Consultation Requests Research Articles

Infectious Diseases Telemedicine to the Arizona Department of Corrections During SARS-CoV-2 Pandemic. A Short Report.

The University of Arizona infectious diseases provides telemedicine clinics to the Arizona Department of Corrections (DOC) and Pima County Jail. Beginning in January 2020 there was a sharp drop in the number of monthly consultations following the public health emergency regarding the SARS-CoV-2 pandemic. Only since ending the emergency have the number of consults risen each month to pre-pandemic numbers. However, the nature of consult requests has changed. In this report we document the change from predominately human immunodeficiency virus (HIV) consults to a broader spectrum of infectious-related issues, most noteworthy being infective endocarditis, osteomyelitis, and chronic hepatitis B and C infection, the majority of cases due to intravenous drug injection. Although the DOC and jail underwent major upheavals intramurally due to the pandemic, medical outcomes with the diseases listed above, were excellent. The telemedicine infectious diseases clinics continued to provide timely, effective care for inmates.

An analysis of cardiology consultation requests in infants presented to the pediatric emergency department of a tertiary children’s hospital

ABSTRACT Introduction Cardiological emergencies are reported to constitute almost 15% of all emergency department visits. This study aimed to characterize the main signs and symptoms of the infants that necessitated pediatric cardiology consultation and to analyze the characteristics of patients diagnosed with a cardiological disorder Material and methods Patients aged 1 month to 1 year who were consulted to the pediatric cardiology service during a 4-year period were retrospectively evaluated. Patients’ age, sex, nationality, complaints at PED, physical examination findings, reason for echocardiography (echo) and final diagnosis were recorded from the hospital medical record system for further analysis. Patients were divided into two groups according to the severity of the echo findings (patients with significant cardiovascular issues and patients without significant cardiovascular issues). Results Of the 200 patients included in the study, 19 were in the significant cardiovascular issues, and 181 were in the without significant cardiovascular issue group. The leading complaints of the patients who were consulted to cardiology were cyanosis (22.5%), seizure (22.5%), cough (22%), and fever (19.5%). In emergency presentations, jaundice (16%), nutritional problems (21%), and cardiomegaly (21%) on x-rays were higher in patients with significant cardiovascular issues (p < 0.05). Conclusion In conclusion, congenital heart disease is usually diagnosed in the neonatal period, but some patients may be missed due to a variety of symptoms and findings. Infants with feeding problems and jaundice, especially those with cardiomegaly on chest radiographs, should be carefully evaluated for underlying serious congenital heart disease.

Integrated Behavioral Health in Pediatric Primary Care: Rates of Consultation Requests and Treatment Duration

Integrated Behavioral Health in Pediatric Primary Care: Rates of Consultation Requests and Treatment Duration

Investigating Shared Storytelling with a Chatbot as an Approach in Assessing and Maintaining Positive Mental Well-Being among Students

Global reports indicate a steady increase in the number of people who are facing mental health concerns. Among those affected are students who struggle with balancing the demands of a hybrid learning environment. Recent studies are emerging on the use of chatbots as an accessible technology-based alternative to help address the challenges faced by school counselors in accommodating the influx of requests for consultations from students. This paper explores the potential in using a chatbot to provide a first-respondent service to help students maintain good mental well-being, a necessary precursor for individuals to practice self-care while reducing the risks of mental illnesses. We designed a chatbot that leverages storytelling strategies to assess the students’ well-being and to guide them in formulating actions necessary to sustain an optimal mental health. End-user validation captured students’ feedback regarding their perception on the support afforded by the chatbot from their three-day sessions. Expert analysis of the chatlogs revealed insights on the user expectations of the role of the chatbot and the impact of storytelling-based conversation flow in addressing support seekers’ needs toward sustaining positive mental health and well-being.

