Consultation Requests Research Articles

Телемедицина как инструмент межрегионального дистанционного взаимодействия с профильными медицинскими организациями субъектов Российской Федерации: опыт Чебок- сарского филиала ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С. Н. Федорова» Минздрава России

At present, the possibility of providing qualified medical care anywhere in the world has become a reality thanks to the development of telemedicine technologies. The development and improvement of telemedicine technologies is due to the regulatory and legal regulation and implementation of the national project «Health Care», which was developed on the basis of the Presidential Decree № 204 of 07.05.2018 «On the national goals and strategic objectives of the Russian Federation for the period until 2024». (hereinafter – the Decree of the President of the Russian Federation of 07.05.2018 № 204) [9]. The National Medical Research Centers (NMRCs) were tasked with organizing advisory and methodological expert support for specialized regional medical organizations of the 3rd level of RF subjects. Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» supervises ophthalmological service of 8 subjects of the Russian Federation: Nizhny Novgorod, Kirov, Ulyanovsk regions, Republics of Mordovia, Udmurtia, Mari-El, Tatarstan and Chuvashia. The article presents the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine technologies to improve the provision of specialized, including high-tech medical care in the profile «Ophthalmology». Over the 3-year period of operation, the number of requests for telemedicine consultations at the «doctor-physician» level has increased significantly. In addition, from January 2021, Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» provides consultative care at the «doctor-patient» level. Purpose of the study is to present the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine consultations (TMC) performed using the «Telemedicine consultations» component of the federal electronic registry subsystem of the unified state information system in healthcare (USGISZ FER TMC component) from 2019 to 2021 and the «MEDTERA Telemedicine» unified secure technological platform from 2021. Material and Methods. Telemedical consultations on the basis of the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» are performed by highly qualified specialists – heads of the departments, research workers, leading specialists in different fields of ophthalmology. Telemedical consultations at the «doctor-physician» level are performed as follows: at the initial stage, a request for a consultation is received from specialized medical organizations of the subjects of the Russian Federation, which is processed by the employees of the Department of Telemedical Consultations. Information about the request is registered in the database, its profile is evaluated, as well as the quality, completeness and relevance of the data of the attached medical documentation. For real-time consultation «doctor-patient» through video or audio conferencing, the patient makes an independent appointment for a convenient date and time with a particular specialist. Results. During 3 years of the TMC functioning at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» the number of requests for telemedicine consultations at the “doctor-physician” level in the field of ophthalmology from 8 subjects of the Russian Federation of the Volga Federal District is progressively increasing. The bulk of telemedicine consultations are scheduled requests. During the 3-year period of telemedicine consultations at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» there were 94 TMK from the Republic of Tatarstan, 79 TMK from the Chuvash Republic, 61 TMK from the Republic of Mariy-El, 53 TMK from the Republic of Udmurtia, 46 TMK from the Kirov region, 37 TMK from the Nizhny Novgorod region, 36 TMK from the Ulyanovsk region, 23 TMK from the Republic of Mordovia. Findings. Summarizing the results of the analysis of the structure of telemedicine consultations performed using the IGISZ FER TMC component, it can be summarized that the IGISZ FER TMC component is a convenient, effective tool, which allows to comply with the Russian legislation in conducting telemedicine consultations, as well as to analyze the structure of telemedicine consultations conducted with its use.

Call the Psychiatrist! - Study about Delirium in the context of liaison psychiatry

IntroductionDelirium is characterized as a short-term consciousness and cognition disturbance which tends to fluctuate during the course of the day. It is a common and serious problem, mainly in hospitalized older adults, potentially avoidable and often poorly recognized.ObjectivesWe propose an analysis on the theme through a work that evaluates the requests for psychiatric consultation made in a district hospital in Portugal during the course of 12 months.MethodsWe identified all patients on the requests for psychiatric consultation and obtained a demographic, clinical and consultation requests by medical specialties data and conducted statistical analysis using Excel.ResultsWe identified 106 consultation requests, in which 41 cases were eventually diagnosed as delirium. Most (83%) were hyperactive delirium, 12% were hypoactive delirium and 5% were mixed delirium. Incidence was higher in males (59%) and in those aged between 66 and 80 years old (56.1%). Most consultation requests were made by Internal Medicine (46.3%), followed by General Surgery (26.8%), Pulmonology (14.6%), Orthopedics (9.8%) and Neurology (2.5%). Finally, we analyzed which symptoms mentioned in the request made physicians consider requesting a psychiatric evaluation. Approximately half of the cases (48.8%) reported psychomotor agitation, followed by temporal/spatial disorientation (41.5%) and aggressive behaviour (17.1%).ConclusionsWe highlight a still notorious lack of proper identification of delirium, resulting in symptoms being incorrectly interpreted as a psychiatric disorder. This may cause a delay in the adequate diagnosis and management of the condition, increasing the morbidity and mortality of patients.DisclosureNo significant relationships.

