Browsing by Subject "COVID‐19"
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Item A novel conceptual model of trauma-informed care for patients with post-acute sequelae of SARS-CoV-2 illness (PASC)(Wiley, 2022) Burton, Candace W.; Downs, Charles A.; Hughes, Thomas; Lambert, Natalie; Abrahim, Heather L.; Giraldo Herrera, Maria; Huang, Yong; Rahmani, Amir; Lee, Jung-Ah; Chakraborty, Rana; Pinto, Melissa D.; Biostatistics, School of Public HealthAim: This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC). Design: This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes. Data sources: PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors. Implications for nursing: The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness. Conclusion: Applying a trauma-informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience. Impact: The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.Item Clinical genetic counselor experience in the adoption of telehealth in the United States and Canada during the COVID-19 pandemic(Wiley, 2021) Ma, Daria; Ahimaz, Priyanka R.; Mirocha, James M.; Cook, Lola; Giordano, Jessica L.; Mohan, Pooja; Cohen, Stephanie A.; Medical and Molecular Genetics, School of MedicineThe COVID‐19 pandemic has significantly impacted the service delivery model (SDM) of clinical genetic counseling across the United States and Canada. A cross‐sectional survey was distributed to 4,956 genetic counselors (GCs) from the American Board of Genetic Counselors and Canadian Association of Genetic Counselors mailing lists in August 2020 to assess the change in utilization of telehealth for clinical genetic counseling during the COVID‐19 pandemic compared with prior to the pandemic. Data from 411 eligible clinical genetic counselors on GC attitudes and their experiences prior to and during the pandemic were collected and analyzed to explore the change in SDM, change in appointment characteristics, change in billing practices, GC perceived benefits and limitations of telehealth, and prediction of future trends in SDM in the post‐pandemic era. The study showed the overall utilization of audiovisual and telephone encounters increased by 43.4% and 26.2%, respectively. The majority of respondents who provided audiovisual and telephone encounters reported increased patient volume compared with prior to the pandemic, with an average increase of 79.4% and 42.8%, respectively. There was an increase of 69.4% of GCs rendering genetic services from home offices. The percentage of participants who billed for telehealth services increased from 45.7% before the pandemic to 80.3% during the pandemic. The top GC perceived benefits of telehealth included safety for high‐risk COVID patients (95.2%) and saved commute time for patients (94.7%). The top GC perceived limitations of telehealth included difficulty to conduct physician evaluation/coordinating with healthcare providers (HCP) (73.7%) and difficulty addressing non‐English speaking patients (68.5%). Overall, 89.6% of GCs were satisfied with telehealth; however, 55.3% reported uncertainty whether the newly adopted SDM would continue after the pandemic subsides. Results from this study demonstrate the rapid adoption of telehealth for clinical genetic counseling services as a result of the COVID‐19 pandemic, an increase in billing for these services, and support the feasibility of telehealth for genetic counseling as a longer term solution to reach patients who are geographically distant.Item COVID-associated non-vasculitic thrombotic retiform purpura of the face and extremities: A case report(Wiley, 2022-12-27) Bunch, Connor M.; Zackariya, Nuha; Thomas, Anthony V.; Langford, Jack H.; Aboukhaled, Michael; Thomas, Samuel J.; Ansari, Aida; Patel, Shivani S.; Buckner, Hallie; Miller, Joseph B.; Annis, Christy L.; Quate-Operacz, Margaret A.; Schmitz, Leslie A.; Pulvirenti, Joseph J.; Konopinski, Jonathan C.; Kelley, Kathleen M.; Hassna, Samer; Nelligan, Luke G.; Walsh, Mark M.; Medicine, School of MedicineSARS-CoV-2 infection can manifest many rashes. However, thrombotic retiform purpura rarely occurs during COVID-19 illness. Aggressive anti-COVID-19 therapy with a high-dose steroid regimen led to rapid recovery. This immunothrombotic phenomenon likely represents a poor type 1 interferon response and complement activation on the endothelial surface in response to acute infection.Item Heart Rate Variability Parameters Indicate Altered Autonomic Tone in Patients with COVID‐19(Wiley, 2022) Gruionu, Gabriel; Gupta, Anita; Rattin, Megan; Nowak, Thomas V.; Ward, Matthew; Everett, Thomas H.; Medicine, School of MedicineThe COVID‐19 disease induces long term heart health complications and may induce autonomic nervous system