Vermittlung der Terminservicestellen Psychotherapie im Jahr 2019

ZusammenfassungHintergrundEine Maßnahme des Versorgungsstärkungsgesetzes war die Vermittlung psychotherapeutischer Leistungen (psychotherapeutische Sprechstunde, Akutbehandlung und probatorische Sitzungen) durch die Terminservicestellen der Kassenärztlichen Vereinigungen (KVen). Wir untersuchten diese Vermittlung differenziert nach Vermittlungsanliegen sowie nach Stadtstaat versus Flächenland.MethodenDie Anzahl der Anfragen und Terminvereinbarungen im Jahr 2019 wurde bei den KVen Deutschlands mittels Fragebogen erfragt. Die statistische Analyse bestand aus einer deskriptiven Auswertung und einem Kruskal-Wallis-Test.ErgebnisseDaten zu Terminvereinbarungen lagen von 17 KVen und Informationen zu Anfragen von 16 KVen vor. Insgesamt wurden 134.578 Termine vereinbart. Die Spannweite von 193 bis 21.810 Terminvereinbarungen offenbarte deutliche Unterschiede zwischen den einzelnen KVen. Der Anteil der psychotherapeutischen Sprechstunde an allen psychotherapeutischen Terminvereinbarungen lag im Median bei 92 %. Pro KV konnten im Median 87 % der Anfragen nach psychotherapeutischen Sprechstunden (Spannweite 56–100 %), 96 % nach Akutbehandlungen (29–100 %) und 97 % nach probatorischen Sitzungen (27–100 %) vermittelt werden (je n = 16). Es zeigten sich geringe Unterschiede zwischen Stadtstaaten und Flächenländern bei der Vermittlung von Akutbehandlungen und probatorischen Sitzungen.DiskussionBei KVen sowohl in Stadtstaaten als auch in Flächenländern bestehen Defizite insbesondere bei der Vermittlung von Akutbehandlungen und probatorischen Sitzungen. Unsere Ergebnisse lassen keine Rückschlüsse auf den Vermittlungsradius oder die Wartezeit auf Termine zu.

Transition from intensive care to palliative care : A retrospective analysis of 102 consultation requests

The transition of patients from the intensive care unit (ICU) to the palliative care (PC) ward often implies changes including establishing apalliative concept. Adaptation of therapeutic goals can be challenging for medical staff, patients and relatives; however, descriptions of these transition trajectories are rare. The aim of this retrospective study was to characterize the consultation requests of the ICU to the PC consultation team as well as the patients by a description of trajectories and interventions. Retrospective analysis of all patients receiving intensive care at RWTH Aachen University Hospital in 2019 for whom aPC consultation was requested. The patient population transferred from the ICU to the PC ward was compared with the non-transferred population. In each case, the primary consultation was evaluated regarding the following factors: question, vigilance, length of time from consultation request to its performance, and primary focus of the question. The question focus was categorized into "symptom control", "counselling" and "transfer" (tick options). In addition, afree text field was available for further notes. Exploration of diagnoses was complemented by accessing the electronic health records. A total of 102 consultation requests from the ICU to the PC ward were evaluated. The morbidity of patients was high, and most patients had at least one of the following diagnoses: pulmonary (62%), cardiovascular (61%), and/or neurological disease (55%). Of the patients 32 (31%) were transferred to the PC ward, among whom weakness (94%), fatigue (77%), anxiety (55%), pain (53%), and dyspnea (48%) were the most frequently noted symptoms. Of the transferred patients 5 (16%) could be discharged to home, nursing home, hospice or other. In total, 35 (34%) of all patients who were seen by palliative care specialists on ICUs in 2019 could be discharged alive. The most frequent reasons for nonadmission were lack of capacity of the PC ward (33%), dying while being on the waiting list (20%), and refusal by the patient (20%). Of the patients, 7 (26%) died within 48 h after they had been transferred to the PC ward. Performed consultation services "symptom control" (χ2 = 10.17; p < 0.05) and "counselling" (χ2 = 12.82; p < 0.001), which were requested by the intensive care physicians, showed asignificant linkage with the respective intervention performed by the palliative care team. On the other hand, no statistically significant difference was found for requested and performed "transfer" of patients from ICUs to PC ward. Comparing the transferred versus non-transferred patient population, asignificantly more frequent transfer of patients with malignant tumors (p = 0.00) was observed. The need for palliative care support in the ICUs exceeded the admission capacity of the PC ward. Future studies should further examine palliative care models in intensive care medicine.

