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Introduction: COVID-19 infection is associated with marked inflammatory response and the patients who are admitted to the hospital are at increased risk of developing venous thromboembolism. sRAGE (soluble receptor for advanced glycation end-products) are acutely elevated in host inflammatory response to infections [1]. Fractal dimension ( df), the biomarker of clot microstructure that measures thrombogenicity has shown to be elevated in acute inflammatory conditions such as sepsis and severe sepsis. The aim of the study was to analyse these biomarkers in COVID-19 infection and whether these biomarkers help to predict mortality. Method(s): 120 suspected COVID-19 patients were recruited from the Emergency Department of a tertiary teaching hospital. One patient was excluded because they were anticoagulated, blood samples were taken to perform fractal dimension ( df) and sRAGE. Result(s): When compared to PCR -ve group, 95 patients in the PCR + ve group had significantly elevated sRAGE (p < 0.001), but not df (p = 0.43). When compared to those who survived, sRAGE was significantly elevated (p = 0.01) in 14 patients who died in PCR + ve group, but not df (p = 0.08). No significant correlation existed between sRAGE levels and df in those patients who survived (p = 0.72) or died (p = 0.92). Logistic regression analysis showed that sRAGE and df in combination acted as highly significant predictors of mortality in COVID-19 (p = 0.009) in PCR + ve group. Conclusion(s): COVID-19 patients had a profound inflammatory response as evidenced by significantly elevated sRAGE levels. This inflammatory process was more profound in those who died. The thrombogenicity in COVID-19 patients and those who died with COVID-19 appears to be not significant as measured by df. sRAGE in combination with df can be utilised as significant predictors of mortality in COVID-19 patients.
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Purpose of Study: During the COVID-19 pandemic, the number of home births increased due to a rising perception of danger at hospitals. Social media is a way to share stories and experiences on topics including birth, and it has become a main means by which people gather information, regardless of whether it is accurate or not. While reasons for choosing home birth have been studied before, gathering this information from social media, especially considering the recent pandemic, has not yet been done. Reddit is a social media platform that includes 52 million daily users that post publicly and anonymously, thus sharing unfiltered information for anyone to see. Through a review of public posts and comments on Reddit from January 2017 through July 2022, using guidelines from previous studies, major themes on perceptions, attitudes, and advice people have about home birth were gathered. Methods Used: Search words on Reddit included home birth?, home vs. hospital birth?, home birth and covid?, home birth and birth trauma?, and home birth and trans men?. There were up to five themes per post or comment. These themes were categorized as positive (in support of home birth), negative (against home birth), or neutral. Posts had to be from the US, in English, with at least 10 comments and 10 upvotes, and from the last five years. Posts were excluded if they did not meet minimum comments and/or upvotes requirement, were explicitly from another country, were not directly related to home birth, it was not a planned home birth, it was a free birth, or they were from more than five years ago. Summary of Results: A total of 425 posts and 13,013 comments were reviewed for all search words. Out of 142 posts included, 68% were in support, 21% were against, and 11% were neutral. There were 1,384 comments included. Specific communities (subreddits?) were also searched and 36% of posts came from r/homebirth?. Supportive themes included concerns about safety in hospital delivery and reassurance about home birth safety, patient control with home deliveries, and advice about preparing for home birth. Negative themes included concerns about the risk of home birth, charges of negligence for those attempting it, reassurance that hospital birth offers women more control, and that medical interventions can be lifesaving. Conclusion(s): The results of this study will be used to help physicians recognize what women worry about hospital birth and what (mis)information they may have about home birth to better advise patients about their delivery options. This gives a voice to patients and their concerns regarding birth, which can help bridge gaps in physician-patient communication.
