Effects of pericardiocentesis on renal function and cardiac hemodynamics.

BACKGROUND: Previous case studies have reported reversal of acute renal failure after pericardiocentesis in pericardial effusion. This study examines the effects of pericardiocentesis on preprocedural low cardiac output and acute renal dysfunction in patients with pericardial effusion. METHODS: This is a retrospective study of 95 patients undergoing pericardiocentesis between 2015 and 2020. Pre- and post-procedure transthoracic echocardiograms (TTE) were reviewed for evidence of cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and post-procedure. Patients on active renal replacement therapy were excluded. RESULTS: Ninety-five patients were included for analysis (mean age 62.2 ± 17.8 years, 58% male). There was a significant increase in glomerular filtration rate pre- and post-procedure. Fifty-six patients (58.9%) had an improvement in glomerular filtration rate after pericardiocentesis (termed "responders"), and these patients had a lower pre-procedure glomerular filtration rate than "non-responders." There was a significant improvement in estimated cardiac output and right atrial pressure for patients in both groups. Patients who had an improvement in renal function had significantly lower pre-procedural diastolic blood pressure and mean arterial pressure. CONCLUSIONS: Pericardial drainage may improve effusion-mediated acute renal dysfunction by reducing right atrial pressure and thus systemic venous congestion, and by increasing forward stroke volume and perfusion pressure.

A Comprehensive, Community-Based Coalition to Address Racial Disparities in Chronic Disease: REACH in Allegheny County, Pennsylvania.

BACKGROUND: Funded by the Centers for Disease Control and Prevention Racial and Ethnic Approaches to Community Health Initiative, Live Well Allegheny: Lifting Wellness for African Americans (LWA) in Allegheny County, Pennsylvania, aims to enhance health equity by addressing chronic disease in six African American communities via three key strategies: nutrition, physical activity, and community-clinical linkages. OBJECTIVES: This manuscript describes the coalition's partnership dynamics and evaluation methods with a focus on nutrition strategies. METHODS: We have a network of committed partners implementing the strategies and we are evaluating our efforts using community asset mapping, county population-based survey data, qualitative process interviews, focus groups, and program performance measures. RESULTS: The LWA coalition is the culmination of years of partnership building, which allows for more targeted activities related to health equity in the region. Thus far, the LWA coalition is thriving. The network of committed and talented partners in the nutrition strategy (healthy nutrition standards, food systems, and breastfeeding) reached 22 sites and more than 46,000 people during the first 2 years of the project. Process interviews conducted as part of the evaluation identified challenges and successes of implementation, and development of the coalition. CONCLUSIONS: This comprehensive evaluation approach supports formative processes, evaluation metrics, and prolonged sustainability plans of this community-based coalition.

Leveraging digital technology for social connectedness among adults with chronic conditions: A systematic review.

Purpose: To review the evidence about the impact of digital technology on social connectedness among adults with one or more chronic health conditions. Methods: PubMed, Embase, Social Sciences, CINAHL, and Compendex were systematically searched for full-text, peer-reviewed empirical evidence published between 2012 and 2023 and reported using the PRISMA flow diagram. Articles were critically appraised applying the Joanna Briggs Institute checklists. Specific data were extracted based on the framework for social identity and technology approaches for health outcomes and then analyzed and synthesized. Results: Thirty-four studies met study criteria. Evidence showed heterogeneity among research methodology, chronic health conditions, digital technology, and health outcomes. Technology use was influenced by factors such as usability, anonymity, availability, and control. More advanced digital technologies require higher digital literacy and improved accessibility features/modifications. Social support was the most measured aspect of social connectedness. The emotional and informational forms of social support were most reported; instrumental support was the least likely to be delivered. Self-efficacy for using technology was considered in seven articles. Sixteen articles reported health outcomes: 31.2% (n = 5) described mental health outcomes only, 18.8% (n = 3) reported physical health outcomes only, 31.2% (n = 5) detailed both physical and mental health outcomes, whereas 18.8% (n = 3) denoted well-being or quality-of-life outcomes. Most often, health outcomes were positive, with negative outcomes for selected groups also noted. Conclusion: Leveraging digital technology to promote social connectedness has the potential to affect positive health outcomes. Further research is needed to better understand the social integration of technology among populations with different contexts and chronic health conditions to enhance and tailor digital interventions.