Neuro-ophthalmology Emergency Department and Inpatient Consultations at a Large Academic Referral Center

Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists means that the increasing outpatient demand cannot be met, prompting many emergency department (ED) referrals by non-neuro-ophthalmologists. We describe our quaternary care institution's ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes. Prospective observational study. Consecutive neuro-ophthalmology ED and inpatient consultation requests over 1 year. We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up. Consultation patterns and diagnoses, complexity, and follow-up. Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year, 241 of 494 consultations (49%) occurred at night or during weekends. Of ED consultations (322 of 494 [65%]), 127 of 322 consultations (39%) occurred during weekdays, 126 of 322 consultations (39%) occurred on weeknights, and 69 of 322 consultations (22%) occurred on weekends or holidays. Of 322 ED consultations, 225 of 322 consultations (70%) were patients who initially sought treatment in the ED with a neuro-ophthalmic chief symptom. Of the 196 patients sent to the ED by a health care professional, 148 patients (148/196 [76%]) were referred by eye care specialists (74 optometrists and 74 ophthalmologists). The most common ED referral questions were for papilledema (75 of 322 [23%]) and vision loss (72 of 322 [22%]). A total of 219 of 322 patients (68%) received a final active neuro-ophthalmic diagnosis, 222 of 322 patients (69%) were cases of high or very high complexity, and 143 of 322 patients (44%) required admission. Inpatient consultations (n= 172) were requested most frequently by hospitalists, including neurologists (71 of 172 [41%]) and oncologists (20 of 172 [12%]) for vision loss (43 of 172 [25%]) and eye movement disorders (36 of 172 [21%]) and by neurosurgeons (58 of 172 [33%]) for examination for mass or a preoperative evaluation (19 of 172 [11%]). An active neuro-ophthalmic diagnosis was confirmed in 67% of patients (116 of 172). Outpatient neuro-ophthalmology follow-up was required for 291 of 494 patients (59%). Neuro-ophthalmology consultations are critical to the diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The Impact of Covid-19 Pandemic on Mental Health Services: A Comparison Between First Psychiatric Consultations Before and After the Pandemic.

A high rate of onset or exacerbation of several mental disorders has been observed during the COVID-19 pandemic. However, the risk contributing to mental distress during the pandemic remains unclear. The study aims to evaluate the risk of the onset of mental disorders by comparing the number of requests for the first psychiatric consultation before and after the COVID-19 pandemic at the psychiatric outpatient services of Varese, a small town in Northern Italy. This observational retrospective study aims to compare the requests for the first psychiatric consultation at the outpatient services of Varese during the 14-month period before COVID-19 pandemic (from 1st January 2019 to 28th February 2020) versus the 14-month period after the pandemic (from 1st March 2020 to 31st May 2021) extracted from the server SIPRL-Psicheweb database (Sistema Informativo della Psichiatria, Lombardy Region). For each patient, socio-demographic features and clinical data (psychiatric diagnosis, psychiatric comorbidities, previous psychiatric records, and previous hospitalization in the psychiatric ward) were collected. Three hundred ninety-five consultations were made during the pre-COVID period and 346 during the post-COVID period. No statistically significant difference was found between the number of first consultation requests in the two periods evaluated but a slight decrease in the total number during the pandemic period (395 vs 346; p=0.07) can be noticed. In the subjects of the pre-COVID group, a statistically significant association was detected with no previous psychiatric records ("absent") and with stressor-related disorders. In the post-COVID group, a statistically significant correlation between "present" previous records and anxiety-depressive disorders emerged. It has been observed that anxiety-depressive disorders increased in the post-COVID-19 period compared to the pre-COVID-19, instead of stressor-related disorders. This might be because stressor-related disorders may be treated by general practitioners with no psychiatric interventions. Most of the first consultations during the period of the COVID-19 pandemic were for patients who already had contact with psychiatric services.The study shows an increasing request for care by more severe patients in the first phase of the SARS-CoV-2 pandemic. Further research is needed to investigate the long-term impact of the COVID-19 pandemic on emergency departments and hospital services.

