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Background: A small Midwest cystic fibrosis (CF) center gained child life support in fall of 2016, but availability was limited due to sharing full-time equivalents (FTEs) between 31 outpatient subspecialty clinics. Child life involvementwas often restricted to immediate stressors (e.g., throat swabs, blood draws, first pulmonary function tests) in a reactive approach, but in the summer of 2020, the child life team added FTEs, increasing the ability for a primary child life specialist (CLS) to be more integrated into the clinic workflow. Partnering with the nurse care coordinators, a comprehensive, proactive approach to the integration of child life was formed, focusing on full scope of practice. Method(s): CFregistered nurse care coordinators collaborated with the CLSto discuss the goal of integration while understanding knownpatient stressors and optimal developmental and coping goals for patients younger than 19 and their siblings. We also determined ways to reduce disruption to clinic workflowwhile leveraging scheduling and increasing awareness of scope of practice of the interdisciplinary team, patients, and families. The CLS also obtained feedback from the family advisory committee engrained in clinic along with hosting a booth at the center's annual CF familyevent that targets caregivers of children with CF. Throughout each of these formative actions,(Figure Presented) Figure 1. : Child life integration protocol the primary focus was on collaboration with the interdisciplinary team, employing the full scope of practice of the CLS, mitigating logistical barriers, and optimizing patient experience and satisfaction. Result(s): The current plan (Figure 1) is based on identified time points where developmentally appropriate interventions and resources are implemented in a stepwise fashion, building upon itself. Interventions are individualized for each patient or family member based on coping and learning needs or developmental differences and are completed by the CLS based on professional judgment and after assessment and rapport is built. The scope of practice includes preparation for procedures or changes in the plan of care, procedural support, creation of coping plans for in-clinic and at-home care routines or events, educational activities and resources (e.g., making slime to learn about mucus, word searches about medications), therapeutic activities to support emotional processing of chronic illness, providing information on typical growth and development to caregivers, and facilitating developmentally appropriate transition-readiness goals through CF R.I.S.E. materials. During the COVID global pandemic, changes to outpatient clinic, including addition of virtual appointments, allowed the CLS to expand practice further. In these video appointments, teen patients appear to be more engaging and talkative, allowing the CLS to better assess coping, adherence, and transition readiness in a relaxed Table 1. Two-way table depicting concordance between substance use and mental health screening results at same encounter. General Anxiety Disorder (GAD7) and Patient Health Questionnaire (PHQ9) results were aggregated such that a positive screening result on either was compared with neither being positive.(Table Presented) environment more suited to their developmental needs. Based on the success of having video appointments with adolescent patients without caregivers present, the CLS and the registered nurse care coordinators agreed to include these moving forward. Conclusion(s): The integration of the CLS at full scope of practice benefits not only patients and families, but also the interdisciplinary team and clinic as a whole. By taking a proactive and preventative approach, coping and psychosocial concerns can be navigated throughout the developmental stages with greater stability and emotional safety for patients and their familiesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Methods: Data were pulled from an internal administrative dashboard. Referrals include services for Veterans who live a prescribed driving distance from a VAMC, wait times over threshold, services unavailable, or for reasons of the best medical interest. Data was pulled for fiscal years 2020 through 2021 and included: chiropractic care, acupuncture, biofeedback, neuron feedback, clinical hypnosis, massage therapy, meditation (specifically MBSR), Tai Chi/qigong, and yoga. Standardized tracking of referrals began with the implementation of Standard Episodes of Care (SEOC) which define care requested and include number of visits permitted and timeframe. Results: Referrals increased for all approaches from FY20-21 shown as (FY20;FY21): chiropractic (104,197;197,357), acupuncture (59,787;100,908), massage therapy (5,021;17,646), biofeedback (31;69), neuron feedback (27;74), clinical hypnosis (10;40), MBSR (2;8), Tai Chi (2;8) and Yoga (1;2). Background: The Veterans Health Administration (VHA) Directive 1137: Provision of Complementary and Integrative Health (CIH) identifies the inclusion of evidence-based CIH approaches in the VHA's Medical Benefits Package (acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/qigong, and yoga). The purpose of this administrative data review is to identify which approaches are being referred to Community Care from VHA medical centers (VAMC), and to identify if COVID-19 has had an impact on referrals to the community. Conclusion: CIH is expanding across the VHA and could be useful in supporting a cultural transformation that includes integrative health approaches within conventional medical systems. While all VAMCs provide some CIH in-house, a substantial amount is provided through Community Care. As the largest integrated healthcare system in the United States, this could impact growth of CIH and the need for more providers in the community. By hiring CIH professionals onstation and expanding the network to the community, VHA could be one of the largest providers and users of CIH.