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Purpose of Study: During the COVID-19 pandemic, patients avoided hospitals for many conditions, including giving birth. When compared to births in 2019, home births increased by 22% in 2020 and neonate outcomes worsened. Apgar scores of 0-3 and preterm births increased by 35.9% and 39.3% respectively. Previous studies have examined why patients choose home birth, but there has not been a recent study using social media as a source to identify these reasons. In this study, we identified themes in TikTok comments and posts to describe current attitudes toward home birth as it becomes a more prevalent choice in birth location among people despite the fact it is associated with worse birth outcomes. Methods Used: Using the search terms "home birth" and "home vs. hospital birth," videos were extracted from TikTok 's database and sorted by relevance to the search query. Video posts were reviewed for inclusion criteria: a minimum of ten comments, in English, in the date rage of January 2017- July 2022, and discussing birth within the United States. Inductive thematic saturation was used to classify the themes within the included video posts and proceeding comments. Once thematic saturation was reached in the comments, defined as ten consecutive comments with no new themes, the next post in the search results was reviewed. When 10 consecutive new posts with no new themes were found, the next search term was examined. All themes were extracted from each post and comment. The subjective importance of each of the themes within a post or comment were not identified. Summary of Results: The search yielded 352 posts and 34,439 comments. 115 posts and 1024 comments met inclusion criteria. Overall, 71.3% of posts were supportive of home birth, 17.4% were opposed, and 11.3% were neutral;70% of posts were from 2022 and nearly all the rest from 2021. Fourteen supportive themes such as desire to control the birth environment and experience, perceived danger in hospital birth, desire for fewer medical interventions, and personal stories were identified while ten themes in opposition emerged such as the perceived danger of home birth, desire for medical interventions, and personal birth experience. Three themes focused on an individual's right to make their own choices were identified as neutral. Analyzing the total theme counts: 894 supported home birth, 359 opposed it, and 172 were neutral. Conclusion(s): The COVID-19 pandemic brought the topic of home birth to the forefront. Women appear to be drawn to home birth because it is an environment where they have control and feel safe and comfortable. This study's results may be used to understand current attitudes of a vocal minority toward home birth, improve counseling patients received from physicians, and be implemented to improve hospital birth experiences.
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The papers in this special issue highlight the ways in which study abroad (SA) has been reimagined since the onset of COVID-19 in March 2020, an unprecedented time when international travel was abruptly paused. As both the virus and society's responses to it continue to evolve, it would be unwise (and frankly impossible) to simply resume SA programming as if nothing has happened. Life as we know it has changed. But what makes us the same despite differences in borders, time zones, and languages–what makes us all humans– is our ability to face adversity head-on and adapt to changes in ways we never knew were possible. Such discoveries serve as the products of change, shaping where the field of international education is headed. This special issue has brought to light the ways in which students, teachers, and administrators have creatively navigated SA throughout the peaks and valleys of the pandemic, thus charting a path forward through previously uncharted territory. In this epilogue, we summarize notions from the contributing authors to answer the following questions concerning quo vadis, or where the field of SA is headed. © 2023 by the author(s).
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The onset of COVID-19 has prompted world language professionals to reconceptualize best practices in second language (L2) teaching and research during a time of limited interaction due to social distancing across the globe (Morris, 2022). Not surprisingly, study abroad programs that once fostered communicative and intercultural development were put on pause, also halting opportunities for the transformative learning that can occur in immersion contexts (Leaver et al., 2021). Because study abroad can provide L2 learners with authentic L2 input and opportunities for meaningful interaction in diverse social contexts in ways that traditional classrooms simply cannot replicate, it provides fertile ground for L2 pragmatic development, particularly when supported with explicit instruction (Morris, 2017). This paper provides evidence from two studies of pragmatics that justifies the importance of getting back abroad to maximize L2 pragmatic development. The first study of 16 advanced L2 Spanish learners at home revealed limited pragmatic knowledge among all participants, including those who had studied abroad, thus pointing out the shortcomings of uninstructed pragmatic development. The second study of beginning L2 Spanish learners abroad confirmed the development of pragmatic competence among all students, particularly those who received a task-based instructional treatment. These studies signal that it is not only important to get back to Rome, per se, but also essential to support students in discovering what the Romans do, along with how, when, and why they do it, thus supporting their communicative effectiveness both in and out of the classroom as we move through and beyond the pandemic. © 2023 by the author(s).
