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Background: Medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become more important and more challenging. Focused attention on teamwork is required. Cystic fibrosis clinical research programs across the country have struggled with team dynamics during the pandemic, and attention to how the team interacts is important. The clinical research program in pediatric pulmonary disease at Rainbowconsisted of two teams (cystic fibrosis (CF), asthma and other pulmonary disease). We identified the struggle during the pandemic of losing touch with our team because of staggered schedules, the way studies were assigned, and separation of the teams in the program. Research coordinators (RCs) were working in silos that led to one RC being very busy while others might not be busy. A survey of four RCs revealed that the top four challenges they faced as individuals were completing tasks effectively, work distribution, communication, and lack of transparency. The top three challenges they faced as a team were communication, doing things "on the fly" (not planning ahead), and workload equity between team members. Method(s): The objective was to create an environment in which everyone worked together for a common goal: advancing clinical trials to support our patients through improved team dynamics with a shared vision. To accomplish this goal, we adapted our research program to include staff from all of the Pediatric Pulmonology Disease Division, allowing us to have six RCs who can move between multiple studies. The clinical research operations manager (CROM) assigns the teams during study startup. Teams of three RCs and one regulatory coordinator are assigned to each study. During startup, delegation of responsibilities is decided with the aid of a startup and implementation checklist. The three-person teams rotate to allowall team members to work with and support each other. The RCs have no regulatory responsibilities, and the Support Services team meets most processing needs. Weekly huddles are held to review visits and discuss coverage and logistics for the upcoming week. To further develop the team dynamic, a huddle is reservedweekly to reviewa study or logistics of a new or ongoing study. The entire team also meetsweekly, including the primary investigators, to review the status of studies at various stages of the clinical research cycle. Result(s): The pediatric pulmonary team model was implemented in September 2021;since then, 13 studies have migrated to the team-based approach. This model has helped the team dynamic significantly by taking a team-based approach rather than working in silos within the program. It has allowed work to be spread more evenly across the team and enhanced the ability to work from home or take time off with short notice. It has also allowed the RCs to focus on areas of research that play to their strengths. Some team members prefer to recruit or do data entry for studies, whereas others prefer to participate in patient-facing visits. Conclusion(s): Team dynamics is an essential consideration for the success of clinical research programs. During a time of isolation and uncertainty, teams can overcome hurdles and become stronger by developing a shared vision and shared responsibilities across several studies. The team model has allowed individuals to work across teams using their strengths and talents.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Introduction Patients' satisfaction after breast reconstruction can be evaluated with validated questionnaires as the Breast-Q questionnaire. The Breast-Q questionnaire includes different domains;one of them is "satisfaction with the result". Material(s) and Method(s): In the multicentre, prospective studies PRO (patient related outcome)-BRA (clinicaltrials.gov: NCT01885572) and PRO-Pocket (clinicaltrials.gov: NCT03868514), patient satisfaction was assessed using the Breast-Q questionnaire. In the PRO-Bra study, 269 patients underwent subpectoral surgery using the TiLOOP Bra polypropylene mesh (pfm medical ag, Germany). In the 'PRO-Pocket' study, 311 patients underwent prepectoral surgery using the TiLOOP Bra Pocket polypropylene mesh. For the evaluation, those patients from the PRO-Bra and PRO-Pocket studies who completed a Breast-Q questionnaire 6 and/or 12 months after surgery were included. The BreastQ score is measured from 0 to 100, with a score of 100 corresponding to 'very satisfied'. Satisfaction with the result of the breast reconstruction was evaluated. Result(s): In the PRO-Bra study, a total of 221 and 203 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. The mean age and BMI of the patients with completed Breast-Q were comparable between the two studies (PRO-Bra: 49.3 [+/-11.6] years, 22.9 kg/m2 [+/-3.5];PRO-Pocket: 47.7 [+/-11.7] years, 24.5 kg/m2 [+/-4.3]). In the PRO-Pocket study, a total of 258 and 266 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. In the PRO-Bra study the mean score of satisfaction with the result at 6 months follow-up (FU) was 74.5 (+/-19.9), in the PRO-Pocket 79.1 (+/-19.1), at 12 months FU the mean scores were 76.3 (+/-18.9) for PRO-Bra and 78.2 (+/-20.4) for PRO-Pocket. Furthermore, stratification according to age (cutoff 50 years) or BMI (cutoff 25 kg/m2) did not reveal any differences between the subgroups or the two studies (see Table). PRO-Bra PRO-Pocket mean score (+/-SD) 6 months 12 months 6 months 12 months BMI <= 25 75.1 (+/-19.7) 76.4 (+/-17.8) 77.7 (+/-19.9) 78.9 (+/-19.8) BMI > 25 72.1 (+/-20.7) 76.1 (+/-22.9) 82.1 (+/-16.9) 76.8 (+/-21.8) age <= 50 76.4 (+/-18.7) 77.0 (+/-18.9) 80.1 (+/-18.7) 78.1 (+/-19.6) age > 50 71.5 (+/-21.5) 75.3 (+/-19.0) 77.5 (+/-19.5) 78.4 (+/-21.8) Conclusion(s): Our data so far show high patient satisfaction with overall outcome of the surgery. In addition, patients' satisfaction with the result was comparable after subpectoral as well as prepectoral implant placement. This is particularly important in the PRO-Pocket study, as approximately 60% of the operations and the follow-up period took place during the COVID-19 pandemic.