The Impact of the COVID-19 Pandemic on the Unmet Healthcare Needs in People Aged Over 50 in Portugal

The COVID-19 pandemic led to the cancellation of healthcare appointments and to lower demand, which generated unmet healthcare needs. The aim of this study was to evaluate their prevalence and distribution in Portugal. Data came from the "Survey of Health, Ageing and Retirement in Europe". Between June and August 2020, 1118 Portuguese individuals aged 50 or over were inquired about unmet healthcare needs due to: i) fear of getting infected; ii) cancellation by the doctor/healthcare services; iii) unsuccessful consultation request. The analysis of the prevalence of unmet needs was complemented by the calculation of the concentration indices as a function of the variables: income, education and health status. About 60% of respondents reported at least one unmet need, which was almost twice the European average. Motive ii) cancellation by the doctor/healthcare services was the most frequent. The prevalence of unmet needs differed depending on income level and health status. The indices evidence the concentration of unmet needs in individuals with the worst health status, although for the reason fear of infection the concentration occurred in those with higher levels of income and education. Our study showed a high prevalence of unmet needs and their concentration in individuals with worse health status. Given the association between unmet needs and the subsequent deterioration of health, these results should raise concerns about the near future.

Being a psychiatric resident during COVID times – personal experiences of Hungarian trainees

IntroductionDuring the COVID-19 pandemic residents of the central region of Hungary also had to adapt to several challenges such as changes of hospitals’ specialty profiles and delegation of health care workers to COVID wards.Hungarian residents have their practical training in various hospitals, while their psychiatric academic training is organised in groups.ObjectivesOur aim is to share our personal experiences about how our work and training have changed during the pandemic and it’s effect on our patients.MethodsParticipants of the study were the authors of the poster. Responses to open questions were structured based on the following topics: competencies in internal medicine, infectious diseases and psychiatry, our collaboration with other medical disciplines, psychiatric training and attitudes towards mental health patients.ResultsWe worked min 2 weeks max 8 months at COVID wards and also treated COVID-19 infected psychiatric patients, thus gaining a greater experience in general medicine. In psychiatric work, acute care became prominent, communication in PPE and restricted contact with patients’ relatives were particularly difficult. Our relationship with other specialists has improved, consultation became easier. Increased use and misuse of psychiatric consultation requests led to further pressure. Restrictions, stigmatisation and discrimination increased against psychiatric patients, including difficult access to care. Psychiatric training in the hospitals became limited, however seminars organized by the university continued online with our active participation.ConclusionsDuring the pandemic we gained greater experience in general medicine. Psychiatric care and our training was negatively affected, however the latter was mitigated by online seminars.DisclosureNo significant relationships.

Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network

ContextPalliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU. ObjectivesCompare characteristics of specialty PC consultations in the ICU to those on medical-surgical wards. MethodsRetrospective analysis of national Palliative Care Quality Network data for hospitalized patients receiving specialty PC consultation January 1, 2013 to December 31, 2019 in ICU or medical-surgical setting. 98 inpatient PC teams in 16 states contributed data. Measures and outcomes included patient characteristics, consultation features, process metrics and patient outcomes. Mixed effects multivariable logistic regression was used to compare ICU and medical-surgical units. ResultsOf 102,597 patients 63,082 were in medical-surgical units and 39,515 ICU. ICU patients were younger and more likely to have non-cancer diagnoses (all P < 0.001). While fewer ICU patients were able to report symptoms, most patients in both groups reported improved symptoms. ICU patients were more likely to have consultation requests for GOC, comfort care, and withdrawal of interventions and less likely for pain and/or symptoms (OR-all P < 0.001). ICU patients were less often discharged alive. ConclusionICU patients receiving PC consultation are more likely to have non-cancer diagnoses and less likely able to communicate. Although symptom management and GOC are standard parts of ICU care, specialty PC in the ICU is often engaged for these issues and results in improved symptoms, suggesting routine interventions and consultation targeting these needs could improve care.

Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults.

