Loneliness Decreased for Older Adults Using Telephone and Video Communications

AimsTo study feasibility and impact of telephone and video communication on perceptions of loneliness and social isolation in community-dwelling older adults.MethodsPurposive flyer distribution to communities, area agencies on aging, meals on wheels, and snowball sampling. Sixteen people met inclusion criteria. Pre- and post-intervention data were collected: UCLA-3, UCLA20, FRAIL Scale, and Social Frailty Scale. Participants were allocated to either telephone or video communication groups, completing 8 weeks of one time per week 45-60-minute conversations.ResultsUCLA-20 demonstrated statistical significance (p = .017) for the full cohort with large effect size (Hedges' g = 1.273). UCLA-3, SFS-8, and FRAIL Scale did not demonstrate statistically significant pre-post differences. No statistically significant differences (p > .05) were identified between the telephone and video communication groups.ConclusionRemote communication may have a positive impact on perceptions of loneliness that appear to be independent of the communication modality utilized. Randomized controlled trials are required to determine if either modality is more effective.

Comparisons of School-Day Glycemia in Different Settings for Children with Type 1 Diabetes Using Continuous Glucose Monitoring

Objective. Using continuous glucose monitoring (CGM), we examined patterns in glycemia during school hours for children with type 1 diabetes, exploring diferences between school and nonschool time. Methods. We conducted a retrospective analysis of CGM metrics in children 7-12 years (n = 217, diabetes duration 3.5 +/- 2.5 years, hemoglobin A1c 7.5 +/- 0.8%). Metrics were obtained for weekday school hours (8 AM to 3 PM) during four weeks in fall 2019. Two comparison settings included weekend (fall 2019) and weekday (spring 2020) data when children had transitioned to virtual school due to COVID-19. We used multilevel mixed models to examine factors associated with time in range (TIR) and compare glycemia between in-school, weekends, and virtual school. Results. Tough CGM metrics were clinically similar across settings, TIR was statistically higher, and time above range (TAR), mean glucose, and standard deviation (SD) were lower, for weekends and virtual school (p < 0.001). Hour and setting exhibited a signifcant interaction for several metrics (p < 0.001). TIR in-school improved from a mean of 40.9% at the start of the school day to 58.0% later in school, with a corresponding decrease in TAR. TIR decreased on weekends (60.8 to 50.7%) and virtual school (62.2 to 47.8%) during the same interval. Mean glucose exhibited a similar pattern, though there was little change in SD. Younger age (p = 0.006), lower hemoglobin A1c (p < 0.001), and insulin pump use (p = 0.02) were associated with higher TIR in-school. Conclusion. Although TIR was higher for weekends and virtual school, glycemic metrics improve while in-school, possibly related to benefcial school day routines.

Adaptive capacity: A qualitative study of midlife Australian women's resilience during COVID-19

This article explores adaptive capacity as a framework for understanding how South Australian women in midlife (aged 45-64) demonstrated resilience during the early phases of COVID-19. In-depth interviews were undertaken with 40 women mid-2020 as a follow-up study to interviews with the same women undertaken 2018-19 (before COVID-19 emerged). Transcripts were analysed following a critical realist approach using Grothmann and Patt's construct of adaptive capacity as a framework for analysis. This enabled authors to unpack the mechanisms of resilience that shaped women's experiences of appraising, and then showing an intention to adapt to COVID-19 adversity. Findings support the explanatory utility of adaptive capacity to understand resilience processes in the context of person-environment changes - the environment being the COVID-19 context - and women's capability to adapt to social distancing and lockdown conditions. With COVID-19 evoking health, social and economic challenges at incomparable scales, potentially fracturing mental stability, this article provides insight useful to policy makers and health professionals to support resilience as the pandemic continues.Copyright © 2022 The Authors

"I Don't Know Who Gets More Out of It, the Children or Us Tutors”: The Online Intergenerational Tutoring Program

The Online Intergenerational Tutoring Program addresses a service delivery gap in schools because older adult volunteers expand schools' capacity to implement evidence-based instruction with students in need of individual support. Tutoring includes dialogic reading with digital books and Tutoring Buddy, a web-based program used to improve children's letter sound fluency. Developed during the school closures resulting from COVID-19, the program uses online technology to deliver individual instruction to students after school. Our preliminary research found online intergenerational tutoring is a promising, socially valid model for addressing students' learning loss resulting from the pandemic. © 2023 Taylor & Francis Group, LLC.