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Background: Left atrial appendage closure (LAAC) devices are a practical replacement to long term oral anticoagulation in the appropriate patient. Incomplete occlusion and resulting device leak are important clinical endpoints which may prompt anticoagulation continuation. During the coronavirus pandemic, cardiac computed tomography (CCT) was used as an alternative to transesophageal echocardiogram (TEE) for pre-planning and post-operative confirmation. A residual leak of >5mm on TEE has been used as a cutoff for anticoagulation continuation, but CCT is less codified for device leak quantification and its significance. Objective: Compare CCT and TEE in regards to post-operative leak with respect to resulting outcomes after LAAC device implant. Methods: Between March 1st 2020 and October 31st 2021, 151 patients underwent LAAC device implantation at a single center. These patients had a pre-procedural CCT or TEE and a subsequent confirmatory CCT or TEE 45 days after implant. Baseline demographics, imaging, device characteristics, and resulting outcome measures were collected by chart review. Data was then retrospectively analyzed with a non-linear model to assess significance. Results: Of the 151 patients, the median age was 77 with an interquartile range (IQR) of 10 and 40% were female. The median CHADSVASc was 4 and HASBLED score was 4 with an IQR of 2 and 1, respectively. For the 45 day post-procedural imaging confirmation there was a total of 110 patients who underwent TEE, 30 underwent CCT, and 11 dropped out. A total of 34 patients (22%) had a device leak of any size. In CCT group there were 18 patients (60%) with a device leak <5mm and in the TEE group 16 patients (15%) had a device leak with 14 having a primary leak <5mm (P < 0.001). Major adverse events include: 1 death (all-cause), 14 major bleeding events, 1 MACE event (MI). There was zero instances of post-device stroke. None of these outcomes were statistically significant in regards to device leak or imaging modality. Conclusion: Based on this analysis, CCT had a significantly greater rate of detecting post-operative device leak when compared to TEE. There does not appear to be any significant difference in outcomes with regards to CCT and TEE in patients undergoing LAAC device implant. This suggests that CCT may be overly sensitive for subclinical device leak.
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Purpose: Nationally, only 23% of lung cancer cases are diagnosed at an early stage and on top of that Black Americans with lung cancer are 16% less likely to be diagnosed early. If everyone currently eligible were screened, close to 48,000 lives could be saved. Interestingly, pre-COVID-19 17% of the individuals getting screened for lung cancer were Black, and post-COVID-19 36% are Black. This study aims to explore potential reasons for this sudden increase in low-dose CT lung cancer screenings in Black patients by examining variables in the electronic health record and by interviewing pundits in clinical oncology practice. Methods: 416 deidentified electronic health records were collected from a data repository at the Medical College of Wisconsin. We analyzed low-dose CT screening for lung cancer among Black and white patients pre- and post-COVID-19 (4 cohorts). The post-COVID-19 cohorts looked at screening from 1/1/2020-7/8/2021, compared to a proportionate time frame pre-COVID-19 (1/1/2018-7/8/2019). Because of low numbers of other racial/ethnic backgrounds (Asian, Hispanic, Pacific Islander, etc.), only Black and white patients were examined in this study. Variables examined include insurance status, marital status, age, COVID-19 testing or diagnosis, gender, employment status, comorbidities (cardiovascular disease, chronic obstructive pulmonary disease, diabetes and hypertension), and lung cancer diagnosis. Results: Employment status, lung cancer diagnosis, and gender were all significantly different between Black and white cohorts preCOVID-19. Post-COVID-19, similar differences are seen in employment status, while patterns in lung cancer diagnosis, gender, and insurance status are contradictory. Black patients pre-COVID-19 had a higher incidence of being men and a lower incidence of lung cancer diagnosis. On the contrary, post-COVID-19 Black patients have a higher incidence of being women and lung cancer diagnosis, and additionally a higher incidence of Medicare use. Despite the drastic differences in healthcare before and after COVID-19, COVID-19 testing and diagnosis did not appear to be linked to increased lung cancer screenings for Black patients. However, in conversations with thoracic surgeons and community health workers, we learned of significant screening efforts within Black populations due to grants funded during the COVID-19 pandemic. Conclusions: In this study, insurance status was the strongest difference between the pre- and post-COVID-19 Black cohorts. In a conversation with thoracic surgeons, we learned that a major initiative was launched post-COVID-19 that increased insurance access for Black populations. Increasing access to healthcare appears to be a promising first step in eradicating lung cancer disparities in Black populations. So, this research could serve as a guidepost to provide policymakers, researchers and healthcare providers, as well as patients and families, with data that pinpoints where future resources should be aimed in the effort to end lung cancer and its corresponding health disparities.
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In the wake of the COVID-19 pandemic, beginning in March 2020, educators at all levels faced the challenge of responding to student needs and utilizing technology for instruction. While much of the emerging research highlights the experiences of students and instructors as they shifted from face-to-face to remote learning, this study explored the experiences of students in a fully online graduate program as the scope of the pandemic was growing. What is the best way to maintain a community of inquiry when so much is changing? This case study explored the impact of a variety of course design changes that sought to help students meet learning objectives while also seeking to alleviate the unanticipated pressures created by external forces. Ultimately, the findings suggest that increased flexibility with due dates and access to course materials were the most helpful strategy for helping students deal with the disruptive events of the semester. In addition, managing the disruptions and finding a sense of balance were important for both instructors and students.