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Sun exposure is physiologically necessary, yet excessive amounts can be detrimental to skin, causing photoaging, sunburn, and skin cancer. Sunburn, presenting as delayed onset erythema, has been partially characterized for Caucasians, however the impact of excessive sun exposure has been less studied across race/ethnicity and skin tones. Herein, we present findings from a survey conducted across the United States, where sunburns were examined in a racially and ethnically diverse sample of 3597 participants spanning the Fitzpatrick skin phototype (FSP) scale. Individuals reporting sunburn were probed on the signs, severity, pain level, and anatomical location of their most recent sunburn and on the associated type of activity. Over the 8-month evaluation period (January-August 2020), sunburns were self-reported at rates generally consistent with those reported annually pre-COVID, with 39% Caucasian, 20% Asian, 12% African American and 32% Latino respondents reporting at least one sunburn. While average sunburn incidence among African American is low, a closer look reveals that African Americans with lighter skin tones (FSPs I-II) report higher sunburn rates (25.5%, n = 12), thus highlighting that sunburn risk does not depend on race/ethnicity alone. Furthermore, African Americans and Hispanics self-reported a significantly higher percentage of severe sunburns compared with Caucasians (27%, 20% and 11%, respectively) and African Americans, unlike Caucasians, indicated “peeling” as the top sign of their sunburn. This work provides a better understanding of the sunburn experience across race/ethnicity and skin tones and is a step toward enabling more personalized sun safety awareness and education.
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BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD): 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.
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BACKGROUND: Diabetes group visits (GVs) or shared medical appointments have been shown to improve clinical outcomes, but few have reported results from virtual diabetes GVs. No studies have evaluated virtual GVs among community health center patients across a region of the U.S. METHODS: Six health center sites across five states conducted six monthly virtual GVs with up to 12 adult patients with type 2 diabetes and suboptimal glycemic control (glycosylated hemoglobin (A1C) ≥8%). Virtual group visits consisted of six monthly 60 to 90 minute-long diabetes education sessions led by health center staff via a videoconferencing platform. GV patients enrolled at the site also had an appointment with their primary care physician within two weeks of each monthly virtual group visit. Primary outcome was change in patients' A1C from baseline to 6- months. Secondary outcomes were changes in patients' blood pressure, low density lipoproteins (LDL) and weight. Patients also completed surveys at baseline and 6-months describing their diabetes self-care behaviors and satisfaction with the virtual GVs. Generalized linear mixed models and linear mixed models were used to test the effects of GVs, time points and their interaction. RESULTS: Forty eight patients were enrolled (mean age 55 ± 12 years, 67% female, 63% black/African American, 32% white/Caucasian, and 8% Hispanic/Latino, 88% had public health insurance, mean baseline A1C of 9.84% ± 1.78%, 35% with A1c <9%). 34 patients completed one or more virtual GVs;14 patients attended no virtual group visits. At 6-months, average A1C was 8.96 ±1.82;A1C decreased by -0.56% ± 0.31 compared to baseline which was borderline significant (p=0.08). At 6-months, 58% of patients had an A1C < 9% which was borderline significantly decreased (p=0.055) compared to baseline. For patients with an A1C at baseline >9%, there was a significant decrease in A1C at 6 months (-1.06 ±0.45, p=0.03). There was no significant difference in blood pressure, LDL or weight from baseline to 6- months or association of number of visits attended and change in A1C. There were no significant changes in foot self-exams, blood sugar testing, nor exercise, but patients did report more days of healthy eating in the past week at 6-months compared to baseline (4.5 ±2.3 vs. 3.2 +2.7 days, p=0.02). Overall satisfaction with the virtual GVs was high with 90%of participants being very satisfied and 95% saying they would attend GVs in the future. CONCLUSIONS: Virtual GVs show high patient satisfaction and promise for improving A1C among patients with poor glycemic control who receive care in community health centers. Future studies are needed with a larger patient sample size and a control comparison group to determine which patients and health centers are best suited for virtual GVs.
