualified for the study. We conducted a mixed methods survey comprised of both multiple choice and open-ended questions to ascertain what barriers patients face to continuous engagement in care and to achieving viral suppression. We developed a re-engagement outreach cycle which included: text messages and phone calls, electronic messages via patient portal or email, phone call to pharmacy to cross-check contact information, outreach to patients' emergency contact, and sending a letter by mail. Results. Of 46 participants, 32 were reached and 14 were not found. Sixteen re-engaged in care and of these, 14 completed the survey (see Figure). Those who completed the survey noted the following barriers to care: poor mental health, financial issues, problems committing to an appointment due to work/family/transportation, and COVID-19. Out of all 46 participants, the 14 who were not found had an overall a higher index of chaos. This index of chaos included, but was not limited to: homelessness, IV drug use, domestic violence, and stigma. Conclusion. Intensive efforts are required to re-engage patients, counsel on adherence, and achieve viral suppression. The reasons for lack of engagement in care are real and challenging. Multiple cycles of continuous outreach serve to establish trust, address barriers, and connect to HIV care.

Co-designing the translation of research into practice to support mentally healthy workplaces in agricultural industries

Introduction: Australian agriculture is vulnerable to an ageing and deceasing workforce, increasing technological demands, global markets, climate change and uncertainty. This poses challenges for work demand/control, workplace support, change management, role clarity/conflict, workplace relationships and environmental conditions—ultimately increasing psychological distress and suicide risk. The Primary Producer Knowledge Network (PPKN) aims to develop practical strategies to prevent work-related mental health risks in agriculture. Method: PPKN engaged in a detailed co-design process with farmers and industry stakeholders—including stakeholder interviews, online development and feedback workshops, and pilot testing, and delivered online due to COVID19 restrictions. Co-design was informed by mental health research, evidence-based co-design strategies for working with vulnerable consumers, and identified work-related risks to health, wellbeing and safety. Results: 9 recommendations were derived via co-design—guiding development of an interactive web platform, roadshow, and complementary resources to meet varying digital access/expertise. Ongoing solution-focused topic development—an iterative process with experts and primary producers—reflects varied needs of industry groups and age cohorts, and drives change in the design/management of work systems. Conclusions: PPKN addresses work-related risk factors via an approach that is relevant, meaningful and empowering for the agriculture workforce. Co-design outcomes, challenges and recommendations are applicable across occupational groups where mental health and safety are of con

Diagnostic justice: Testing for COVID-19

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literatures on clinical care as well as clinical research (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. © 2021 Ashley Graham Kennedy and Bryan Cwik

Building Resilience and Attachment in Vulnerable Adolescents (BRAVA): Piloting a Virtual Adaptation of a Brief Group Intervention for Adolescents With Mild-to-Moderate Suicidal Ideation and Their Caregivers

Objectives: Suicidal ideation (SI) is common in adolescents and increases the risk of completed suicide. Due to the COVID-19 pandemic, healthcare providers rapidly shifted to providing telehealth and virtual options for clients. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a group intervention designed for adolescents and their caregivers to reduce adolescent SI. The objective of this study was to adapt BRAVA for virtual delivery and evaluate the feasibility of this adaptation. Methods: We conducted an 8-week open trial between October and December 2020. Twelve participants (6 adolescents and 6 primary caregivers) were recruited from a pediatric hospital in Eastern Ontario. Through Zoom, adolescents and caregivers completed an intake assessment together, 6 weekly BRAVA group sessions separately, and an exit assessment together 1-week post-BRAVA. The primary adolescent outcome variable was the Suicidal Ideation Questionnaire Junior (SIQ-JR). Data were analyzed in IBM SPSS v.27. Pre-post comparisons on the SIQ-JR were done with a 2-tailed t test for matched pairs. Results: The study uptake rate was 42.9% of the eligible participants. There were no study dropouts. Adolescent (Mean [M] age = 15.3 years;SD age = 1.0;66.7% female) and caregiver attendance rates for BRAVA group sessions were high (median = 6). Overall group satisfaction scores were high for adolescents (M = 4.2;SD = 0.8) and their caregivers (M = 4.2;SD = 0.7). Most youth (83.4%) and caregivers (66.7%) reported that the virtual process worked well. Whereas all caregivers (100%) agreed they would participate in a virtual group session again, youth responses were more variable (50% agree, 33.3% neutral, 16.7% disagree). Adolescent SI decreased after completing the intervention (M pretreatment [tx] = 50.7, SD pretreatment [tx] = 16.7;M post-tx = 29.7, SD post-tx = 20.4;t = 5.7;95% CI, 11.52-30.5;p = 0.002). Conclusions: Study results indicate that the virtual delivery of BRAVA is feasible. Study uptake was good, retention was complete, and satisfaction was high for adolescents and their caregivers. Importantly, initial results suggest that this adaptation of BRAVA may help reduce SI in adolescents. Feedback from participants will inform further changes to improve the adaptation of BRAVA for use in a planned RCT. S, ADOL, FT

Patterns of telehealth utilization during the COVID-19 pandemic and preferences for postpandemic telehealth use: A national survey of oncology clinicians