BackgroundPatient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests.MethodsA random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult.ResultsThe top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days.ConclusionsThe primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults.Practical ImplicationsThe study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

The problems related to internal medicine consultations in the emergency department

Objectives: Overcrowding in the Emergency Department (ED) is a serious and growing problem during recent years and one of the main causes of it is dysfunctional consultation system. We aimed to determine the problems related to patients who were admitted to the ED and requested consultations from internal medicine (IM) physicians and to contribute to the gap in the literature regarding this isssue. Methods: In a period of one year, 3601 patients, who were admitted to the ED of a university hospital and were consulted by IM physicians were included in this prospective cross-sectional study. The epidemiological characteristics of patients, length of ED stay and consultation-related problems were investigated. Results: The most common problems related to consultations were delayed completion of the consultation procedures for 88 (2.4%) patients, and unnecessary consultation requests for 66 (1.8%) patients, and patient referrals with inappropriate indications from IM outpatient clinics to the ED for 53 (1.5%) patients. There were differences of opinion among IM physicians and emergency medicine specialists regarding the need for consultation for 36 (1%) patients. The most important difference was in the various infections seen in patients with histories of hematologic or solid organ malignancies (n = 9). Conclusions: According to these findings, good collaboration must be established among ED physicians and consultant physicians. Furthermore, physicians must avoid inappropriate referral patients from outpatient clinics to the ED. Additionally, unnecessary consultation requests from the ED must be avoided, and consultation requests must be addressed quickly.

Inpatient Pediatric Palliative Care Consult Requests and Recommendations.

Little is known about the requests for and recommendations from inpatient pediatric palliative care (PPC) consults and whether they differ by patient location (ward vs. intensive care unit) or patient type (new vs. established with PPC). Single-center, retrospective cohort study comparing PPC consult requests and recommendations for children who received a PPC consult between January 1, 2018 and June 30, 2019. Comparisons were made by patient location and patient type using bivariate statistics. Three hundred twenty-seven PPC encounters were evaluated. Symptoms were more likely to be addressed in consults for ward patients than for intensive care unit patients. Compared with established patients, consults for new patients occurred significantly later in the hospital course and were more likely to be for psychosocial support or goals of care. We found variability in PPC consult requests and recommendations that may inform future work and targeted education for primary providers.

Implementation of a Case Presentation Program for Clinical Nutrition Students.

Background and AimsTo implement a training method increase clinical nutritionists' knowledge and make doctors more familiar with this specialty.MethodsThe study was conducted in an internship course of all third semester clinical nutrition students. At first, conventional training was presented for students, and then, in the same duration, case presentation training program was implemented. The presentations were filmed and uploaded to the Internet, and the link was placed on the hospital's website. At the end of the 2 phases, the students were asked to answer the survey questionnaire. Additionally, consultation report sheets were evaluated and scored by 2 physicians. Number of consultation requests was also recorded in 2 study phases.ResultsThe mean satisfaction score was statistically higher in the case presentation training program than in the conventional program. All the students recommended similar case report program courses for the students in the future. Although the mean consultation report score was not statistically different between the two training programs, case presentation program resulted in significantly better scores in 4 items of nutrition focused physical examinations, assessment of malnutrition, assessment of related laboratory tests, and food-drug interactions. Number of consultation requests was significantly increased during the case presentation program training compared to the conventional training from 194 to 272 (P < 0.001).ConclusionFrom the students' perspective, the case-based learning report was preferred to the conventional method. From the physicians' viewpoint, the answer to the counseling sheets was more complete and helpful.

Utilization of a neurology specialty service by primary care providers for headache management at a tertiary care hospital.

BackgroundRecent data indicate that the three-month prevalence of severe headaches or migraines in the US general population is close to 25%. Participation of primary care providers will therefore be critical in providing care to affected individuals.ObjectiveTo determine the number of headache disorder consult requests to a neurology outpatient service in a tertiary medical center, the appropriateness of the consult requests, and the effectiveness of a lecture series on headache diagnosis and management in preventing inappropriate consult requests from non-neurology providers.MethodsClinical data on US Veterans is captured and documented in the Veterans Health Information Systems and Technology Architecture (VISTA). The Computerized Patient Record System (CPRS) electronic medical record (EMR) was used for data entry and retrieval. All consult requests for the study period within the VA North Texas Health Care System were identified in VISTA, and the clinical information reviewed in CPRS. Based on a defined algorithm, headache consult request were categorized as appropriate or inappropriate. A board-certified neurologist provided four in-person/virtual lectures to ambulatory care providers, primary care providers, internal medicine residents, and emergency room providers within the VA North Texas Health Care System on the diagnosis and management of headaches. Prior and post the lecture series, the total number of headache consults per day was assessed over 45-day periods.ResultsThe number of daily headache consult requests in the 45-day period prior to the lecture series was 3.6 per day (standard deviation 2.7), and 6.0 per day after the lecture series (standard deviation 2.1). The difference was not statistically significant. There were as many inappropriate headache consult requests after the lecture series as appropriate ones (50% each).ConclusionWe found that a short-term educational initiative that instructed primary care providers on the diagnosis and management of common headache disorders did not reduce the number of consultation requests and, surprisingly, it did not improve the appropriateness of the consults. Given the prevalence of headaches in the general population, better training of all primary care providers in headache management should be pursued.

