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Item Learning by Doing: Local Stories from SARS-CoV-2 Pandemic Vaccination Planning(Indiana University School of Medicine, 2021-12-16) Whiteside, J. A.; Niebuhr, Brian P.Aim: Attempts to end the COVID-19 pandemic focus on rapid manufacture, procurement, and distribution of the SARS-CoV-2 vaccine to states. However, little work has been reported regarding local implementation and planning for providing vaccinations—despite the critical role state and local implementation strategies have played in previous mass vaccination campaigns as well as early mitigation of the COVID-19 pandemic. We therefore assessed state and local efforts of SARS-CoV-2 vaccine planning in Indiana. Subject and Methods: Four semi-structured interviews were conducted with representatives of the Indiana Department of Health and three Indiana county health departments in the earliest stages of the COVID-19 pandemic: between July and August of 2020. Results: Common themes extracted from the interviews identified several strategies based on published evidence and previous local experience, including early advanced planning with stakeholders, flexibility, leveraging strategic partners, and demographic and geographic surveillance of vaccine uptake. Conclusion: While there is no one-size fits-all approach for a successful vaccination campaign, there are evidence-based approaches that should be co-developed and shared among local health departments. This study adds important local narratives of a vital, yet disproportionately understudied area of vaccine delivery: traversing “the last mile” before vaccine administration. Further qualitative and quantitative studies directed at local practices during the COVID-19 pandemic are critical to developing best practices in, and lessons learned from, community immunization.Item Patient acceptance of teleneurology across neurologic conditions(Springer, 2024-02-23) Seigel, Courtney R.; Martin, Holly; Bastin, Grace; Myers, Laura J.; Taylor, Stan; Pike, Francis; Wilkinson, Jayne; Williams, Linda S.Introduction: Patient acceptability with outpatient teleneurology has been reported within specific conditions, but less is known about acceptability across neurologic conditions. The study objective was to compare the acceptability of teleneurology between patients with various neurological conditions and determine what other factors influence acceptability. Methods: This was a prospective study of Veterans who completed new outpatient teleneurology visits with the Department of Veterans Affairs National Teleneurology Program. Visits were conducted via video to home or video to the outpatient clinic. Patient acceptability was assessed via telephone interview two weeks post-visit. Acceptability was a summed score (3-21) of three 7-point Likert questions (higher = more acceptable). Clinical diagnosis categories were based on the neurologists' ICD10 diagnosis code. Acceptability score was modeled using a censored Tobit model controlling for demographics, type of tele-visit, medical comorbidity, and ICD10 category. Results: In FY 2021, 277 of 637 (43.5%) patients completed an interview with analyzable acceptability data. Of these 277, 70 (25.3%) had codes indicating headache, 46 (16.6%) movement disorder, 45 (16.2%) general symptoms, and 116 (41.9%) for all other categories. Mean patient acceptability was 18.3 (SD 3.2). There was no significant difference in scores between these groups. The only factor independently related to acceptability was medical comorbidity, with higher comorbidity associated with higher acceptability scores. Discussion: Patients find their outpatient teleneurology experience highly acceptable independent of neurologic condition. Those with more comorbidity report higher acceptability. Use of teleneurology may be useful and acceptable across many outpatient neurologic conditions including for more medically complex patients.Item Practical Considerations for Mass SARS- CoV-2 Pandemic Vaccination: A Narrative Review(Indiana University School of Medicine, 2021-12-16) Niebuhr, Brian P.; Whiteside, J. A.Vaccine development against SARS-CoV-2 has dominated the literature during the 2019-21 COVID-19 pandemic, with minimal reporting regarding efficacious local implementation of vaccine campaigns—despite its critical role in vaccine uptake. This narrative review identifies practices to consider for local SARS-CoV-2 and future pandemic vaccination campaigns. We searched PubMed and the CDC’s Immunization Information Systems database and identified 941 articles, selecting 18 for review based on local implementation relevance. We extracted strategies applicable to state and local SARS-CoV-2 vaccination efforts. Considerations included: establishing well-defined priority groups and partnerships; advanced planning emphasizing communication; surveillance and evaluation; flexibility; and overcoming cost-related limitations. National guidelines, such as those developed by the U.S. Health and Human Services, are necessary but insufficient for high coverage rates, as they depend on variable local supply chains and community strategies. Local Health Departments should recognize prior successful approaches to plan more coordinated, targeted, and successful SARS-CoV-2 vaccination.Item "I Bring Her up with Love': Perspectives of Caregivers of Children with Neurodevelopmental Delays in Western Kenya(2023-01) Heng, Yi Yan; Nafiseh, Amira; Oyungu, Eren; Ombitsa, Ananda Roselyne; Cherop, Carolyn; McHenry, Megan S.Objective: This study aims to understand the challenges and perspectives of caregivers with neurodevelopmental delays (NDD) in rural Kenya. Methods: Semi-structured interviews and the Affiliate Stigma Scale were administered to the primary caregivers of children with NDDs recruited from the communities near Eldoret, Kenya. Constant comparison and triangulation methods were used to inductively develop relevant themes and concepts. Results: Sixteen caregivers participated. Challenges, which included hardships related to safety and supervision, challenging emotions and financial difficulties, were compounded by a lack of social support and community stigma towards these children. However, caregivers still felt deep love for their children, desired acceptance from the community and found sources of strength from faith and religious institutions. Conclusion: The study uncovered crucial insights into the perspectives of caregivers within this population and revealed a paucity of disability awareness and understanding within the community, possibly informing future programmes and intervention policies.Item The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs)(PLOS Digital Health, 2023-10-25) Bucher, Sherri Lynn; Young, Allison; Dolan, Madison; Padmanaban, Geetha Priya; Chandnani, Khushboo; Purkayastha, SaptarshiItem Assessment of patient follow-up from student-run free eye clinic to county ophthalmology clinic(Springer Nature, 2022) Scheive, Melanie; Rowe, Lucas W.; Tso, Hanna L.; Wurster, Patrick; Kalafatis, Nicholas E.; Camp, David A.; Yung, Chi Wah Rudy; Ophthalmology, School of MedicineThe Ophthalmology Student Interest Group at Indiana University School of Medicine provides a free student-run eye screening clinic for an underserved community in Indianapolis. Patients with abnormal findings are referred to the ophthalmology service of the local county hospital for further evaluation. This retrospective chart review studied 180 patients referred from our free eye clinic to follow up at the ophthalmology service of a local county hospital from October 2013 to February 2020. This study investigated factors impacting follow-up of patients by analyzing demographics, medical history, insurance coverage, and final diagnoses at follow-up. Thirty-five (19.4%) of 180 patients successfully followed up at the local county hospital with an average time to follow-up of 14.4 (± 15.9) months. Mean patient age was 51 (± 13.6) with nearly equal numbers of males and females. The most common diagnoses at follow-up included refractive error (51.4%), cataract (45.7%), and glaucoma (28.6%). Patients with diabetes diagnoses or Healthy Indiana Plan insurance coverage had increased probability of follow-up. This study reveals gaps in timely follow-up to the local county hospital, demonstrating the current limitations of our free clinic in connecting patients to more definitive care and the need for an improved referral process.