Barriers and solutions to developing and maintaining research networks during a pandemic: An example from the iELEVATE perinatal network

Introduction

To improve maternal health outcomes, increased diversity is needed among pregnant people in research studies and community surveillance. To expand the pool, we sought to develop a network encompassing academic and community obstetrics clinics. Typical challenges in developing a network include site identification, contracting, onboarding sites, staff engagement, participant recruitment, funding, and institutional review board approvals. While not insurmountable, these challenges became magnified as we built a research network during a global pandemic. Our objective is to describe the framework utilized to resolve pandemic-related issues.

Methods

We developed a framework for site-specific adaptation of the generalized study protocol. Twice monthly video meetings were held between the lead academic sites to identify local challenges and to generate ideas for solutions. We identified site and participant recruitment challenges and then implemented solutions tailored to the local workflow. These solutions included the use of an electronic consent and videoconferences with local clinic leadership and staff. The processes for network development and maintenance changed to address issues related to the COVID-19 pandemic. However, aspects of the sample processing/storage and data collection elements were held constant between sites.

Results

Adapting our consenting approach enabled maintaining study enrollment during the pandemic. The pandemic amplified issues related to contracting, onboarding, and IRB approval. Maintaining continuity in sample management and clinical data collection allowed for pooling of information between sites.

Conclusions

Adaptability is key to maintaining network sites. Rapidly changing guidelines for beginning and continuing research during the pandemic required frequent intra- and inter-institutional communication to navigate.

Abstract P186: Position Effects Blood Pressure Measurement During Pregnancy

Hypertension in pregnancy is a leading cause of maternal morbidity and mortality. Studies demonstrate that body positions affect the blood pressure (BP) measurements and have led to guidelines for proper positioning by the ACC and AHA. However, studies excluded pregnant women and did not include all common patient positions, such as semi-Fowlers. These studies cannot be applied to pregnant women due to dynamic cardiovascular changes in pregnancy. We measured BP in pregnant women in inpatient and outpatient settings in various positions. These BPs were compared to the published ACC/AHA guideline position: seated with arms and feet supported. Trained team members used an aneroid sphygmomanometer and stethoscope and/or a validated electronic BP machine. There is no significant difference between BP measurements using a sphygmomanometer/stethoscope vs. an electronic BP machine in the ACC/AHA guideline position (systolic p=0.60 diastolic p=0.91). There was not a significant difference in either systolic or diastolic means in the semi-Fowlers position (at 45 degrees measured by goniometer) (systolic=0.60 diastolic=0.95). Positioning did affect the diastolic BP measurement in the seated without support position (p=0.01) and both the systolic (p< 0.001) and diastolic (p<0.001) measurements in the left lateral recumbent position. Our data demonstrate that an accurate BP measurement in pregnancy is dependent upon patient position. Monitoring BP position in left lateral recumbent may mask an elevated BP. This study also suggests that it may be possible to substitute semi-Fowlers position for reliable BP measurements when chair sitting is not practical, such as labor.

Medicare: an advocacy perspective for social workers

Many Medicare recipients and social work advocates assume this program of federal health care insurance for the elderly and disabled to be relatively trouble free and, therefore, not relevant for advocacy efforts. Only when confronted with a reimbursement denial do the internal complexities and contradictions of the Medicare program, and the resultant need for advocacy, become apparent to recipient and worker alike. This paper presents a conceptual framework and advocacy perspective on Medicare's structure, benefits, and appeals procedures in order to aid a social work advocate in deciding whether to deal with recurrent Medicare problems through techniques to maximize benefits, appeals procedures, or legislative advocacy.