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Background Graft versus host disease (GVHD) most often occurs 100-365 days after hematopoietic stem cell transplant (HSCT). Manifestations most often are dermatologic, hepatic or pulmonic, and are rarely cardiac. We present a unique case of GVHD inducing cardiogenic shock necessitating advanced heart failure therapies. Case This is a 34 year-old male with a history of acute lymphoblastic leukemia who completed chemoradiation and HSCT from an HLA perfect sibling in 1992. In May 2020, he presented with dyspnea for 6 weeks. An echocardiogram at that time showed an EF of 10% and severe biventricular dilatation. He was originally hospitalized at an outside institution for hypoxia where a left heart catheterization showed normal coronaries and goal directed therapy was initiated. After 2 negative COVID tests, he was discharged with a LifeVest. One month later, despite medication compliance, he returned in cardiogenic shock after his LifeVest was activated for ventricular tachycardia (VT). Decision-making He was started on inotropic therapy and an intra-aortic balloon pump (IABP) was placed 1:1 prior to transfer to our tertiary center. After support was started, a right heart catheterization showed a right atrial pressure of 13 mmHg, a wedge of 17, and a cardiac index of 2.6. His course was complicated by VT storm. Differentials for his non-ischemic cardiomyopathy (NICMO) included myocarditis (viral vs. giant cell) with a possible component of chemotherapy/radiation induced NICMO. Immediate AHFT work-up was started. He was unable to be weaned off his IABP or inotropic support. The decision was made to pursue emergent left ventricular assist device placement (LVAD) and achieve a definitive diagnosis with a core biopsy. Pathology resulted with myocyte hypertrophy, chronic inflammation with eosinophils concerning for chronic GVHD. Conclusion There have only been a handful of case reports describing cardiac manifestations of GVHD, and none with NICMO and cardiogenic shock requiring an LVAD. Despite this, suspicion should remain present for GVHD in HSCT patients regardless of time frame from oncologic therapies or specificity of HLA match when presenting in cardiogenic shock.Copyright © 2023 American College of Cardiology Foundation
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Background. Tixagevimab/cilgavimab (TC) was approved by the FDA in December 2021 for use as pre-exposure prophylaxis in patients with moderate to severe immune compromise. On February 24, FDA recommended a second dose for patients who received the original dosing because of decreased activity against Omicron subvariants. We were interested in reviewing TC experience in Minnesota. Methods. Minnesota Department of Health established a voluntary TC patient registry in December 2021, including date of treatment, COVID-19 vaccination status and immunocompromising conditions. Patients were matched to state COVID-19 case data from December 1, 2021 to April 22, 2022, to examine occurrence of SARS-CoV-2 infection (a positive test by PCR or antigen) following receipt of TC. Results. Data were available for 289 patients, representing 5-10% of all patients treated with TC in Minnesota. 53% were male with a median age of 62 (IQR 48-70). 13 patients (4.5%) had not received COVID-19 vaccine at the time of initial TC dose. 128 patients (44%) received 2 doses of TC. Immunocompromising conditions included: hematological malignancy (114, 39.4%), treatment with immunosuppressant medications (113, 39.1%), solid organ transplant (45, 15.6%), and stem cell transplant (13, 4.5%). 5 patients (1.7%) had a positive SARS-CoV-2 test (4 PCR, 1 antigen) following receipt of TC (Table 1);patients tested positive on days 7, 11, 13, 17 and 48/70. Three patients were on rituximab and 2 had hematological malignancy. All 5 had received 3 doses of COVID-19 vaccine prior to receipt of TC. Variant information was available for 2 patients: BA.1 and BA.1.1. 1 patient required hospitalization for COVID-19 and died 39 days after the positive test but had 3 subsequent negative tests before discharge;death was attributed to underlying malignancy. Table 1: Characteristics of patients with positive SARS-CoV-2 tests following treatment with tixagevimab/cilgavimab. Conclusion. In a convenience sample of 289 patients who received TC, 5 patients had COVID-19, with 3 occurring within the SARS CoV-2 incubation period following receipt of TC. One of the other patients was positive after receiving 2 doses of TC. Following effectiveness of TC will be useful as SARS CoV-2 continues to evolve.