Impact of COVID-19 on a Community Health Coalition and Its Residents in Allegheny County, Pennsylvania: Insights Into Adaptation From Focus Groups and Evaluation Reports.

Live Well Allegheny: Lifting Wellness for African Americans (LWA2) is a coalition in Allegheny County, Pennsylvania, funded by the Centers for Disease Control and Prevention's (CDC) Racial and Ethnic Approaches to Community Health (REACH) initiative. LWA2 consists of partner organizations addressing chronic disease prevention in six Black communities through nutrition, physical activity, and community-clinical linkage strategies. This analysis focuses on qualitative data exploring the influence of COVID-19 on coalition functioning and communities. We conducted focus groups with residents in REACH communities and collected evaluation reports from partner organizations. Three focus groups assessed awareness of and participation in the REACH initiative, feedback, and the impact of COVID-19 when applicable. An additional focus group included questions related to flu vaccine messaging and the COVID-19 vaccine. These data sources provided insight regarding how COVID-19 affected planned tasks. Evaluation team members analyzed focus groups and collated summaries as part of a larger comprehensive evaluation. Partner organizations experienced an increase in food stamp applications, delays in opening farmers' markets, a shift to virtual preventive health programs, canceled in-person events, and programmatic interruptions that shifted long-term goals. Community resident concerns included difficulty accessing public transportation, decreased physical activity, fear of in-person interactions, and increased wait times for mental health services. Coalition members developed methods to continue functioning and sustaining program activities. Residents were able to engage differently with chronic illness prevention techniques. Reports from the ongoing analysis will be used to adapt coalition functioning.

Instituting Racial Equity: The Allegheny County Racial and Ethnic Approaches to Community Health Initiative.

INTRODUCTION: In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. METHODS: Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. RESULTS: Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization's mission, goals and subsequent actions. DISCUSSION: As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work.

Pharmacist Involvement in Addressing Public Health Priorities and Community Needs: The Allegheny County Racial and Ethnic Approaches to Community Health (REACH) Project.

Community-clinical linkages are connections between community and clinical sectors to improve population health, and community-based pharmacists are well positioned to implement this strategy. We implemented a novel approach to community-clinical linkages in African American communities in which community-based pharmacists implement screenings for chronic disease and social determinants of health, make referrals to clinical and social services, and follow up with patients to support linkage to care in nontraditional health care settings. The community-based pharmacist navigation program works with multisector partners to increase referrals and access to existing health and social service programs. We used a mixed-methods evaluation approach to collect and analyze data on program characteristics and the linkage intervention. From February 2019 to March 2020, 702 African American community members received preventive health screenings, and 508 (72%) were referred to clinical and social services. Pharmacists demonstrated the ability to implement clinical preventive services in nontraditional health care settings and improve access to care through the provision of community-clinical linkages.

Young people's views on their role in the COVID-19 pandemic and society's recovery from it.

OBJECTIVE: There has been little formal exploration of how young people see their role in the COVID-19 pandemic. DESIGN/SETTING: Focus-group discussion with 15 Children's Hospital Young People's Forum members (23/5) to explore their perspective on the impact of COVID-19 on both their lives and those of their community, on school closures, and the role they wished to play in society's recovery from the pandemic. Audio recordings were transcribed verbatim using NVivo Software and analysed using an inductive thematic analysis approach. OUTCOME: Four major themes identified: (1) Awareness of pandemic's impact on others: participants showed mature awareness of the effects on broader society, especially the elderly, socially disadvantaged and parents. (2) Perceived impact on their own lives: principal concerns were the educational and practical repercussions of school closures and social isolation, including effects on educational prospects. (3) Views about school reopening: young people understood the broader rationale for school reopening and were generally positive about it, but expressed concerned about their safety and that of others. (4) Communication issues: a need for clear, concise, understandable information readily accessible for young people was expressed. Up to now, they felt passive recipients rather than participants. CONCLUSION: Young people were concerned about their future, their family and broader society, consistent with a high level of moral development. They want to be active participants in social recovery, including concepts around return to school but require appropriate information and a means by which their voices can be heard. The alternative suggested roles as pawns or pathfinders were discounted.