COVID-19 and Beyond: Taming the Virtual Healthcare Tiger with Colored Petri Nets based Modeling and Simulation

The Coronavirus crisis has forced hospitals globally to develop new virtual service portals and systems to: 1) triage, diagnose, and manage new patients virtually for every clinical specialty at home as their symptoms emerge, avoiding COVID-19 exposure to patient or physicians, and hospitalization, as much as possible, and 2) discharge, track, and support recovered patients via homecare and virtual visits to free as many critical care beds as possible. This paper focuses on simulating and modeling an episode of care with innovative initial patient contact and triage processes using the Colored Petri Net (CPN) formalism to help optimize workflow, patient throughput, and overall system efficacy. The two patient triage programs under consideration are a health system in Australia and an orthopedic surgical program in the US. We describe our model for the US program. Our presented results establish a desired stratification of patients through a virtual musculoskeletal triage. © 2022 IEEE Computer Society. All rights reserved.

Anaesthesia for vascular emergencies - a state of the art review.

In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre-operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri-operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID-19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri-operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post-procedural evaluation.

An International, Multicenter Evaluation of Pharmacist Medication Management in Icu Recovery Centers

INTRODUCTION: Post Intensive Care Syndrome (PICS) is a new or worsening impairment in physical, cognitive, or mental health following critical illness. Similar to PICS, survivors of critical illness due to COVID-19 may develop Post Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID. ICU recovery centers (ICU-RC) are suggested as an interprofessional approach to treat patients with PICS or PASC. Currently, over 40 different ICU-RC worldwide report having a clinical pharmacist. The purpose of this study was to describe the role of pharmacists in identifying and treating medication-related problems in survivors of critical illness. METHOD(S): This prospective, observational study was conducted in 12 ICU-RC between September 2019 and July 2021. A full medication review comprising of medication reconciliation, a patient interview, and counseling session was conducted by a clinical pharmacist on patients seen at the ICU-RC. Baseline demographic and hospital course data were obtained from the electronic health record and at the ICU-RC appointment. Data are reported using descriptive statistics. RESULT(S): A total of 507 patients were referred to an ICU-RC, of which 474 attended and 472 had a full medication review performed by a pharmacist. 237 (47%) of referred patients had a diagnosis of COVID-19. Pharmacy interventions were made in 397 (84%) patients. The median number of pharmacy interventions per patient was 2 (IQR 1,3). Medications were stopped and started in 124 (26%) and 91 (19%) patients, respectively. There was no difference in median total number of medications prescribed at the start and end of the patient visit (10, IQR = 5, 15). The number of patients that had a dose decreased and a dose increased was 51 (11%) and 43 (9%) patients, respectively. Adverse drug event (ADE) preventive measures were implemented in 115 (24%) patients and ADEs were identified in 69 (15%) patients. Drug interactions were identified in 30 (6%) patients. CONCLUSION(S): Pharmacists play an integral role in ICURC resulting in identification, prevention, and treatment of numerous medication-related problems. This paper should serve as a call to action on the importance of including a pharmacist on the interprofessional team in ICU-RC.

Antidepressant and Antipsychotic Prescribing Following Icu Admission Due to Covid-19

INTRODUCTION: Patients with post-intensive care syndrome (PICS) suffer from a constellation of cognitive, mental, and physical effects. Previous studies have demonstrated increased antidepressant prescribing in patients with PICS. The purpose of this study was to examine the rates of antidepressant and antipsychotic use in patients with PICS following critical illness due to COVID-19. METHOD(S): This was a retrospective chart review of adult patients (>18 years old) with PICS following critical illness due to COVID-19 who had at least 1 visit to the ICU survivor clinic at IU Health between September 2020 and July 2022. Patients were excluded if they were never admitted to the ICU, were admitted to a non IU Health ICU, or if they had incomplete medical records. The primary endpoint was the rate of combined antidepressant and antipsychotic use before ICU admission compared to their last clinic visit. The chi-square test was used to compare nominal data. RESULT(S): A total of 117 patients presented to the survivor clinic during the study time period. 35 patients were included in the analysis. Patients had a mean (+/- SD) age 53 (+/- 17) years and tended to be Caucasian 23 (66%) with low rates of having a college degree 6 (17%). During their ICU stays patients there were high rates of mechanical ventilation 24 (69%). While use of ECMO 9 (26%) and documented delirium 10 (28%) were less frequent. Underlying conditions identified at the initial clinic visit included cognitive impairment 20 (57%), depression 11 (31%), anxiety 8 (23%), and PTSD 4 (11%). Antidepressant and antipsychotic use was higher at the last clinic visit when compared to prior to ICU admission [16 (46%) vs. 5 (14%);p=0.0041]. At the time of the last clinic visit none of the 16 patients were receiving an antipsychotic while all were receiving an antidepressant. CONCLUSION(S): Patients with PICS following critical illness due to COVID-19 have an increased rate of antidepressant prescribing use compared to pre-illness. Further research is needed regarding the management and outcomes of these patients following critical illness due to COVID-19.