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Introduction: One team, multiple sites is a principle supporting our Academic Health Sciences Centre (AHSC) partnership vision for academic and clinical excellence. COVID-19 has highlighted the need for co-ordinated crossorganisational working within ICU. There is currently no nationally agreed competency framework for ICU Physiotherapists. Having a streamlined set of competencies across the AHSC would be beneficial for safety, quality of care, training efficiency, workforce development, workforce mobility and further embed collaborative cross-site relationships. Objective: To develop streamlined competencies for ICU Physiotherapists working within an AHSC. Methods: Physiotherapy ICU leads from each site in the AHSC were identified via stakeholder mapping. This work stream was facilitated by a dedicated project lead, using a Plan-Do-Study-Act (PDSA) cycle. Organisational and national competencies1-3 relevant to ICU Physiotherapists were collated. Benchmarking and mapping were completed to identify commonalities and deficits. Initial meetings were conducted weekly via virtual forums to ensure benchmarking and mapping procedures were validated by all members. Two face-to-face meetings were employed to discuss the ideal competency set based on expert clinical opinion alongside the results from benchmarking and mapping. A whiteboard collaboration platform provided by Miro4 enabled all members to contribute whilst negotiations were facilitated by the project lead. Consensus on decisions pertaining to the streamlined document required all members to be in agreement. The method for achieving this centred on open discussion and regular communication. Results: The work stream utilised eighteen organisational competency documents and three national documents.1-3 The final competency set was formulated using common themes which allowed for incorporation of specific competencies from each site. Agreement on each theme and specific competencies were easily reached due to the extent of commonality between existing organisational documents. Rather than using bands to denote progression through competencies the work stream agreed on use of the terms Foundation, Specialist, Advanced and Expert, aligning the document with the Intensive Care Society AHP professional development framework.1 These levels are loosely aligned to the expectations for staff in bands 5-8, though allows staff to develop skills through the levels with no ceiling effect based on paygrade. The group comprehensively devised the foundation level set of competencies and approved a sign-off procedure using elements from organisational documents, including self-reported confidence measures and senior supervised assessment of competence. Conclusion: Using quality improvement methodology, the work stream was able to rapidly produce a comprehensive streamlined competency set for foundation level Physiotherapists in ICU across the AHSC. Next steps include gaining workforce feedback as part of a further PDSA cycle to refine the document prior to implementation. Continued collaboration by the work-stream will enable additional competency levels to be built from the foundation set. Education and training aligned to the document is essential for its success. Development of this will extend and reinforce the cross-organisational working and collaboration which is now embedded within the teams. The methodology to date demonstrates a proof of concept which can be utilised with other AHP groups in ICU, other settings or wider regional areas.
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The coronavirus, COVID-19 pandemic spread across the globe in 2020, with an initial high case mortality in those requiring intensive care treatment due to serious complication. A vaccine programme was quickly developed and currently the UK is one of highest double vaccinated and boosted countries in the world. Despite tremendous efforts by the UK, new cases of COVID-19 are still occurring, due to viral mutation. A major problem associated with COVID-19 is the large a-symptomatic spread within the population. Little investigation into the a-symptomatic population has been carried out and therefore we pose that the residual effects of a-symptomatic infection is still largely unknown. Prior to mass vaccination, a multi-phased single cohort study of IgM and IgG COVID-19 antibody prevalence and the associated haemostatic changes were assessed in a Welsh cohort of 739 participants, at three time points. Positive antibody participants with age and gender matched negative antibody controls were assessed at 0, 3 and 6 months. Antibody positive females appeared to have lower antibody responses in comparison to their a-symptomatic male counterparts. Despite this initial testing showed a unique significant increase in TRAP-6-induced platelet aggregation, prothrombin time (PT) and clot initiation time. Despite coagulation parameters beginning to return to normal at 3 months, significant decreases are observed in both haemoglobin and haematocrit levels. The production of extracellular vesicles (EV) was also determined in this study. Although the overall number of EV does not change throughout the study, at the initial 0 months' time point a significant increase in the percentage of circulating pro-coagulant platelet derived EV is seen, which does not appear to be related to the extent of platelet activation in the subject. We conclude that early, but reversible changes in haemostatic pathways within the a-symptomatic, female, antibody positive COVID-19 individuals are present. These changes may be key in identifying a period of pro-coagulative risk for a-symptomatic female patients.