7. ‘INAPPROPRIATE’ EMERGENCY TRANSFERS FOR EVALUATION BY PLASTIC SURGERY

PURPOSE: So-called ‘inappropriate’ patient transfers in plastic surgery (PRS) are common and costly, yet lacking in any operational definitions. To address this, we investigated emergent, interfacility transfer requests for plastic surgery consultation at our institution in order to identify potential barriers and solutions for reducing rates of ‘inappropriate’ transfers. METHODS: We identified all transfer requests for PRS consultation at our institution over a one-year period and collected and analyzed relevant data. RESULTS: We identified 287 transfer requests, of which 239 (83.3%) were accepted by PRS. Transfer acceptance was significantly associated with the time of day (p=0.034), but not patient age, sex, insurance status, distance, injury mechanism, or region. Nearly 90% of transfers arrived via ambulance despite a median distance of 30.4 miles (range 1-293). 10.0% of transfers were taken for emergent operative intervention, whereas 68.1% underwent ED procedure only. This constituted definitive treatment (i.e. no subsequent outpatient or inpatient interventions) in 60.8% of cases, with low rates of return to the ED (6.3%) or complications (4.2%). 19.2% of transfers were discharged without a hospital admission or any interventions. Patients not accepted by PRS for transfer did not experience delays in-clinic follow-up (1.85 vs 4.7 days, p=0.680) or scheduling outpatient procedures (0.7 vs. 3.95 days, p=0.698). CONCLUSION: In this study, we utilize reproducible, objective, and evidence-based criteria to better characterize so-called ‘inappropriate’ patient transfer in PRS. Our findings represent a blueprint for identifying patients for whom emergent transfer for evaluation by a plastic surgeon may not increase the value of care.

Hikikomori du jeune : accueillir et prendre en charge le fardeau de la famille

Home confinement of a young person is a global problem whether or not it is associated with a psychiatric disorder. It is a maladaptive behavior that tends to repeat itself and finally involves the whole family in a shared difficulty of attachment/separation. Relieving the family burden using parental guidance could help to break the cercle vicious of guilt and shame among family members.Many studies on the features of families in hikikomori situations are cited in the article, mostly from Japanese authors. Constrained family culture, misunderstanding between the young person and his family, and dependency to parental figures are far more important today than in previous works where the poor quality of family relations were stressed. Studies about families in hikikomori situations are now beginning to emerge in non-Japanese countries, notably in Spain and Italy. It would be interesting to develop such research stream in France. This article also presents our clinical experience in responding to requests for consultations from families with a hikikomori situation, in developing a professional network via the AFHIKI association, and in animating a family exchange group about hikikomori.

Multidisciplinary support for ethics deliberations during the first COVID wave.

The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics-Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was to describe the Cell's functions during that period. This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient's/designated representative's preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Only our university hospital's clinicians could request EST intervention. The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. 33 requests (patients' mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions.

Dermatology consultation requests from a university hospital's pediatric and adult emergency departments: A 5-year retrospective analysis.