dysfunction. Heart Rate Variability (HRV) is a measure of sympathetic (SNS) and parasympathetic (PNS) control of heart function. Recently, studies have shown that HRV analysis may be used as a predictor of COVID‐19 symptoms and correlates with progression of the disease. We aimed to uncover the interplay between SNS and PNS in hospitalized COVID‐19 patients at the time of admission and compare it with similar measurements in healthy patients (no comorbidities) and patients with cardiovascular disease. We hypothesized that COVID‐19 would induce autonomic dysfunction similar to patients with cardiovascular disease (CVD). ECG telemetry recordings of 30‐60 minutes in duration were acquired from patients that were admitted to Indiana University Health system hospitals for either COVID‐19 complications or for complications associated with cardiovascular disease (CVD) states (arrhythmia, heart failure, coronary artery disease). In addition, 20‐minute ECG Lead I recordings were obtained from healthy volunteers with no associated comorbidities. HRV parameters were calculated during sinus rhythm in the time, frequency, and nonlinear domains from the ECG telemetry recordings. The patient population was composed of 50 COVID‐19 patients (average age 63, range 26‐94), 32 healthy (average age 32.7, range 17‐69) and 49 patients with cardiovascular disease (average age 65.4, range 30‐88) as control groups. The COVID‐19 group had a higher percentage of patients with BMI>30 (obese) than the control groups (55% vs 36%). Also, the COVID‐19 and CVD patients had significantly higher heart rate and time‐domain HRV parameters (including SDRR, RMSSD, SDSD) and SD1 in the non‐linear domain when compared to healthy patients (88.8±53.0 and 87.9±55.2 vs 49.5±31.3, p<0.01). In the frequency domain, the LF/HF ratio was significantly lower in the COVID and CVD groups compared to healthy controls (0.5±0.76 and 0.55±0.50 vs 1.05±0.96, p<0.01). COVID‐19 patients have significant HRV alterations which suggest increased vagal tone than in healthy volunteers but similar to patients with severe cardiovascular disease comorbidities. Even though the COVID patients had an increased heart rate, the results of the HRV analysis indicate increased vagal tone which would support autonomic nervous system dysfunction in these patients.Item Impacts of state COVID-19 reopening policy on human mobility and mixing behavior(Wiley, 2021) Nguyen, Thuy D.; Gupta, Sumedha; Andersen, Martin S.; Bento, Ana I.; Simon, Kosali I.; Wing, Coady; Economics, School of Liberal ArtsThis study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.Item Racialized minorities, trust, and crisis: Muslim- American nonprofits, their leadership and government relations during COVID-19(Wiley, 2022) Noor, Zeeshan; Wasif, Rafeel; Siddiqui, Shariq; Khan, Sabith; Lilly Family School of PhilanthropyThe COVID‐19 pandemic disproportionately affects already‐vulnerable minorities, highlighting the need for strong, trusting relationships between governments and minority nonprofits for everyone's benefit. The current scholarship suggests minority members often lack trust in government. This study contributes to the field by examining trust levels Muslim‐American nonprofits have for federal, state, and local government. Nearly two‐thirds (65%) of Muslim nonprofit leaders believe that they may be discriminated against in the award of CARES Act funding, but on racial rather than religious ones. Moreover, partisanship affects trust levels. Muslim nonprofits in Republican “red” states show less trust in government compared with those in Democratic “blue” states. This study finds evidence that past relationships with the government strengthen trust. Past awards of government grants correlated positively with higher trust at both federal and local levels.Item The role of head and neck cancer advocacy organizations during the COVID-19 pandemic(Wiley, 2020-05-29) Yan, Flora; Rauscher, Erika; Hollinger, Amanda; Caputo, Mary Ann; Ready, John; Fakhry, Carole; Nathan, Cherie-Ann O.; Leonardis, Chris; Yearout, Danielle; Tsue, Terance T.; Day, Terry A.; Moore, Michael G.; Otolaryngology -- Head and Neck Surgery, School of MedicineItem Safety implications of different forms of understaffing among nurses during the COVID-19 pandemic(Wiley, 2022) Andel, Stephanie A.; Tedone, Archana M.; Shen, Winny; Arvan, Maryana L.; Psychology, School of ScienceAim: The aim of this study was to investigate the processes through which personnel understaffing and expertise understaffing jointly shape near misses among nurses during the COVID-19 pandemic. Background: Inadequate staffing is a chronic issue within the nursing profession, with the safety consequences of understaffing