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COVID-19 , Hemostatics , Cohort Studies , Female , Humans , Immunoglobulin G , Male , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
Background/Purpose: There is limited information on how the COVID-19 pandemic has impacted those living with cancer and those delivering their psychosocial care. The goals of this study were to understand: (1) psycho-oncology providers' perspectives on and observations of the psychological responses and coping of their patients living with cancer during the COVID-19 pandemic, and (2) psychooncology providers' own experiences delivering care during this time. Methods: In this concurrent mixed method study, a survey was distributed to psychosocial providers who were members of the American Psychosocial Oncology Society (APOS). Survey respondents were invited to participate in a one-on-one audiorecorded interview via phone or secure Zoom® with a member of the study team. Results: There were 76 self-identified psycho-oncology providers who responded to the survey and 11 who participated in a one-onone interview. Approximately half of those surveyed reported that patients responded in unique ways to COVID-19 stress relative to other populations. Three themes emerged from qualitative analyses: (1) unique burden on patients, (2) cancer patients' pandemic response and its relationship to their cancer experience, and (3) unexpected positive changes. Providers emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patients' resiliency. Two themes emerged regarding providers' delivery of care during the pandemic: (1) new professional and personal challenges and (2) provider resiliency. Psycho-oncology providers used innovative strategies to support patients, such as triaging patients in a different way and helping patients find more meaning and purpose in their lives. They also fostered their own mental health as providers through deep reflection and gratitude. Conclusions and Implications: Individual and systems-based strategies are needed to address sustainability of the quality of care in times of high patient volume and increased distress levels for both patients and providers during a pandemic.
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Introduction: A significant degree of mortality and morbidity in COVID-19 is due to thromboembolic disease. Changes in coagulation markers have been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time. We sought to investigate how coagulation markers change over the course of COVID-19 infection and whether they might predict disease severity. Methods: Patients were recruited from a single University Teaching Hospital ED at the time of presentation. Those with a positive PCR test were followed up throughout their stay. Rotational thromboelastometry (ROTEM) was performed on arrival, after 24 h, 3-5 days and 7 days, alongside routine haematological and biochemical testing. ROTEM values at each of these time points were analysed, and compared. Length of stay and patient outcome were also recorded for subgroup analysis. The ROTEM parameters selected for analysis were both EXTEM and INTEM Clotting Time (CT), Clot Formation Time (CFT), Maximal Clot Firmness (MCF), Alpha Angle (Alpha) and Maximum Lysis Percentage (ML). This reflects clot formation kinetics, mechanical strength and clot breakdown via both extrinsic and intrinsic pathways. Results: EXTEM (7.64 ± 5.53 vs 11.83 ± 6.30) and INTEM ML (4.69 ± 3.55 vs 9.95 ± 5.22) were significantly reduced in those who died vs patients with a prolonged hospital stay. Over time there were no patterns of change to ROTEM values in any outcome group. Conclusions: Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of COVID-19 compared with those who survive a prolonged hospital stay to discharge was the extent to which fibrinolysis could occur. Failure to break clots down could be a significant mechanism in the mortality and morbidity of COVID-19.
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Introduction: A significant degree of mortality and morbidity in COVID-19 is due to thromboembolic disease. We use viscoelastic testing to investigate changes to coagulation profile over the progression of COVID-19 infection. Methods: Patients presenting to a single large University Teaching Hospital ED were recruited at presentation. Those with positive COVID- 19 PCR test were included for analysis. Whole blood samples were taken for viscoelastic tests. Fractal Dimension ( Df) and Time to Gel Point ( TGP) are biomarkers of thrombogenicity which measure the biomechanical properties of the incipient clot [1]. Patients were followed up throughout their hospital stay, with sampling taken at arrival, after 24 h, 3-5 days and 7 days. Length of stay and patient outcome were recorded and used for subgroup analysis. Once admitted to the hospital all patients received low molecular weight heparin (LMWH) as per standard treatment pathways, if commenced before the first sample was taken, this was recorded and controlled for. Results: Df and TGP showed no changes over time in COVID-19 infection. Subgroup analysis also showed no differences in Df or TGP in different outcome groups. Patients who received LMWH from the clinical team before recruitment to the study demonstrated no significant difference in Df (1.715 ± 0.061 no LMWH vs 1.699 ± 0.068 with LMWH), but TGP was prolonged in those receiving LMWH(445.0 ± 195.2 vs 307.6 ± 91.6). Additionally there was no correlation between Anti-Xa level and Df. Conclusions: The therapeutic efficacy of LMWH appears to be blunted in COVID-19 infection. This may be due to the inflammatory state creating a resistance to the activity of LMWH, and may in part explain why LMWH appears to have less effect in reducing thromboembolic disease in COVID-19 than it does in other disease states.