Unnecessary dermatology consultation requests from emergency departments (EDs) are a common occurrence worldwide. This study aimed to analyze the demographic and clinical characteristics of patients consulted to the dermatology department for dermatologic disorders by a university hospital's pediatric ED (PED) and adult ED (AED). The electronic medical records of 2316 dermatology consultation requests from the PED and AED during a 5-year period were retrospectively reviewed. Patient demographic and clinical characteristics, dermatological diagnoses, and time of day of dermatology consultation requests from the PED and AED were retrospectively analyzed. The electronic medical records of 1845 consultation requests with complete data were included in the study. There were 969 (52.5%) consultation requests from the PED and 876 (47.5%) from the AED. Mean time from onset of dermatological symptoms to ED presentation was 31.6 d. Herpes zoster infections (18.5%), adverse cutaneous drug reactions (8.1%), and urticaria with angioedema (7.9%) were the most common skin disorders resulting in consultation requests from the AED, versus non-specific viral infections (9.2%), insect bites (8.3%), and atopic dermatitis (8.2%) from the PED. In all, 11.5% of ED patients that received dermatology department consultation required hospitalization due to dermatologic disorders. As patients commonly present to EDs with non-urgent dermatological diseases, ED physicians should receive training on common dermatological diseases so as to decrease the number of unnecessary dermatology consultation requests.

Clinical Ethics Consultation and the Reframing of Risk.

As a clinical ethics consultant, I've received numerous consultation requests from health-care providers that reflect the tension at the heart of the concept of dignity of risk, often presented in this form: "The patient wants to [do something that we think is unsafe]. How can we change their mind or stop them?" These consultation requests are almost always framed within a medicalized conception of risk: each is presented as a medical provider's concern that a patient's behavior or choice will lead to a specific physiological harm that the medical team wishes to avoid. However, this medicalized perspective neglects the subjective nature of self-determined choices and ignores important aspects of how patients integrate their disability or illness into a broader narrative of how their preferences and actions fit within their self-understanding. In this article, I offer ways to reframe provider perspectives as an attempt to foster an empathetic understanding of "risky" patient preferences at the physiological, environmental, and psychosocial levels.

Evaluation of Dermatology Consultations Requested from the Pediatric Clinic

Objective: The aim of this study is to evaluate the clinical, demographic, and diagnostic characteristics of pediatric patients consulting the dermatology department.&#x0D; Methods: Patients who were consulted to the dermatology department from pediatric clinic of XX Hospital between January 2021 and August 2021 were scanned retrospectively. The demographic data of the patients, the pediatric department requesting consultation, their complaints at admission, the reasons for asking for consultation, and the diagnoses they received as a result of the consultation were recorded.&#x0D; Results: A total of 296 patients, 150 (50.7%) females and 146 (49.3%) males, with a median age of 5.5 years (1.5-10.5 ) were evaluated. The outpatient clinic were seen to have made the most requests for consultation. The most frequent complaints on presentation were seen to be redness of the skin in 168 (56.8%) cases and itching in 36 (12.2%). The five most common diagnoses made as a result of the consultation were unspecified dermatitis in 47 (15.9%) cases, scabies in 34 (11.5%), insect bite in 17 (5.7%), atopic dermatitis in 13 (4.4%), and seborrheic dermatitis in 13 (4.4%). When the diagnoses were examined according to the age groups, unspecified dermatitis was usually seen in the 0-2, 6-11, and 12-18 years age groups and insect bite was more common in the 3-5 years age group.&#x0D; Conclusion: The establishment of effectively functioning consultation mechanisms not only facilitates a correct diagnosis for the patient and appropriate treatment, but also can shorten the length of hospital stay for pediatric patients and can reduce economic costs.

Couple Connectedness in the Time of COVID-19

The COVID-19 pandemic has resulted in unprecedented global morbidity and mortality which altered people's daily lives, as well as created multiple societal challenges. One significant problem posed by this unique stressor is maintaining healthy intimate relationships, which are linked to mental and physical health. The literature has shown that the pandemic has exacerbated issues for couples such as financial difficulties, a lack of privacy, medical issues, and family and professional concerns. The pandemic has also forced all healthcare systems, hospitals, and clinics to quickly incorporate telehealth services. The number of requests for mental health consultations has risen to the point where demand exceeds supply. This paper provides an overview of ways couples can stay emotionally connected during this time as well as provide future directions for therapists to help couples develop or improve adaptive relationship mechanisms.

Otorhinolaryngology consultations in a multidisciplinary hospital - their effects on residents training on floor.

