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BackgroundThere is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF.ObjectiveThe purpose of this pre-post study was to assess the feasibility and acceptability of a text message–based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management.MethodsHospitalized patients with ADHF were enrolled in an automated text message–based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction.ResultsOf 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake (66%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention.ConclusionsOver half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management.

No current model accurately predicts joint-state utility using the component single-state utilities. When possible, joint-state utilities should be elicited. If not possible, the minimum model is recommended. Research to identify better models is needed.

Background Convalescent plasma therapy for COVID‐19 relies on transfer of anti‐viral antibody from donors to recipients via plasma transfusion. The relationship between clinical characteristics and antibody response to COVID‐19 is not well defined. We investigated predictors of convalescent antibody production and quantified recipient antibody response in a convalescent plasma therapy clinical trial. Methods Multivariable analysis of clinical and serological parameters in 103 confirmed COVID‐19 convalescent plasma donors 28 days or more following symptom resolution was performed. Mixed‐effects regression models with piecewise linear trends were used to characterize serial antibody responses in 10 convalescent plasma recipients with severe COVID‐19. Results Donor antibody titres ranged from 0 to 1 : 3892 (anti‐receptor binding domain (RBD)) and 0 to 1 : 3289 (anti‐spike). Higher anti‐RBD and anti‐spike titres were associated with increased age, hospitalization for COVID‐19, fever and absence of myalgia (all P < 0.05). Fatigue was significantly associated with anti‐RBD ( P = 0.03). In pairwise comparison amongst ABO blood types, AB donors had higher anti‐RBD and anti‐spike than O donors ( P < 0.05). No toxicity was associated with plasma transfusion. Non‐ECMO recipient anti‐RBD antibody titre increased on average 31% per day during the first three days post‐transfusion ( P = 0.01) and anti‐spike antibody titre by 40.3% ( P = 0.02). Conclusion Advanced age, fever, absence of myalgia, fatigue, blood type and hospitalization were associated with higher convalescent antibody titre to COVID‐19. Despite variability in donor titre, 80% of convalescent plasma recipients showed significant increase in antibody levels post‐transfusion. A more complete understanding of the dose‐response effect of plasma transfusion amongst COVID‐19‐infected patients is needed.

W e consider the partitioning of care types into wings from the perspective of a hospital administrator who wishes to optimize the use of a fixed number of beds that provide services for heterogeneous care types. The hospital administrator decides on the number of wings to form, the number of beds to allocate to each wing, and the set of care types to assign to each wing to maximize the total utility to the hospital. The administrator faces an inherent trade-off between forming large wings to pool demand and bed capacity, and forming specialized wings to focus on narrow ranges of care types. Specialized wings not only provide advantages from focused care but also allow the protection of beds for high-utility care types. We provide an optimization model for the wing formation decision and address the advantages of focus endogenously in our model. Using data from a large urban teaching hospital in the United States along with a national database, we report on a number of managerial insights. In particular, as the overall demand increases across all care types, wings are formed to reserve more beds for higher-utility types, which leads to higher overall hospital utility but also some disparity across types, such as increased hospital access for some and decreased access for others. Furthermore, overall bed occupancy decreases as the hospital is split into wings. However, if sufficient focus is attained, shorter lengths-of-stay associated with focused care may increase overall patient throughput. We also observe that when patients are willing to wait longer for admission, the hospital tends to form more wings. This implies that hospitals that garner longer waits can form more specialized wings and thereby benefit from focused care, whereas hospitals that cannot will tend to form fewer, if any, wings, choosing to pool demand and bed capacity.