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The upheaval caused by the global Covid-19 pandemic has been an unavoidable driver of rapid digitalization in engineering education. The goal of this preliminary study was to test a prototype survey to identify and evaluate problems encountered by engineering students during the pandemic. A special focus was placed on students from historically underrepresented groups, first generation students, those with a migration background, students with disabilities and students with children. An online survey of students was conducted during the pandemic. Questions were posed regarding their experiences with distance learning, language difficulties, social, financial, psychological and child-care problems during the pandemic. Initial results identified problems common to all students as well as problems specific to certain students from historically underrepresented groups. © 2022 Croatian Society MIPRO.
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Health literacy is the degree to which individuals are enabled by their educational, social, and/or health system to obtain, process, and understand health information needed to make appropriate health decisions. It is not about focusing on people's skills to meet the complex demands of systems but on focusing on the system's skills to meet the complex demands of people.
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The impact of COVID-19 on teamwork came abrupt and transformed nearly all teams into virtual teams. A special challenge for leaders of virtual teams, not only in the pandemic, is to foster team cohesion, which positive influences team performance. However, many virtual leaders do not implement cohesion-empowering measures, which in turn can reduce team members' feeling of belonging to both the team and the organization. Our research responds to this short-coming and presents measures which virtual leaders can integrate to strengthen cohesion. Within 40 interviews in 24 organizations, we identify a wide and comprehensible overview of measures, which can be categorized into “on the job” and “off the job”. Hereby, we not only want to help to overcome the feeling of “loneliness” and “isolation” in the pandemic, but rather contribute to develop a profound feeling of cohesion in virtual teams in the long-term. © AMCIS 2021.
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German municipalities face major and unforeseen challenges during crises, as demonstrated by the COVID-19 pandemic. Existing (crisis) strategies do not bring the desired results because they are not adapted to the given situation. Therefore, a concept is needed that builds on existing strategies and adapts them to new circumstances. Using design science research methodology (DSRM), we present six steps on how to analyze, evaluate, and strengthen existing strategies against external influences using a monitoring approach. The objective is to develop a dynamic and integrated monitoring concept for the systematic analysis and evaluation of municipal strategies and strengthen German municipalities resiliently in future smart cities. © 2021 Owner/Author.