Background: Rarely used in routine practice pre-pandemic, telehealth utilization for cancer care rose significantly during the COVID-19 pandemic. Increased familiarity with telehealth has led to calls to continue its use after the pandemic ends. Yet national patterns of oncology telehealth utilization by visit type, preferences for telehealth use post-pandemic and barriers to telehealth for patients with cancer have not been described. Methods: 9,336 survey invitations were emailed to US-based ASCO members who have agreed to receive communications. Survey distribution was equally divided over five US regions, and practice type (e.g., academic, community) was reflective of ASCO membership proportions. The survey was open and data collected from January 4-28, 2021. Non-respondents received two reminder emails at week intervals. Analysis is descriptive. Results: 200 respondents completed the survey (2%). Respondents were 72% medical oncologists, 66% urban, 64% academic-affiliated, and from 42 states. 99% currently offered telehealth. 63% used telehealth for <=30% of all patient visits in the last 30 days;18% used telehealth for more than half of visits. Telehealth utilization varied by visit type (table). 64% reported that the care delivered in telehealth visits was similar quality to in-person visits (29% worse). Assuming no regulatory or financial barriers to telehealth use after the pandemic, 92% would like to use telehealth for at least some visit types;only 8% prefer not to use telehealth. 20% would like to use telehealth for all visits types, and 64%, 54%, 33% and 17% would like to use telehealth for survivorship, symptom management, evaluation of patients receiving treatment and new patient visits, respectively (multiple selections allowed). Major barriers to telehealth were lack of patient access to technology (reported by 81%), limited patient technological proficiency (80%), language barriers (45%), uncertainty about future reimbursement (41%) and lack of administrative resources to support clinicians (33%). 68% agreed that the barriers increase cancer care disparities. Conclusions: Telehealth utilization was widespread during the COVID pandemic and varied by visit type. Most respondents plan to use telehealth in the future, but report barriers to continued use that worsen disparities.

Trends of Publication in the Education and Practice Sections of the IJTMB: a Call to Action

The scope of the IJTMB includes not only publishing scientific research studies, but also to publish education innovation and practice-oriented approaches for all allied health providers whose practice include manually applied therapeutic massage and bodywork. The aims of the Practice and Education sections of the Journal are described in this editorial. The Education section covers topics including curriculum and competencies development, instructional design and delivery, instructional technology, distance learning, and testing/evaluative procedures for both initial education as well as continuing education. Planning, organization, marketing, and management of a successful practice, the incorporation of new scientific findings and methods into clinical practice, new clinical approaches to prevention and treatment of specific health conditions, and ethical issues are included in the Practice section. In an effort to increase publication within these sections we have put forth this call to action. We invite educators and practitioners to submit manuscripts discussing innovations in massage therapy education, how schools and students dealt with the Covid-19 pandemic, practitioners and clients adapted to the pandemic, investigations of the massage therapy profession and about massage therapists, as well as interesting case studies.

Translating Co-Design from Face-to-Face to Online: An Australian Primary Producer Project Conducted during COVID-19

Primary producers face considerable risks for poor mental health. While this population can be difficult to engage in programs to prevent poor mental health, approaches tailored to reflect the context of primary producers' life and work have been successful. This paper reports on the co-design phase of a project designed to prevent poor mental health for primary producers-specifically, the advantages, challenges and considerations of translating face-to-face co-design methods to an online environment in response to COVID-19 restrictions. The co-design phase drew upon the existing seven-step co-design framework developed by Trischler and colleagues. Online methods were adopted for all steps of the process. This paper models how this co-design approach can work in an online, primary producer context and details key considerations for future initiatives of this type. The development of online co-design methods is an important additional research method for use not only during a pandemic but also when operating with limited resources or geographic constraints. Results demonstrate the following: (i) co-designing online is possible given adequate preparation, training and resource allocation;(ii) "hard to reach" populations can be engaged using online methods providing there is adequate early-stage relationship building;(iii) co-design quality need not be compromised and may be improved when translating to online;and (iv) saved costs and resources associated with online methods can be realigned towards intervention/service creation, promotion and user engagement. Suggestions for extending Trischler and colleagues' model are incorporated.

A Virtual Rapid Response Pathway for Risk Management through COVID-19

COVID-19 related restrictions made it necessary for mental health outpatient care to abruptly transition to virtual care. For some youth and families, multiple stresses related to isolation, loss of friend and family supports, school cancellation are exacerbated by financial stress, limited parenting skills and challenges with emotion regulation. Such situations put young people at risk for deteriorating mental health and conflictual family situations, which could lead to Emergency (ED) presentations, admission, and child protective service or police involvement. At-risk young people include current outpatients, those who have been referred but not seen, and patients presenting to ED. Methods: A system was developed for categorizing all patients as high, medium or low risk and an algorithm de-veloped as to level of intervention required for each. All patients on the waitlist were triaged for risk level. A pathway was developed to have high risk patients referred from ED seen virtually within 3 days and other high risk patients monitored closely. Patient flow was adjusted to allow flexible matching of capacity to demand. Return visits to ED and evaluation of patient satisfaction with virtual care were used as outcome measures. Results: Patients referred to the rapid response pathway were seen in a shorter time than had previously been the case. Fewer patients returned to the ED on multiple occasions. Conclusions: Development of systems for categorizing patient risk levels, development of a virtual rapid response pathway, and flexing capacity to meet demand has enabled flexible rapid response to high needs patients.