Telehealth during the pandemic: Patient perceptions and policy implications.

INTRODUCTION: Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. DESIGN: Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. METHODS: As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. RESULTS: Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). CONCLUSION: As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. CLINICAL RELEVANCE: Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.

Students Tele-All: Self-Efficacy and Self-Reflection as Measures of Student Success in Telepractice Training

With an increasing demand for telepractice services, the need for telepractice education is more important than ever. In addition to learning how to deliver these services, certain clinical and technological skills learned through telepractice apply more broadly to in-person care. Evaluating students’ abilities to master these skills is necessary to ensure clinical skill competence. We utilized self-efficacy ratings and self-reflections to determine student growth after hands-on telepractice training among nursing, occupational therapy, physical therapy, and speech-language pathology students. Students across disciplines demonstrated growth in all measured skill areas and reported overall increased confidence. Students with less prior telepractice experience reported greater increased confidence in seven measured competency areas than students with more prior telepractice experience. The number of completed sessions at the end of student placements was correlated with increased confidence for one measured skill area. Regardless of whether or not students had prior experience when starting their placement, as the number of telepractice sessions completed increased, thus did students’ confidence levels. The results of this study support telepractice as a viable clinical education tool for student growth and the use of self-efficacy and self-reflection as valuable tools for monitoring the effectiveness of telepractice clinical learning activities.

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series.

BACKGROUND: In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. CASE PRESENTATION: We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. CONCLUSIONS: In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.

When Advocates are Forced to go Virtual: The Long-Term Care Ombudsman Response to COVID 19

This study explores strategies used by the nation’s Long-Term Care (LTC) Ombudsman Programs (LTCOP) to perform their grass roots, investigatory, sentinel defense advocacy during the near total COVID LTC lock out from March 13th 2020 through September 17th, when the “ban” was conditionally lifted. Our layered systematic searches by title, subject, and total text for unrestricted allusions to the LTCOP used the multi-disciplinary database Academic Search Ultimate that includes mass media. Selection criteria included print and broadcast news. Search keywords were “ombudsman” singly and with 10 other terms. This was augmented by reviewing the National LTC Ombudsman Resource Center (NORC) clearinghouse information website and by interviewing NORC staff. Resulting (172) media entries (92% print) were manually coded independently by a team of five, and iteratively reconciled according to a simple flat frame format to identify key words and associated themes. Four main LTCOP lock out strategies emerged: (1) virtual resident interventions (via phone, Skype, Zoom, in-facility allies);(2) public outreach (services provided, sharing COVID data and best practices, social isolation threats and mitigation efforts [window visits], need for volunteers);(3) systems advocacy (state/federal;CMS, legislative and other testimony about social isolation, CARES Act check problems, visitation issues;and (4) partnering with others (multi-agency planning groups, task forces, Zoom town halls, interstate information sharing). NORC interviews revealed that older LTCOP volunteers are seizing the COVID lock-out to retire undermining an already short-staffed network—so calls for volunteers were evident in about 25% of all stories regardless of any other focus.

VIRTUAL RECREATION of REYNALDO DIERBERGER LANDSCAPE PROJECTS for UFRRJ CAMPUS

This paper presents some current results of the research, which proposes a virtual recreation of Reynaldo Dierberger original project for the Seropédica campus of UFRRJ, located in Rio de Janeiro State, Brazil. The gardens, as well as the original architectural ensemble, in neocolonial style, have been legally protected in 2001. The group of researchers faced a triple challenge to make the virtual recreation. The first one concerns the identification of what was designed and not built, based on original hand-made drawings filed in the Document Conservation Laboratory of UFRRJ (LabDOC) and other university departments. The second challenge concerns the interpretation of the elements from English Garden design principles that emerged in the 19th century and were developed in Brazil by European landscapers such as Glaziou (1828-1906). The third one concerns making design drawings digital to elaborate 3d models considering a group of digital graphic tools available and also the application of Sevilla Principles (2011). It is important to mention that some of the research activities were impaired by the COVID-19 pandemic. © 2021 A. P. R. Araujo et al.

Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients With Human Immunodeficiency Virus and Coronavirus Disease 2019.

BACKGROUND: People living with human immunodeficiency virus (HIV) may have numerous risk factors for acquiring coronavirus disease 2019 (COVID-19) and developing severe outcomes, but current data are conflicting. METHODS: Health-care providers enrolled consecutively, by nonrandom sampling, people living with HIV (PWH) with lab-confirmed COVID-19, diagnosed at their facilities between 1 April and 1 July 2020. Deidentified data were entered into an electronic Research Electronic Data Capture (REDCap) system. The primary endpoint was a severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. RESULTS: There were 286 patients included; the mean age was 51.4 years (standard deviation, 14.4), 25.9% were female, and 75.4% were African American or Hispanic. Most patients (94.3%) were on antiretroviral therapy, 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm3) was associated with the primary and secondary endpoints. There were no associations between the ART regimen or lack of viral suppression and the predefined outcomes. CONCLUSIONS: Severe clinical outcomes occurred commonly in PWH with COVID-19. The risks for poor outcomes were higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression. CLINICAL TRIALS REGISTRATION: NCT04333953.

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status.

The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.

Dangerous Models?

Gray expresses insights about models. All models are wrong, but some models are useful is the familiar George Box refrain. Statistics has enjoyed (or suffered) a lot of attention during the COVID-19 pandemic. Maps, graphs, counts- all are perused by millions who listen to experts and politicians and then argue about When will it peak? or Herd immunity versus lockdown? Statisticians are the first to ask for more data, but sometimes the last to ask what is being done with their analyses once the data have been acquired. Data scientists are working frantically to develop algorithms that will provide a better means of singling out groups and individuals as potential victims or those who have recovered.