Novel Electronic Health Records-Based Consultation Workflow Improves Time to Operating Room for Vascular Surgery Patients in an Acute Setting

Inefficient clinical workflows can have downstream effects of increased costs, poor resource utilization, and worse patient outcomes. The surgical consultation process can be complex with unclear communication, potentially delaying care for patients requiring time-sensitive intervention in an acute setting. A novel electronic health records (EHR)-based workflow was implemented to improve the consultation process. After implementation, we assessed the impact of this initiative in patients requiring vascular surgery consultation. An EHR-driven consultation workflow was implemented at a single institution, standardizing the process across all consulting services. This order-initiated workflow automated notification to clinicians of consult requests, communication of patient data, patient addition to consultants' lists, and tracking consult completion. Preimplementation (1/1/2020-1/31/2022) and postimplementation (2/1/2022-12/4/2022) vascular surgery consultation cohorts were compared to evaluate the impact of this initiative on timeliness of care. There were 554 inpatient vascular surgery consultations (255 preimplementation and 299 postimplementation); 45 and 76 consults required surgery before and after implementation, respectively. The novel workflow resulted in placement of a consult note 32min faster than preimplementation (preimplementation: 462min, postimplementation: 430min, P=0.001) for all vascular surgery consults. Furthermore, vascular surgery patients with ASA class III or IV status requiring an urgent or emergent operation were transported to the operating room 63.3% faster after implementation of the workflow (preimplementation: 284min, postimplementation: 180min, P=0.02). There were no differences in procedure duration, postoperative disposition, or intraoperative complication rates. We implemented a novel workflow utilizing the EHR to standardize and automate the consultation process in the acute inpatient setting. This institutional initiative significantly improved timeliness of care for vascular surgery patients, including decreased time to operation. Innovations such as this can be further disseminated across shared EHR platforms across institutions, representing a powerful tool to increase the value of care in vascular surgery and healthcare overall.

Making Trauma Less Traumatic: Implementing Inpatient Pediatric Screening of Acute Stress Symptoms.

Pediatric patients hospitalized for physical injury and trauma are at increased risk of developing acute stress disorder. Routine identification and referral for treatment of patients with psychological sequelae of traumatic injury were added to the accreditation requirements of the American College of Surgeons for pediatric trauma centers in 2022. We aimed to use quality improvement methodology with iterative interventions to increase psychological screening consults for admitted pediatric trauma patients to 80% in 6 months. We planned a quality improvement intervention to increase identification of posttraumatic psychological symptoms in pediatric trauma patients. We created a Making Trauma Less Traumatic consultation service with a dedicated therapist to provide screening, treatment, and referral. Key interventions included education of key stakeholders and iterative improvements in consultation workflow. Our primary measure was frequency of eligible pediatric trauma patients who had consultation requests for posttrauma therapy during admission. We additionally monitored percent of patients with positive symptom screens and lost to follow-up. From September 2020 through November 2021, consults for eligible pediatric trauma patients improved from a baseline of 4.1% to a weekly mean of 100%. Of those screened, 32.7% had at least 1 symptom of acute stress. No families declined screening or therapy, though 29.5% were lost to intended follow-up. We present a successful model of implementing routine psychological screening of pediatric trauma patients utilizing a dedicated consultation service. A high number of admitted patients screened positive for symptoms during hospitalization. Families were accepting of the intervention though follow-up was challenging.

The impact of headache disorders: a prospective analysis of headache referrals to outpatient and inpatient neurology and emergency services in an Irish University teaching hospital

BackgroundHeadache represents a significant proportion of disability globally in general practice, neurology outpatient settings, and emergency departments. There is scant literature regarding the impact of headache on healthcare services in Ireland.AimsWe aimed to investigate headache burden across the emergency department, inpatient stays, and neurology outpatient department referrals in an Irish University teaching hospital.MethodsWe prospectively collected data regarding emergency department presentations, inpatient neurology consultations, and neurology outpatient referrals for patients with headache between 13th January and 8th March 2020. Data were analyzed using descriptive statistics.ResultsThere were 180 emergency department attendances, 50 inpatient consultations, and 76 outpatient referrals with headache. Neurological examinations were often incomplete; neuroimaging was commonly employed. Migraine was the most frequent headache diagnosis at discharge in the emergency department and among inpatients after neurology review. Diagnostic uncertainty was identified—33% of patients left the emergency department with no diagnosis, and “unknown/unspecified headache” was recorded on 49% of outpatient referrals and 30% of inpatient consult requests. Medication overuse headache coexisted with migraine in nine patients in the inpatient group. Prophylaxis had been trialed in 56% of patients with migraine referred to outpatients.ConclusionsPrimary headache disorders have a large impact on hospital services. Diagnostic uncertainty is common; neuroimaging is relied upon. Appropriate care pathways, education, and resource allocation should be prioritized.