likely being exacerbated by the COVID-19 pandemic. Design: This study used a three-wave, time-separated survey design and collected data from 120 nurses in the United States working on the frontline of the pandemic in hospital settings. Methods: Participants were recruited through convenience sampling in early April 2020. Eligible nurses completed three surveys across a 6-week period during the COVID-19 pandemic from mid-April to the end of May 2020. Study hypotheses were tested with path analyses. Results/findings: Results reveal that personnel understaffing and expertise understaffing jointly shape near misses, which are known to precede and contribute to accidents and injuries, through different mechanisms. Specifically, personnel understaffing led to greater use of safety workarounds, which only induced near misses when cognitive failures were high. Further, higher levels of cognitive failures appeared to be the result of greater expertise understaffing. Conclusion: This study highlights the importance of addressing issues of understaffing, especially during times of crisis, to better promote nurse and patient safety. Impact: This study was the first to examine the distinct mechanisms by which two forms of understaffing impact safety outcomes in the form of near misses. Understanding these mechanisms can help leaders and policymakers make informed staffing decisions by considering the safety implications of understaffing issues.Item Socially distanced teaching: The mental health impact of the COVID‐19 pandemic on special education teachers(Wiley, 2022-04) Cormier, Christopher J.; McGrew, John; Ruble, Lisa; Fischer, Melanie; Psychology, School of ScienceLittle is known about the impact of the COVID‐19 pandemic on special education teachers. Of 468 surveyed across the United States, 38.4% met clinical criteria for generalized anxiety disorder, a rate 12.4 times greater than the U.S. population, and 37.6% for major depressive disorder, a rate 5.6 times greater than the population. Race/ethnicity, gender, or school funding was not related to mental health. The impact of the pandemic was moderate to extreme on stress (91%), depression (58%), anxiety (76%), and emotional exhaustion (83%).Item Tachyarrhythmias During Hospitalization for COVID-19 or Multisystem Inflammatory Syndrome in Children and Adolescents(American Heart Association, 2022) Dionne, Audrey; Friedman, Kevin G.; Young, Cameron C.; Newhams, Margaret M.; Kucukak, Suden; Jackson, Ashley M.; Fitzgerald, Julie C.; Smallcomb, Laura S.; Heidemann, Sabrina; McLaughlin, Gwenn E.; Irby, Katherine; Bradford, Tamara T.; Horwitz, Steven M.; Loftis, Laura L.; Soma, Vijaya L.; Rowan, Courtney M.; Kong, Michele; Halasa, Natasha B.; Tarquinio, Keiko M.; Schwarz, Adam J.; Hume, Janet R.; Gertz, Shira J.; Clouser, Katharine N.; Carroll, Christopher L.; Wellnitz, Kari; Cullimore, Melissa L.; Doymaz, Sule; Levy, Emily R.; Typpo, Katri V.; Lansell, Amanda N.; Butler, Andrew D.; Kuebler, Joseph D.; Zambrano, Laura D.; Campbell, Angela P.; Patel, Manish M.; Randolph, Adrienne G.; Newburger, Jane W.; Overcoming COVID-19 Investigators; Pediatrics, School of MedicineBackground: Cardiac complications related to COVID‐19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID‐19 or multisystem inflammatory syndrome in children. Methods and Results: This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals. Patients with tachyarrhythmias were compared with patients with severe COVID‐19–related complications without tachyarrhythmias. Tachyarrhythmias were reported in 22 of 1257 patients (1.8%) with acute COVID‐19 and 41 of 2343 (1.7%) patients with multisystem inflammatory syndrome in children. They included supraventricular tachycardia in 28 (44%), accelerated junctional rhythm in 9 (14%), and ventricular tachycardia in 38 (60%); >1 type was reported in 12 (19%). Registry patients with versus without tachyarrhythmia were older (median age, 15.4 [range, 10.4–17.4] versus 10.0 [range, 5.4–14.8] years) and had higher illness severity on hospital admission. Intervention for treatment of tachyarrhythmia was required in 37 (59%) patients and included antiarrhythmic medication (n=31, 49%), electrical cardioversion (n=11, 17%), cardiopulmonary resuscitation (n=8, 13%), and extracorporeal membrane oxygenation (n=9, 14%). Patients with tachyarrhythmias had longer hospital length of stay than those who did not, and 9 (14%) versus 77 (2%) died. Conclusions: Tachyarrhythmias were a rare complication of acute severe COVID‐19 and multisystem inflammatory syndrome in children and adolescents and were associated with worse clinical outcomes, highlighting the importance of close monitoring, aggressive treatment, and postdischarge care.