Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection

OBJECTIVE

To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic.

METHODS

The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed.

RESULTS

Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs.

CONCLUSION

PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.

Viscous sintering phenomena in liquid-liquid dispersions

We present experimental evidence for viscous sintering phenomena in a gel formed by highly viscous emulsion droplets. When a rupturing agent is added to the initially stable emulsion, a gel forms, which further contracts by preserving the geometry of the container. The initial stages of densification (up to 60%) follow very well the "cylindrical model" for viscous sintering, but deviate at the final stages of densification. The observed inverse dependence of the contraction rate on viscosity is consistent with the viscous sintering theory.

Determination of DMPC hydration in the L(alpha) and L(beta') phases by 2H solid state NMR of D2O

The number of water molecules bound to the dimyristoylphosphatidylcholine (DMPC) interface was investigated both in the fluid (L(alpha)) and gel (L(beta')) phases by solid state deuterium NMR of D2O. We determined that each DMPC molecule binds 9.7 +/- 0.5 and less than 4.3 +/- 0.5 D2O in the fluid and gel phases respectively. These results are accounted for by considering the number of DMPC binding sites as well as the molecular organization in each phase.