1206-P: Benefits of Virtual Shared Medical Appointments for Gestational Diabetes

Background: The rate of gestational diabetes (GDM) has increased over the past decade, now effecting up to 14% of pregnancies worldwide. Studies show that these woman benefit from diabetes education, nutrition education and a maternal-fetal medicine (MFM) consultation. However, accommodating this increasing number of women, especially in the middle of a global pandemic, can be challenging. Purpose: First, to develop a curriculum for women with GDM to empower them to optimally manage their diabetes in pregnancy. Second, to evaluate whether this curriculum could be used in a virtual shared medical appointment (SMA) to accommodate more patients while protecting their health during the COVID-19 pandemic. Results: A virtual SMA was created in the electronic medical record using a zoom platform. Up to ten women are seen during this 2-2.5 hour visit. From 1/1/2022 through 12/31/22, 159 women participated in the program. On average, women attended the SMA within 12.9 days of the consult request. All women received a copy of the curriculum via email prior to the visit. During the visit, patients received their MFM consult, diabetes education, and nutrition counseling in a group format. The visit included a one-on-one breakout room with a MFM provider to discuss personal history, glucose levels and use of medication if necessary. Women were billed through insurance for the MFM consultation as well as group nutrition counseling. Of the 159 participants, 139 have delivered. Eighty-nine (64%) women had a vaginal delivery and 50 (36%) had a cesarean delivery. Conclusion: A virtual SMA is an efficient and effective format for educating women with GDM during the COVID-19 pandemic and beyond. Access to these resources was faster for women in the SMA versus those who received individual MFM consultations, nutrition counseling and diabetes education. The rate of cesarean delivery was lower than the rate reported in the literature for women with GDM. Patient reported outcomes regarding this format have also been favorable. Disclosure S.Ehrenberg buchner: Advisory Panel; Dexcom, Inc. H.Hart: None. K.M.Bede: None. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk.

Pediatric private practice in the Nord-Pas-de-Calais region: Demographics, organization, and challenges

While the needs for pediatric care are increasing and becoming more diverse, pediatric private practice in France is encountering difficulties linked to a growing medical demographic deficit. The objective of this study was to give an overview of pediatric private practice in the Nord-Pas-de-Calais region and to describe the main challenges encountered. MethodsFor this descriptive observational survey, private practice pediatricians in the Nord-Pas-de-Calais region filled out an online questionnaire between April 2019 and October 2020. ResultsThe response rate was 64%. Most respondents practiced in an urban area (87%) and shared the practice with other physicians (59%). A majority (85%) had previously worked in hospital; 65% reported training in a subspecialty. Overall, 48% had other professional activities; 28% worked night shifts and 96% accepted urgent requests for consultations. A total of 33% reported having difficulties contacting specialists for consults, and 46% had difficulties in obtaining written reports of their patients’ hospitalizations. All respondents participated in a form of ongoing medical education. The main difficulties were: lack of information about how to found a private practice (68%), lack of personal time (61%), balance between medical and administrative work (59%), and an excess of patients to care for (57%). The main satisfactions were: trusting relationships with patients (98%), freedom in their choice of practice (85%), and the diversity of problems and situations encountered (68%). ConclusionOur study underlines that private practice pediatricians are involved in healthcare provision, in particular regarding ongoing medical training, subspecialties, and continuity of care. It also highlights the problems encountered and the possible improvements: developing better communication between private practice and hospitals, reinforcing training during residency, and highlighting the importance and complementarity of private practice in children's healthcare.

