A Qualitative Study of the Role of Palliative Care During the COVID-19 Pandemic: Perceptions and Experiences Among Critical Care Clinicians, Hospital Leaders, and Spiritual Care Providers.

BACKGROUND: Palliative care offers a unique skill set in response to challenges posed by the COVID-19 pandemic, with expertise in advance care planning, symptom management, family communication, end-of-life care, and bereavement. However, few studies have explored palliative care's role during the pandemic and changes in perceptions and utilization of the specialty among health and spiritual care providers and hospital leaders. OBJECTIVE: To explore the utilization, perceptions, and understanding of palliative care among critical care clinicians, hospital leaders, and spiritual care providers during the pandemic. DESIGN: We conducted a qualitative study employing semi-structured, in-depth interviews. SETTING/PARTICIPANTS: We conducted the study at a tertiary academic medical center in Boston, Massachusetts, USA. Between August and October 2020, we interviewed 25 participants from 3 informant groups: (1) critical care physicians, (2) hospital leaders, and (3) spiritual care providers. RESULTS: Respondents recognized that palliative care's role increased in importance during the pandemic. Palliative care served as a bridge between providers, patients, and families; supported provider well-being; and contributed to hospital efficiency. The pandemic reinforced participants' positive perceptions of palliative care, increased their understanding of the scope of the specialty's practice, and inspired physicians to engage more with palliative care. Respondents indicated the need for more palliative care providers and advocated for their role in bereavement support and future pandemic response. CONCLUSION: Findings highlight evolving and increased utilization of palliative care during the pandemic, suggesting a need for greater investment in palliative care programs and for palliative care involvement in public health emergency preparedness and response.

Expansion and Evaluation of Pharmacist Services in Primary Care.

Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities.

Ethnic and racial diversity in eating disorder prevention trials.

Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials.

An awareness-raising framework for global health networks: lessons learned from a qualitative case study in respectful maternity care.

BACKGROUND: The increase in global health networks as mechanisms for improving health and affecting social change has been recognized as a key component of the global health landscape today. To successfully raise awareness of shared causes, global health networks need tools to help them plan successful campaigns and evaluate the impact of their work, as well as to coordinate and reinforce each other's efforts. One global health network, the Respectful Maternity Care (RMC) Global Council, can be credited with raising the profile of the issues of disrespect and abuse (D&A) in childbirth and the need for RMC within global maternal health. We set out to learn from the work of the RMC Global Council and the RMC movement at large to develop a tool-a framework for planning and evaluating awareness-raising efforts-useful for networks focused on global health and human rights. METHODS: We reviewed the literature for theoretical models on awareness raising and, finding a lack of appropriate tools, developed a new, draft framework using components of the Framework for Effective Campaigns, the SpitFire SmartChart 3.0, and Network Theory. We conducted semi-structured interviews with members of the RMC Global Council to validate the draft framework and identify any additional strategies or tactics that were used during their efforts to raise awareness of D&A and RMC. We also interviewed "influenced" individuals to validate inputs from the influencers and determine the key documents, events, individuals, and organizations that made the greatest contribution to the increased awareness of D&A/RMC. Data were analyzed using deductive and inductive qualitative research methods. RESULTS: The validated awareness-raising framework includes five strategies that characterize a successful awareness-raising effort. Each strategy has a set of tactics that can operationalize those strategies. Each tactic is classified as essential, helpful, or variable based on the number of key informants who utilized it. CONCLUSION: This case study offers an example of how global health networks can create a movement that effects change at global and local levels by providing an empirically-grounded framework to help plan, coordinate, and evaluate future campaigns designed to raise awareness and create momentum in global health, human rights, and quality of care.

BodiMojo: Efficacy of a Mobile-Based Intervention in Improving Body Image and Self-Compassion among Adolescents.

Mobile interventions promoting positive body image are lacking. This study presents a randomized controlled evaluation of BodiMojo, a mobile application (app) intervention grounded in self-compassion to promote positive body image. A sample of 274 adolescents, mean (SD) age = 18.36 (1.34) years, 74% female, were allocated to a control group or used BodiMojo for 6 weeks. Appearance esteem, body image flexibility, appearance comparison, mood, and self-compassion were assessed at baseline, 6, and 12 weeks. Significant time by group interactions emerged for appearance esteem and self-compassion, with appearance esteem and self-compassion increasing in the intervention relative to the control group. These findings provide preliminary support for BodiMojo, a cost-effective mobile app for positive body image.

Body image in emerging adults: The protective role of self-compassion.

Self-compassion is thought to protect from body image concerns. However, the mechanisms of this effect remain unclear. This study examined three positive dimensions of self-compassion as moderators of the mediated relationship between perceived overweight status, appearance comparison, and appearance esteem. A sample of 232 youth aged 13-18 years, mean=18.36 (SD=1.5) years, reported on appearance esteem, appearance comparison, perceived weight status, and self-compassion dimensions including self-kindness, common humanity, and mindfulness. Among boys, mindfulness and common humanity moderated the perceived weight status to appearance comparison pathway of the mediation (ps=.01), such that this relationship was weaker among boys with higher levels of these dimensions of self-compassion. These findings were not replicated among girls. None of the self-compassion dimensions moderated the appearance comparison to appearance esteem pathway. Self-compassion dimensions that decrease the focus on the self may protect against body image concerns among boys.

Short-Term Motor Learning and Retention During Visually Guided Walking in Persons With Multiple Sclerosis.

BACKGROUND: The ability to adapt, a form of short-term motor learning, and retain this adaptation, is essential for rehabilitation and for day-to-day living. Yet little research is available on this topic in persons with multiple sclerosis (PwMS), particularly in relation to complex walking tasks. OBJECTIVE: To determine the ability of PwMS to learn and retain a novel relationship between visual input and motor output-or visuomotor map-during visually guided walking. METHODS: Nineteen PwMS and 17 healthy controls performed a precision walking task while adapting to prism lenses that altered the normal visuomotor map on 1 day, and again after a 1-week delay. The task required individuals to walk and step onto 2 targets without stopping. To quantify motor performance, we determined foot placement error relative to the targets. RESULTS: PwMS with mild disability and healthy controls attenuated foot placement error over repeated trials when exposed to the novel mapping and demonstrated a similar rate and magnitude of adaptation in the first learning session. Both groups equally retained the adaptation 1 week later, reflected by reduced foot placement error and a faster rate of error reduction in that session. CONCLUSION: PwMS can learn and retain a novel visuomotor mapping during a precision-based walking task. This suggests that PwMS with mild disability have the capacity for short-term motor learning and retention, indicating that neural plasticity is preserved.

Brief report: Feasibility of a mindfulness and self-compassion based mobile intervention for adolescents.

The aim of the study was to test the feasibility of a mindfulness and self-compassion based program for adolescents, to be delivered though mobile phones. Twenty racially and ethnically diverse US adolescents enrolled in a study to use the app for 30 days, after which they provided satisfaction data and participated in focus groups to describe their experiences and offer suggestions for improving the app. Usage data were also captured. Results indicated that participants used the app on the majority of days over the intervention period, reported finding it helpful for managing stress, and provided suggestions for substantive areas for improvement. These findings suggest that a mobile app may be a feasible way to disseminate a mindfulness and selfcompassion based program widely among adolescents.