Cord blood and maternal cytokine levels following SARS-CoV-2 infection during pregnancy

Background. Pregnant people and fetuses are uniquely vulnerable to SARS-CoV-2, a driver of inflammation and immune dysregulation. Prior investigations have shown that pregnant people with SARS-CoV-2 are at higher risk of severe illness, mortality, and obstetric complications. We investigated the impact of SARS-CoV-2 infection severity and latency on maternal and infant cytokine levels. Methods. We collected maternal blood and cord blood at delivery from motherinfant dyads (Chicago, IL;3/2020-1/2022). A multiplex cytokine panel (IsoPlexis) was run on plasma from 93 SARS-CoV-2 infected dyads and 32 matched controls. Clinical data was ed by chart review, including latency (acute being <=14 days and distant >14 days from SARS-CoV-2 infection to delivery) and severity (NIH criteria: asymptomatic, mild, moderate, severe/critical). Kruskal-Wallis tests with post-hoc pairwise Dunn Tests were used (alpha=0.05). Results. SARS-CoV-2 exposed infants had lower levels of MIP-1b (p=0.037) and PDGF (p=0.008) than controls [Fig 1]. There were no differences in maternal blood cytokines at time of delivery following SARS-CoV-2 infection during pregnancy (pooled analysis of all SARS-CoV-2). Stratifying by latency, acutely exposed infants showed higher levels of MCP-1 than controls or those with distant maternal SARS-CoV-2 (p=0.016). There were no significant differences in maternal cytokines between control, acute, and distant SARS-CoV-2. In mothers with acute SARS-CoV-2, differences in levels of IL-1B (p=0.011) and IL-10 (p=0.046) were observed across severity groups, with a significant linear trend for each among severity groups (p for trend < 0.001, respectively). Severe/critical acute infection resulted in higher maternal granzyme and IL-8 than mild infection (p=0.037 and 0.047) [Fig 2]. There were no differences across severity groups in 1) mothers with distant infection, 2) infants with acute maternal infection, or 3) infants with distant maternal infection. Conclusion. Cytokine levels in SARS-CoV-2 positive dyads were altered only in the setting of acute or more severe infection and demonstrated anti-inflammatory, anti-viral, and anti-angiogenic responses. In acute infection, greater severity drives higher levels of both a pro- and anti-inflammatory cytokine in pregnant people.

CURRENT APPLICATIONS OF PATIENT COMMUNICATION TECHNOLOGIES IN GERIATRIC CRITICAL CARE

The availability and utility of patient-centered communication technologies in acute-critical care settings have evolved slowly over the past 30 years with wide variability, little standardization, and few randomized controlled clinical trials (RCT). The COVID-19 pandemic forced rapid expansion and use of communication technologies, particularly between patients and remote family caregivers. To capture changes responsive to the pandemic, this paper reviews current literature (< 5 years) on communication technologies in acute-critical care settings focusing on the user experience among older adult patients. We supplement these findings with case-based evidence from a pilot RCT of an electronic tablet communication application provisioned to mechanically ventilated ICU patients, and efforts toward hospital-wide implementation. Recent literature on patient communication technology consists primarily of qualitative, descriptive accounts of video communication (i.e., ICU visits) or provision of augmentative and alternative communication. Recommendations for required skills, standardization, and research regarding patient communication technology are provided.

ENHANCING FEDERAL REVENUE FOR HOME AND COMMUNITY-BASED SERVICES UNDER THE AMERICAN RESCUE PLAN ACT

The American Rescue Plan Act (ARPA) includes a one year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This presentation provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided. It also draws lessons from the Affordable Care Act's Balancing Incentive Program to suggest insights for the potential of ARPA to promote further growth in Medicaid HCBS programs. The presentation concludes by highlighting the importance of instituting strategies and processes for maximizing enhanced federal matching funds under ARPA in preparation for subsequent availability of substantial additional federal resources targeting Medicaid HCBS under other proposed initiatives.

COVID-19 related life changes for family caregivers of persons with Lewy body disease