The impact of 4R Care Delivery Model on timing and sequence of bone density screening among breast cancer patients.

e24061 Background: Bone loss is common in patients with breast cancer and can impact treatment decisions related to endocrine therapy. Hence, bone density assessment prior to start of endocrine therapy is highly important, especially because endocrine therapy is recommended as the first line of adjuvant treatment in patients with ER+ breast cancer. However, implementing bone density assessment in a timely manner is challenging, particularly early in the care trajectory, which involves many specialties and includes many other tests and procedures. We conducted a care delivery optimization in a large health system to implement bone density testing and referral for bone health consultation prior to endocrine therapy. The optimization was conducted as part of implementing the 4R Oncology model (Right Info, Right Care, Right, Right Patient, at the Right Time), a novel approach to optimizing patient-facing care planning, team-based delivery and patient self-management. Here we describe the impact of this optimization. Methods: A cohort of 278 women with breast cancer who were in the 4R intervention (the 4R cohort) was compared to a historical control cohort of 201 women who received care pre-4R. Demographic, bone health history, and oncologic care data were abstracted from chart review and clinical databases. The prevalence of bone loss and timing of bone density consultation request was compared between the 4R and historical control cohorts. Results: The age, race/ethnicity and rate of ER+ cancer were similar between the cohorts. Patients in the 4R cohort were significantly more likely than those in the control cohort to have received a consultation for bone density screening prior to the start of endocrine therapy. They were also more likely to receive a bone density test result during their care. These findings remained significant when data were restricted to those ≥ 50 years (as a proxy for postmenopausal status) and those with ER-positive breast cancer. The rates of osteopenia and osteoporosis were similar between the cohorts: control 47%, 24%; 4R cohort: 46%, 23% respectively (data not shown). Conclusions: Care optimization using the 4R Oncology Model was associated with a significant improvement in the timing of bone density test before initiation of endocrine therapy. The 4R Oncology Model can lead to more informed decision making in adjuvant endocrine therapy for patients with breast cancer. Additional optimizations to improve the rates of bone density tests and referrals will be beneficial. [Table: see text]

Overview of dermatologic tele-expertise in areas of low physician density: A retrospective study at Le Mans general hospital

BackgroundIn areas of low physician density, especially as regards dermatologists in France, there is an increasing interest in tele-expertise. This is particularly the case in the Sarthe department, where the number of physicians continues to decline and access to care was further limited by the COVID 19 epidemic. Study designWe retrospectively collected data from tele-expertise requests submitted to Le Mans General Hospital by general practitioners via a dedicated platform between May 6, 2019, and April 9, 2021. ResultsSix hundred and forty three requests relating to 90 different diagnoses were recorded during this period. One hundred and thirty four patients (20% of requests) were invited to attend a face-to-face consultation within an average of 29 days. DiscussionThrough the use of tele-expertise at Le Mans Genreal Hospital it was possible to introduce a means of tackling the problem of the lack of dermatologists in the Sarthe department. Rapid responses enabled the number of consultation requests to be reduced, leading to fewer population displacements in the context of the present pandemic. ConclusionThese initial results are encouraging and confirm that tele-expertise seems a satisfactory option to optimize access to care for populations in areas of low physician density.

Sports cardiology centre - experience to date, data from the 2020-2022 registry and challenges of the third year of operation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): grant IGA_LF_2022_027. Introduction Sports cardiology is a dynamically developing subspecialty of cardiology. There are four Sports Cardiology Centres in the Czech Republic, which were established under the leadership of the Sports Cardiology Working Group thanks to the Czech Society of Cardiology (CSC) and the Czech Society of Sports Medicine. Objective To describe the experience, data from the registry of the Sports Cardiology Centre of our hospital for the period 1.1.2020-15.8.2022. Functioning and file: A) The patient logs into our way by way of the web interface, where the basic information and previous examinations are given. B) These input data will be incorporated by the center coordinator , ensure communication with the client, other necessary information or examination and after consultation with sports cardiologists, determine a plan of care. C) The organisational aspects of the established procedure are ensured by the nurses. D) After the follow-up examination, the client has a final consultation at the centre, where sport recommendations are always given. Between 1/2020 and 8/15/2022, 133 athletes were consulted at our Sports Cardiology Centre. Of these, 18 athletes are not completed and 115 clients with completed examinations were included in the next cohort, where 100 were male(87%) and 25 were female(13%). All were Caucasian, with a mean age of 26 ± 11 years. The youngest athlete was 15 years old and the oldest was 71 years old. The sports the clients participated in were 66.1% mixed, 27.8% endurance, 4.3% strength and 1.7% skill sports according to the European Society of Cardiology(ESC)2020 sport distribution. The average training load was 10 h/week. The minimum training load was 3h/week and the maximum 25h/week. The average duration of sport activity was 12 years per individual. The most frequent request for consultation was without a medical referral and this was in 41.7%, a physical therapist indicated an examination in 36.5%, a cardiologist in 14.8% and a PL in 6.1%. Reasons for referral were most commonly abnormalities in preparticipation screening /PPS/ 40.9%, symptoms 22.6% and Covid infection 13.9%. A final diagnosis was completed in 89 athletes(77.4%), a suspected diagnosis was made in 8 clients(7%). Eligibility for sport and eligibility with condition was received in 90 individuals(78.3%). Ineligibility was issued in 4 athletes(3.5%). The number of athletes who did not complete the investigation/ did not come in for a result was 21(18.3%). Conclusion The established organisational procedure of consultations allows for the least possible staff load on the hospital and speeds up the process of athlete follow-up. In the pursuit of the development of the field and the achievement of a stable quality of care, our centre is potentially able to meet the requirements of the ESC/ European Association of Preventive Cardiology for a sports cardiology unit in terms of methodological/procedural and personnel parameters.

