Lianne Cole

Background/Objectives: COPD is a leading cause of death in the US, with higher morbidity and mortality in rural areas that lack specialized pulmonary care. Mobile health (mHealth) tools, including remote spirometry, may fill this gap, yet healthcare provider (HCP) perspectives on utility and implementation of remote spirometry and mHealth for COPD management in these settings remain unexplored. This study aimed to examine HCPs’ perspectives of mHealth with remote spirometry to inform future implementation in rural and low medical access settings. Methods: Five HCPs working in rural or medically limited settings in South Carolina participated in a deliberative discussion focus group. A semi-structured interview guide was used to explore insights into feasibility, clinical utility, and implementation needs. Transcripts were analyzed using thematic analysis to identify facilitators, barriers, and implementation considerations. Results: Participants reported that remote spirometry and mHealth had potential to support COPD treatment, increase healthcare access, and support self-management. Key facilitators identified were access to smartphones, potential for individualized COPD care, and visual tools for patient engagement. Barriers included risk of time and workload burden, data information overload, and technological limitations. Participants emphasized the need for team training, thoughtful integration into existing workflows, customizable data displays, and robust support for patient onboarding. Conclusions: Providers viewed mHealth applications with remote spirometry as a valuable tool with potential to improve COPD care but identified critical implementation needs. Participants emphasized that successful integration would require structured support, user-centered design, and attention to reimbursement and workflow alignment to enhance sustainability and patient/provider engagement.

Parents of children with congenital heart disease (CHD) experience higher rates of stress compared with the general population, which adversely affects their health-related quality of life (HRQoL). The purpose of this cross-sectional study was to examine coping strategies as mediators and moderators between perceived stress and HRQoL in parents of children with CHD. The effects of sociodemographic factors on perceived stress and HRQoL were also explored. Parents of children with CHD were recruited to participate from October 2023 to July 2024. Participants completed a self-report, online questionnaire containing the Perceived Stress Scale (PSS), Brief COPE, PedsQL Family Impact module, and the Protocol for Responding to and Assessing Patients Assets, Risks, and Experiences (PRAPARE). SPSS v27.2 and the PROCESS macro extension were used for analysis of mediator and moderator effects of coping strategies. Participants included 53 parents who met criteria and agreed to participate in the study. Parents with Medicaid and other non-private insurance types had higher PSS scores than parents with private insurance. Avoidant coping, self-blame, and behavioral disengagement were positively correlated with PSS and negatively correlated with HRQoL. Regression analysis indicated that coping strategies did not directly mediate the relationship between PSS and HRQoL. Problem-focused coping, active coping, emotional support, acceptance, and self-distraction moderated the effects of PSS on HRQoL. More research is needed to develop and test evidence-based coping interventions that reduce stress and improve HRQoL in parents of children with CHD.

Background: Children with left aortic arch and aberrant right subclavian artery may present with either respiratory or swallowing symptoms beyond the classically described solid-food dysphagia. We describe the clinical features and outcomes of children undergoing surgical repair of an aberrant right subclavian artery.Materials and methods: This was a retrospective review of children undergoing repair of an aberrant right subclavian artery between 2017 and 2022. Primary outcome was symptom improvement. Pre- and post-operative questionnaires were used to assess dysphagia (PEDI-EAT-10) and respiratory symptoms (PEDI-TBM-7). Paired t-test and Fisher’s exact test were used to analyse symptom resolution. Secondary outcomes included perioperative outcomes, complications, and length of stay.Results: Twenty children, median age 2 years (IQR 1–11), were included. All presented with swallowing symptoms, and 14 (70%) also experienced respiratory symptoms. Statistically significant improvements in symptoms were reported for both respiratory and swallowing symptoms. Paired (pre- and post-op) PEDI-EAT-10 and PEDI-TBM-7 scores were obtained for nine patients, resulting in mean (± SD) scores decreasing (improvement in symptoms) from 19.9 (± 9.3) to 2.4 (± 2.5) p = 0.001, and 8.7 (± 4.7) to 2.8 (± 4.0) p = 0.006, respectively. Reoperation was required in one patient due to persistent dysphagia from an oesophageal stricture. Other complications included lymphatic drainage (n = 4) and transient left vocal cord hypomobility (n = 1).Conclusion: Children with a left aortic arch with aberrant right subclavian artery can present with oesophageal and respiratory symptoms beyond solid food dysphagia. A thorough multidisciplinary evaluation is imperative to identify patients who can benefit from surgical repair, which appears to be safe and effective.