Background: Coronavirus disease 2019 (COVID-19) affected individuals' physical and mental health. Protective measures such as closures, social-distancing, masking, and isolation resulted in increased feelings of loneliness and isolation. This study aimed to investigate life changes associated with COVID-19 for family caregivers of persons with Lewy body disease (LBD). Method(s): Data were analyzed from an existing LBD caregiver needs and concerns study that took place between January 2021 and February 2021. A mixed methods approach was used to describe how 20 caregivers' lives changed as a result of the COVID-19 pandemic. Items from the Bakas Caregiving Outcomes Scale (BCOS) were adapted for COVID-19 and rated on a response scale ranging from 1 = changed for the worst to 7 = changed for the best, with 4 = did not change. Qualitative data were collected as participants expanded upon their responses to the scale items. Result(s): Caregivers experienced both positive and negative life changes as a result of COVID-19. On average, positive changes included increased use of the internet to order items (Mean = 4.35), videoconferencing to connect with others (Mean = 4.55), and improved financial well-being (Mean = 4.35). Negative changes included reduced social (Mean = 1.7) and family (Mean = 2.05) activities and decreased ability to cope with stress (Mean = 2.60). Most responses ranged from 1 to 4, with some items having wider ranges from 1 to 7 showing that individual caregivers were impacted differently by the COVID-19 pandemic. Qualitative comments were consistent with quantitative responses. Some caregivers expressed concerns that limited family and social contact contributed to a more rapid decline in the person with LBD. Caregiver health and well-being were negatively affected as well, with caregivers noting decreased level of energy and worsened physical health. Conclusion(s): Family caregivers of persons with LBD experienced both positive and negative life changes as a result of COVID-19. Responses indicated that caregivers were affected in a variety of ways and an individualized approach is recommended in dealing with caregiver life changes resulting from the COVID-19 pandemic. Copyright © 2022 the Alzheimer's Association.

Adaptation Principles to Foster Engagement and Equity in Project-based Learning

Teachers adapt science curriculum materials in planned and unplanned ways to address a variety of goals. This professional learning design seeks to support 18 elementary science teachers in biweekly professional learning (PL) sessions during COVID 19. They discuss and share their own adaptations for enhancing opportunities for productive disciplinary engagement and equity by collaboratively analyzing one another's teaching artifacts. Findings from transcribed interviews, PLs, and video of teaching are synthesized toward five adaptation principles. © ISLS.

Health information technology to improve referral to genetic testing for high-risk patients in a gynecologic oncology clinic (102)

Objectives: Our previously presented pilot study evaluated a web-based tool to collect family cancer history (FCH). It demonstrated that this tool resulted in significantly higher quality FCH compared to standard of care face-to-face physician interviews. However, the true value of FCH requires translation into the utilization of genetic services. Here, we aimed to evaluate referral rates and completion of genetic services for patients completing the web-based tool versus standard of care. Methods: Patients scheduled for a gynecologic oncology new patient visit between September 2019 and September 2021 were eligible for enrollment in this institutional review board-approved prospective trial. The trial had three arms: 1) Standard of care (FCH collection by physicians) 2) Web-based tool administered by email prior to the visit, 3) Web-based tool administered in the office prior to the visit (this arm closed early due to COVID-19 restrictions). Individuals were identified as high-risk for familial cancer if they met National Comprehensive Cancer Network (NCCN) guidelines in the standard of care arm, or if the validated cancer risk models embedded in the web-based tool returned a lifetime cancer risk >20% or mutation risk?>2.5% in the web-based tool arms. Validated risk assessment models included breast and ovarian BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, PANCPRO, and PREMM. The primary endpoint was the percentage of high-risk patients referred for genetic counseling/testing. Secondary endpoints included the completion of genetic counseling and genetic testing. Results: Two hundred and fifty patients were enrolled (Arm 1: 110;Arm 2: 105;Arm 3: 35). Among patients randomized to the web-based tool, 88 (63%) completed the tool. In the control arm, 31 patients (28%) met the criteria for referral to genetics, among which 18 (58%) had previously completed genetic testing. In the web-based tool arm, 26 patients (30%) met the criteria, among which 12 (46%) had previously completed genetic testing, and one was deceased soon after her visit. In the control arm, 54% of high-risk patients were referred to genetic counseling, 23% completed genetic counseling, and 23% completed genetic testing. In the web-based tool arm, 100% of high-risk patients were referred to genetic counseling, 54% completed genetic counseling, and 38% completed genetic testing (Table 1). Conclusions: When successfully completed, the use of a web-based tool for FCH collection facilitated the process of referral to genetics, resulting in significantly higher referral rates to genetic counseling than the standard of care physician interviews (100% vs 54%, p = 0.01). However, 37% of patients could not complete the web-based tool. Our findings demonstrate the potential power of health information technology to identify millions of individuals unknowingly carrying familial cancer syndromes and highlight those tools must be designed in a way to maximize patient participation.[Formula presented]

ADAPTABLE ENGINEERING OF CELLULOSE-BASED VERTICAL FLOW ASSAYS FOR RAPID DIAGNOSTICS - THE CASE OF COVID-19

Paper microfluidics has had a rich history in medical diagnostics owing to their portability, low-cost and capacity for mass manufacture. While nitrocellulose has widespread use in commercial paper-based assays, shortages can become a bottleneck for deployment. Here, we seek to overcome this limitation by enabling swift and efficient production of cellulose-based paper assays with minimal substrate processing via protein engineering. We demonstrate good clinical and lab-based performance for both serological and antigen rapid tests and their compatibility with roll-to-roll mass manufacturing, which validates our proposed workflow for commercialization. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.