ABSTRACT
Background: It is historically difficult to recruit trained cardiac sonographers within New Zealand (NZ) and internationally. In NZ, the Northern Region DHBs have significant and on-going workforce shortages. Auckland metro DHBs have consistently used vacant qualified FTE to employ trainees and support them to obtain cardiac sonographer qualifications. The first few months of training require intensive one-on-one supervision. This reduces throughput as the supervisor is removed from the workforce. We sought to investigate how a combined approach to training, in the initial 6 weeks, would impact on trainees, trainers, and departments in terms of throughput. Method: Auckland Metro DHBs worked together, with NRA support, to plan and prepare a 6-week introduction program for trainees. Each DHB took responsibility for preparing and providing teaching materials for a 2-week block and planned to undertake the hands-on training for that period. They recruited and started 1 trainee each, concurrently. Results: COVID lockdown prevented trainees leaving their home DHB. They attended presentations by Zoom and provided constructive and generally positive feedback. The time commitment for each DHB and impact on throughput was reduced. Relationships between the DHBs and the trainees was enhanced. Conclusion: It is workable and advantageous for regional DHBs to work collaboratively when recruiting and training cardiac sonographers. This leads to economical use of time and resource, develops collegial relationships, and support networks for the trainees. With new technology, the reach of the teaching sessions could be expanded to include participants outside the region.
ABSTRACT
Background: The pathogenesis of neuropsychiatric symptoms persisting months after acute SARS-CoV-2 infection is poorly understood. We examined clinical and laboratory parameters in participants with post-acute COVID-19 neuropsychiatric symptom to assess for systemic and nervous system immune perturbations. Methods: Participants with a history of laboratory confirmed COVID-19 and ongoing neurologic symptoms were enrolled in an observational study that collected medical history;detailed post-COVID symptom survey;and paired cerebrospinal fluid (CSF) and blood. In addition to standard clinical labs, neopterin and anti-SARS-CoV-2 antibodies (anti-spike, RBD, and nucleocapsid) were measured by ELISA. Non-parametric tests were used to compare CSF and blood findings between the post-COVID participants and pre-COVID-19 era healthy controls. Results: Post-COVID participants (n=27) and controls (n=21) were similar in age (median 51 and 46 years), but there was a greater proportion of females (67% vs 24%;p=0.004) and white participants in the post-COVID cohort (63% vs 24%;p=0.04). The post-COVID study visit was a median of 264 days (IQR 59-332) after acute COVID-19 symptom onset. 35% were hospitalized during their acute illness;12% required intensive care. 33% had previously been treated with medications for mental health conditions. The most frequent neuropsychiatric symptoms were cognitive impairment (67%), mood symptoms (67%), headache (56%), and neuropathy (41%). Blood c-reactive protein, T cell count, and T cell subset frequency (CD4% and CD8%) were similar between groups, while D-dimer was higher in the post-COVID cohort (median 0.48 vs 0.27 mg/L;p = 0.019) (Figure). CSF WBC, protein, neopterin, and CSF/blood albumin ratio were similar between the groups;the frequency of CSF lymphocytes was lower in the post-COVID cohort (p = 0.05) (Figure 1). Antibodies against at least one SARS-CoV-2 antigen were detected in 7/10 CSF and 8/9 blood samples in the post-COVID CSF (antibody reactivity range 1.5 to 55-fold greater than to control antigens). Conclusion: In this small cohort of post-COVID participants with neurologic symptoms, we found limited differences in CSF and blood markers when compared to pre-pandemic healthy controls. Deeper immunophenotyping in a larger number of participants may provide greater insight into subtle differences. The presence of anti-SARS-CoV-2 antibodies in CSF months after acute infection warrants further investigation.
ABSTRACT
Background: Public health emergencies increase stress, anxiety, and fear, and older adults and those with pre-existing conditions may be especially vulnerable. We used a survey-based pilot study to explore the psychosocial impact of COVID-19 on older PLWH and correlate the level of COVID-19 related distress with baseline HIV disease metrics. Methods: Participants were PLWH > age 50 who had previously (2017-2020) enrolled in the HARC HIV biorepository study at Yale. 48 PLWH were contacted and 22 participated in this study, conducted Aug-Sep 2020. An 8-part survey was administered to inquire about COVID-19 exposure, financial distress, medication adherence/medical follow-up, social support, substance use, and mood symptoms (Table 1). Cross-sectional analysis was performed on results at the time of survey administration, and longitudinal analysis was performed to compare anxiety (GAD-7), alcohol/drug use (ASSIST), and depression (CES-D) to baseline values obtained pre-pandemic (median 1.3 years prior). Results: Participant demographics are reported in Table 1. 2 participants reported having been diagnosed with COVID-19, 1 of whom had a known COVID-19 positive contact. 68% of participants were retired and reported no changes to their work due to COVID-19, and most reported moderate (4.1 on scale of 0-7) financial distress. Most reported excellent medication adherence, with 77% reporting no missed doses. 95% stated they felt “very well supported” by their primary HIV care providers, with 18% saying their care was improved during COVID-19. Only 18% felt their care was “somewhat worse.” Most participants also scored highly on the social support scale, with an average score of 11 out of 14. There were no significant differences between pre-pandemic and current scores for anxiety, alcohol/drug use, and depression, and there was no correlation between baseline HIV metrics and current level of distress. However, there was an association between COVID-19-associated worsening in GAD-7 score and a history of substance use disorder (p = 0.02). Conclusion: These results suggest that overall, most participants were doing well with excellent medication adherence and no significant changes in scores for anxiety, depression, and substance use, but that older PLWH with a history of substance use disorder had a greater risk for increased anxiety during COVID- 19. These findings can help identify groups who may be the most at-risk to experience distress from a second wave of COVID-19 and put support measures in place.