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The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented challenges that dramatically affected the way of life in the United States and globally in 2020. The pandemic also made the process of protecting individuals from tornadoes more challenging, especially when their personal residence lacks suitable shelter, and particularly for residents of mobile homes. The necessity of having to shelter with other families-either in a public shelter or at another residence-to protect themselves from a tornado threat conflicted with the advice of public health officials who recommended avoiding public places and limiting contact with the public to minimize the spread of COVID-19. There was also a perception that protecting against one threat could amplify the other threat. Asurvey was undertaken with the public to determine the general viewpoint to see if that was indeed the case. The results found that it was possible to attenuate both threats provided that careful planning and actions were undertaken. Understanding how emergency managers should react and plan for such dual threats is important to minimize the spread of COVID-19 while also maintaining the safety of the public. Because there was no precedence for tornado protection scenarios amid a pandemic, both short-term and long-term recommendations were suggested that may also be useful in future pandemic situations.
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Patients with the Bombay blood group who need a blood transfusion can only receive blood of Bombay blood group, otherwise a fatal transfusion reaction may result. This presents a challenge as this blood group is so rare that the Irish Blood Transfusion Service (IBTS) has no registered Bombay blood group donors. We report the case of a 37-years old patient, with Bombay blood group, who needed an elective multiple myomectomy for fibroids. Crossmatch compatible blood was required for surgery. At her medical assessment, she was found to have a moderate iron deficiency anaemia, a hemoglobinopathy screen was negative. Her case was further complicated by comorbidities (thyrotoxicosis), poor compliance with medications and rescheduling of surgery due to the Covid-19 pandemic. Providing blood was however, the most significant challenge. Our options included blood from autologous, targeted, imported or frozen recovered donations. When assessed for autologous donation, we deemed the patient unsuitable to donate due to very low weight and total blood volume. The patient's family in Mauritius were excluded as donors due to the COVID-19 pandemic restrictions. Targeted donations were then considered from neighbouring countries with a known suitable donor pool. Our colleagues in United Kingdom (UK) kindly identified a suitable donor. Meanwhile our patient was monitored regularly to optimise both her hyperthyroidism and iron status. As her compliance and tolerance to oral iron were poor, she received intravenous iron four weeks before surgery and her haemoglobin improved from 10.0 g/dl to 12.4 g/dl. Three days prior to surgery, the identified donor was bled in UK. However unexpected delays occurred at customs because of increased regulation following the exit of the UK from the European Union. Fortunately, these issues were resolved in time and the blood was available for the surgery. Surgery was completed in 40 minutes with 40 ml blood loss and no transfusion administered. Early and close liaison between the gynaecology, haematology and transfusion teams was key in overcoming the challenges associated with this case. The patient's care was optimised thus avoiding a potentially risky transfusion, as the best transfusion outcome is no transfusion.
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Introduction: Obstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions. Methods: We identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran's average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts. Results: Compared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p<0.001). Conclusion: In a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.
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As the COVID-19 pandemic unfolds, we continue to understand the clinical manifestations of this infection. It was initially assumed that the effects of this infection in the pediatric population were minimal. However, an increasing number of case reports of MIS-C associated with COVID-19/incomplete KD have emerged from various countries in Europe and Asia, and most recently from the United States. The case presented here appears to be the first case reported in Indiana in an older individual (20 years) with rapid improvement after immunomodulating therapy (IVIG). The age of this patient is a reminder for all clinicians caring for COVID-19 patients to be aware of this emergent condition in young adults so as to allow early potentially life-saving therapy.
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This paper analyzes the outcomes of an exploratory review of the current research on COVID-19 vaccine hesitancy in relation to misperception, distress, and skepticism. The data used for this study was obtained and replicated from previous research conducted by ASPE, Healthwatch Bexley, KFF, Pew Research Center, and WHO. I performed analyses and made estimates regarding drivers of COVID-19 vaccine hesitancy, reluctance, and refusal. Data collected from 6,600 respondents are tested against the research model. Descriptive statistics of compiled data from the completed surveys were calculated when appropriate. © 2021, Addleton Academic Publishers. All rights reserved.