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Rationale: Severe COVID-19 pneumonia can be complicated by secondary bacterial or fungal infections, but their clinical distinction from isolated SARS-CoV-2 infection is challenging, especially with the more restricted practices regarding invasive diagnostics in patients with COVID-19. We sought to comprehensively screen for secondary infections by DNA pathogens (bacterial, fungal or viral) with a non-invasive, culture-independent metagenomic approach (microbial cell-free DNA sequencing-mcfDNA-Seq), and also examine for the biologic impact of circulating mcfDNA on the host response in COVID-19. Methods: We prospectively enrolled 42 hospitalized patients with COVID-19 and compared them with a historical cohort of mechanically-ventilated patients with culture-positive (n=27) vs. culture-negative pneumonia (n=40) or no clinical infection (n=16 controls). From plasma samples, we performed mcfDNA-Seq with the Karius test (Karius, Inc) and measured 10 host-response biomarkers of innate immunity and epithelial/endothelial injury (IL-6, IL-8, IL-10, RAGE, TNFR1, Angiopoietin-2, Procalcitonin, Fractalkine, Pentraxin-3, ST2). We compared mcfDNA-Seq between clinical groups and examined associations of mcfDNA and biomarker levels with linear regression models. Results: McfDNA-Seq was successful in 33/42 (79%) baseline samples from patients with COVID-19, with nine samples failing QC requirements. McfDNA was detectable in 21/33 (64%) of COVID-19 samples, a proportion significantly lower to culture-positive pneumonia (96%), higher than uninfected controls (31%) and similar to culture-negative pneumonia (56%) (between-groups Fisher's exact p<0.001). A similar distribution was seen for mcfDNA levels, with mcfDNA load in COVID-19 being similarly distributed as non-COVID culture-negative pneumonia (Figure 1A). Among patients with COVID-19, mcfDNA was significantly associated with higher levels of host-response biomarkers (Figure 1B), with stronger effect sizes observed for biomarkers of innate immunity (IL-8 and ST2) and bacterial infections (procalcitonin and pentraxin-3). Conclusions: Plasma metagenomics in patients with COVID-19 revealed mcfDNA load of similar magnitude as in critically-ill patients without COVID-19 with clinically suspected infection but negative microbiologic cultures. The significant associations of mcfDNA with host inflammation support the biological relevance of detectable circulating mcfDNA. Our preliminary results warrant further study of secondary infections in hospitalized patients with COVID-19 to define the clinical utility of noninvasive molecular diagnostics for antimicrobial treatment guidance.
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Rationale: A dysregulated host inflammatory response in COVID-19 is considered a central pathogenetic mechanism of acute lung injury and extrapulmonary end-organ damage. However, limited comparative data are available as to whether the host-response in COVID-19 ARDS differs from patients with other (non-COVID) ARDS etiologies, and how such differences may inform targeted immunomodulating therapeutics. Methods: We prospectively enrolled 36 intubated patients with COVID-19 ARDS and 70 hospitalized non-intubated patients with COVID-19 (COVID-19 non-ARDS), and compared them with a pre-COVID-19 cohort of patients with bacterial (n=21), viral (n=14), and culture-negative ARDS (n=30). We measured 10 host-response biomarkers of innate immunity and epithelial/endothelial injury (IL-6, IL-8, IL-10, RAGE, TNFR1, Angiopoeitin-2, Procalcitonin, Fractalkine, Pentraxin-3, ST2) in plasma. Using a 4-variable predictive model (TNFR1, Angiopoeitin-2, Procalcitonin and bicarbonate levels), we classified patients into hyper-vs. hypo-inflammatory subphenotypes. We compared biomarker levels, subphenotypes and outcomes between the clinical groups. Results: Host-response biomarker levels were widely distributed between the 5 groups, with a characteristic pattern for IL-6, IL-8, Angiopoeitin-2, Procalcitonin, ST-2 and fractalkine: COVID-19 ARDS patients had higher biomarker levels than COVID-19 non-ARDS (p<0.01), lower levels than bacterial or culture-negative ARDS (p<0.01), and similar levels to viral ARDS (Figure 1A example for IL-6). A lower proportion of the COVID-19 ARDS cohort was classified in the adverse hyper-inflammatory subphenotype (15%) compared to bacterial (47%) and culture-negative ARDS (31%) (Figure 1B). Despite the lower level of inflammatory host responses, COVID-ARDS patients had longer median duration of mechanical ventilation (20.5 [10.0-40.8] days) compared to bacterial (8.0 [5.0-25.0]), culture-negative (7.0 [5.2-9.8]) and viral ARDS (7.5 [3.5-14.8]) (p<0.01). Patients with COVID-19 but without ARDS had lower 30-day mortality (6%) compared to patients with ARDS from COVID-19 (31%) or other etiologies (bacterial 33%, culture-negative 40% and viral 21%). Conclusion: Development of ARDS from COVID-19 is characterized by intensified inflammation compared to hospitalized COVID-19 patients not requiring mechanical ventilation. Compared to ARDS from other etiologies, host-response inflammatory profiles in COVID-19 ARDS appear similar to other viral etiologies of ARDS, and are lower compared to bacterial or culture-negative ARDS. The etiology of worse clinical outcomes of COVID-19 ARDS despite the lower frequency of the prognostically adverse hyper-inflammatory subphenotype warrant urgent investigation. (Table Presented).