The Significant Burden of Iatrogenic Vascular Injury on the Vascular Surgery Workforce at an Academic Medical Center

The treatment of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other inpatient services. Vascular surgeons are called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and at the bedside. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to January 8, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, were retrospectively collected from February 1 to October 13 and prospectively collected for the remainder of the study period. Analyses were performed with R version 2022.02.03. There were 63 patients with consultations related to iatrogenic vascular injury. Of these, 29 (46%) were female and the mean age was 59 ± 18 years. The most common consulting services were cardiology (32%), cardiothoracic surgery (27%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (38%), limb ischemia (32%), and treatment for pseudoaneurysm (27%). Of the consults, 25% were intraoperative, 19% related to ECMO cannulation, and 19% related to ventricular assist devices including left ventricular assist devices and intra-aortic balloon pumps. The majority of consult requests occurred during evening and night hours (5 pm to 7 am) (60%) (Figure). Emergent intervention was required in 75% of cases and consisted of: primary open surgical repair of arterial injury (50%), endovascular intervention (15%), and open thromboembolectomy (13%). Overall, in-hospital mortality for the patient cohort was 18% and the reintervention rate was 21%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgery plays an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. These consults and complications require immediate bedside or intraoperative consultation and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to vascular surgeons.

The Pathologic Diagnosis of Pediatric Soft Tissue Tumors in the Era of Molecular Medicine: The Sarcoma Pediatric Pathology Research Interest Group Perspective.

Pediatric soft tissue tumors are one of the areas of pediatric pathology that frequently generate consult requests. Evolving classification systems, ancillary testing methods, new treatment options, research enrollment opportunities, and tissue archival processes create additional complexity in handling these unique specimens. Pathologists are at the heart of this critical decision-making, balancing responsibilities to consider expediency, accessibility, and cost-effectiveness of ancillary testing during pathologic examination and reporting. To provide a practical approach to handling pediatric soft tissue tumor specimens, including volume considerations, immunohistochemical staining panel recommendations, genetic and molecular testing approaches, and other processes that impact the quality and efficiency of tumor tissue triage. The World Health Organization Classification of Soft Tissue and Bone Tumors, 5th edition, other recent literature investigating tissue handling, and the collective clinical experience of the group are used in this manuscript. Pediatric soft tissue tumors can be difficult to diagnose, and evaluation can be improved by adopting a thoughtful, algorithmic approach to maximize available tissue and minimize time to diagnosis.

Effectiveness of a Self-Administered Computerized Mental Health Screening Tool in the Emergency Department.

The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED). Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to psychiatric facility) and patient ED return visits (3 months after discharge vs. 3 months before) were assessed among ED physicians (N=451) who received patients' computerized screening reports (N=207) and those who did not (N=244). All patients received copies of screening results. The computerized mental health screening tool identified previously undiagnosed psychiatric problems. However, no statistically significant differences were found in physician care or patient ED return visits. Computerized mental health screening did not result in further psychiatric diagnoses or treatment; it also did not significantly reduce patient ED return visits. Collaboration among EDs and mental health treatment agencies, organizations, and researchers is needed to facilitate appropriate treatment referrals and linkage.

The Color of Autonomy: Examining Racial Inequity in Coercive Institutional Practices.

Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.