Post-acute sequelae of SARS-CoV-2 (PASC) is a poorly understood condition with significant impact on quality of life. We aimed to better understand the lived experiences of patients with PASC, focusing on the impact of cognitive complaints (“brain fog”) and fatigue on (1) daily activities, (2) work/employment, and (3) interpersonal relationships. We conducted semi-structured qualitative interviews with 15 patients of a Midwestern academic hospital’s post-COVID-19 clinic. We audio-recorded, transcribed, and analyzed interviews thematically using a combined deductive-inductive approach and collected participants’ characteristics from chart review. Participants frequently used descriptive and metaphorical language to describe symptoms that were relapsing-remitting and unpredictable. Fatigue and brain fog affected all domains and identified subthemes included symptoms’ synergistic effects, difficulty with multitasking, lack of support, poor self-perception, and fear of loss of income and employment. Personal relationships were affected with change of responsibilities, difficulty parenting, social isolation, and guilt due to the burdens placed on family. Furthermore, underlying social stigma contributed to negative emotions, which significantly affected emotional and mental health. Our findings highlight PASC’s negative impact on patients’ daily lives. Providers can better support COVID-19 survivors during their recovery by identifying their needs in a sensitive and timely manner.

Objective: To evaluate the impact of a multicenter, try automated dashboard on ASP activities and its acceptance among ASP leaders. Design: Frontline stewards were asked to participate in semi-structured interviews before and after implementation of a web-based ASP information dashboard providing risk-adjusted benchmarking, longitudinal trends, and analysis of antimicrobial usage patterns at each facility. Setting: The study was performed at Iowa City VA Health Care System. Participants: ASP team members from nine medical centers in the VA Midwest Health Care Network (VISN 23). Methods: Semi-structured interviews were conducted pre- and post-implementation, with interview guides informed by clinical experiences and the Consolidated Framework for Implementation Research (CFIR). Participants evaluated the dashboard’s ease of use, applicability to ongoing ASP activities, perceived validity and reliability, and relative advantage over other ASP monitoring systems. Results: Compared to established stewardship data collection and reporting methods, participants found the dashboard more intuitive and accessible, allowing them to reduce dependence on other systems and staff to obtain and share data. Standardized and risk-adjusted rankings were largely accepted as a valuable benchmarking method; however, participants felt their facility’s characteristics significantly influenced the rankings’ validity. Participants recognized staffing, training, and uncertainty with using the dashboard as an intervention tool as barriers to consistent and comprehensive dashboard implementation. Conclusions: Participants generally accepted the dashboard’s risk-adjusted metrics and appreciated its usability. While creating automated tools to rigorously benchmark antimicrobial use across hospitals can be helpful, the displayed metrics require further validation, and the longitudinal utility of the dashboard warrants additional study.

Purpose: Perinatal depression (PND), occurring during pregnancy or within the first year after childbirth, is a common medical complication with serious consequences when left untreated, including hospitalizations, increased morbidity, and suicide. This study examined the intersection among racial, ethnic, and sociodemographic disparities in PND screening and diagnosis within a Midwestern health system. Methods: We performed a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) using electronic health record data for 79,992 deliveries. The study included women aged 15–50 who delivered live-born infants between 22 and 44 weeks of gestation. PND screening was identified by the presence of a PHQ-9 or EPDS score, and ICD9/10 codes were used to define depression diagnosis within one year before or after delivery. Results: Across groups older women (≥ 36 years) were less likely to be screened for PND (OR = 0.65; 95%CI = 0.56–0.75) but not less likely to be diagnosed. Non-Hispanic Black, Hispanic, and Asian women were more likely to receive PND screening (ORs = 1.23–1.31) but less likely to be diagnosed (ORs = 0.16–0.60) compared to Non-Hispanic White women. Enrollment in public insurance was not associated with PND screening but was linked to a higher likelihood of diagnosis (OR = 1.41, CI = 1.24–1.61). Women in rural areas were less likely to be screened for PND (OR = 0.66, CI = 0.58–0.75), with no significant association with diagnosis. Conclusions: Significant disparities exist in PND screening and diagnosis. Groups facing historic structural inequities are more likely to be screened but less likely to receive a diagnosis, highlighting the need for targeted interventions to address these inequities.

Objective: How antibiotic stewardship programs can effectively reduce antibiotic overuse at hospital discharge is unclear. In this study, we assessed barriers and facilitators to performing prospective audit-and-feedback at this transition of care. Design: A qualitative study using semi-structured interviews. Setting: Ten acute-care hospitals participating in a stepped-wedge cluster-randomized trial, including three Veteran’s Health Administration hospitals, two academic medical centers and five community hospitals Participants: Fourteen antimicrobial stewards in participating hospitals across the United States. Methods (or Interventions): A semi-structured interview guide was created applying the RE-AIM framework to focus on perceptions of implementing the intervention. All interviews were audio recorded, transcribed, and coded in a three-person team. Using thematic analysis, codes were developed and collapsed into themes. Results: Half of the intervention sites struggled to identify patients at discharge, limiting the stewardship teams’ ability to conduct prospective audit-and-feedback at discharge. In contrast, strong provider–stewardship relationships and existing hospital initiatives, such as handshake stewardship and discharge planning meetings, facilitated implementation. Stewardship teams at four sites also reported not needing to guide antibiotic use for patients with Infectious Disease (ID) consults, as they agreed with the documented recommendations from the ID specialists. Conclusions: Our findings underscore the importance of accounting for the hospital and organizational context when implementing discharge-focused audit-and-feedback interventions, paying particular attention to existing policies, procedures, and the dynamics between antibiotic stewardship teams and front-line prescribers.

Research and decisions on health-related issues such as Amyotrophic Lateral Sclerosis (ALS) continue to evolve as the etiology of network degenerative disease remains indeterminate. Due to its heterogeneity, clinical trials (CTs) are continually being conducted for beneficial breakthroughs aimed at improving the lives of patients with ALS. However, there is a dearth of research on ALS patients' health-seeking decisions and preferences in CTs, particularly for patients living in rural areas. To bridge this important gap, we explored patients' subjective experiences and preferences in CT participation through their emotions. Seventeen participants (10 ALS patients, 6 healthcare professionals, and an advocacy group representative associated with ALS) affiliated with the University of Iowa ALS Multidisciplinary clinic were purposively selected and interviewed for the study. Qualitative descriptive data were analyzed using thematic content analysis to understand the patients' experiences and preferences. Findings indicate key emotional and logistical challenges including fatigue, travel distance and constraints, limited trial availability, which are exacerbated by the disease's rapid progression and restrictive eligibility criteria. Participants' narratives highlighted frustration, anxiety, and fear as central emotional experiences influencing their health-seeking decisions. Conversely, expressions of hope and empathy emerged as significant motivators, with patients demonstrating a willingness to participate in CTs despite the known risk of limited personal benefits, while focusing on the need to benefit future ALS research. Patients prefer and desire more compensation, broader eligibility and inclusive criteria, trial availability and publicity, and access to telemedicine. Given the multifaceted physical, and emotional challenges faced by ALS patients, this study recommends prioritizing patient preferences in future CTs and intervention designs, while advocating for targeted grants and sustained funding that supports ALS clinical trials. This will better align with the needs and expectations of ALS patients, thereby enhancing trial participation and overall patient satisfaction.