To determine all types and severity of Otolaryngology consultation requests at our tertiary care center and spectral records of problems related to otorhinolaryngology come across initially by residents which will help in re-shaping residency programmes and enhance patient related care. All otorhinolaryngology consultation received over a three-month period were recorded prospectively. Information collected for each encounter included the time, date, reason for consult at primary service and admission with final ENT diagnosis, any surgical or non-surgical intervention, and basic patient demographics. A total of 127 consults for inpatients were reviewed from April 2020 to June 2020. Out of total, 84 (66.1%) patients were male and 43 (33.8%) were females. Adult patient consultations amounted to 87(68.5%) while 18(14.1%) were in the age range of 6-18 years. Only 4(3.1%) consultations were raised for neonatal patients. Routine consultation were had for 64(50.3%) while 45(35.4%) patients were reviewed as an emergency. Operative interventions were required by 43(33.8%) among which tracheostomy was the most common operative procedure performed in 26(20.7%) patients. If we broadly classified ENT consultations, 40 (31.4%) were of problems related to head and neck region while 38 (29.9%) were related to the laryngology sub-specialty. Most common consultation was for airway assessment in 26(20.7%) patients followed by otorrhoea, in 15 (11.8%) patients. In inpatients, upper airway assessment, aural discharge and epistaxis were the most frequent complaints for seeking ENT review. This study should prove to be beneficial in forming a curriculum of educational programme for junior residents.

Telehealth consultations in cardio-oncology

Aim. To evaluate the role of a cardiologist in telehealth counseling of cancer patients at the federal oncology center.Material and methods. This retrospective study was conducted based on the materials of 215 telehealth consultations on cardiooncology, performed in the period from January 2019 to September 2021. Data on referrals to a cardiologist (cardio-oncologist) from various Russian regions and consultants’ answers were analyzed, taking into account the following data: region, sex, age of a patient, cancer type, stage, participation of other consultants, type of cardiovascular disease, the need for additional information and features of treatment — surgery, chemotherapy, radiation therapy. Risk was stratified based on a checklist including the main risk factors for cardiotoxicity. The recommendations of consultants for monitoring patients, as well as drug therapy prescriptions, were analyzed.Results. The most common cancer sites in patients referred for telehealth consultations on cardio-oncology were lungs, larynx and trachea, colon and rectum, kidneys and bladder, ovaries and uterus, and stomach. Cardiologists consulted together with oncologists — surgeons, medical oncologists, as well as anesthesiologists and radiation oncologists. The most common cardiovascular diseases were hypertension — 80,9% of patients, heart failure — 60%, arrhythmias — 41,6% and coronary heart disease — 37,7%. From 71 to 80,3%, 15,6-21% and 3,9-7,8% of patients had preserved, mid-range and reduced left ventricular ejection fraction. In 47,6-66,7% of cases, consultants required additional information. Based on risk stratification of cardiotoxicity of anticancer treatment, 118 (81,9%) patients out of 144 were classified as high and very high risk. Most patients were recommended cardioprotective therapy, which most often included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers — 43,1-53,1%, beta-blockers — 44,8-58,6%, and statins — 22,4-38,3%. An algorithm for creating a request for a cardio-oncology telehealth consultation has been developed.Conclusion. The important role of cardio-oncology telehealth consultations in the work of the federal oncology center is demonstrated. Consulting cardiologists are part of a single multidisciplinary team of specialists and must act taking into account the characteristics of cancer and antitumor therapy prescribed by oncologists.

Standardizing genetic and metabolic consults for non-accidental trauma at a large pediatric academic center

BackgroundEvaluations of suspected non-accidental trauma (NAT) often include consultation with genetic and metabolic teams to assess patients for rare genetic conditions that can mimic or exacerbate child abuse. Diagnoses that may be questioned during court proceedings include osteogenesis imperfecta (OI) and glutaric aciduria type 1 (GA1). Currently there are no official society guidelines for the genetic or metabolic workup of suspected NAT. ObjectiveTo standardize consult recommendations for suspected NAT through collaboration between the Genetics and Genomics Division and the Child Protection Team (CPT). Participants and settingsChildren evaluated for suspected NAT at a single pediatric referral center. MethodsA year of inpatient consult requests for suspected NAT to the genetics division were reviewed. The most common indications for consult were fractures and subdural hematoma. Consult recommendations for similar indications varied between providers. A standard operating procedure (SOP) with specific recommendations for suspected NAT consults for fractures, intracranial hemorrhage, and other indications was created based on expert reviews and other relevant literature. A questionnaire assessing division practice patterns for these consults was distributed both pre (n = 17) and post-introduction of the SOP (n = 11). ResultsAdherence to the SOP and impact on suspected NAT consult recommendations were assessed at 18 months after SOP introduction. Consult recommendations were in line with the SOP for 7/11 consults pre-intervention and 6/7 consults post-intervention. Providers were more likely to report feeling extremely or very confident they were using evidence-based medicine for NAT consults post-intervention.