Hospital Consultants Research Articles

Abstract P700: Stroke in Lupus Spectrum Disorder: A Single-Center Case Series in the Kentucky Appalachian Region

Background: Lupus spectrum disorders (LSDs) encompass systemic lupus erythematosus (SLE), lupus nephritis, antiphospholipid syndrome (APS), and mixed connective tissue disease. Neuro-vascular disorders associated with LSDs include headache, transient ischemic attack, vascular cognitive impairment, immune-mediated cerebral vasculitis, thrombo-embolic stroke, cortical venous sinus thrombosis (CVST), and intracranial hemorrhage. We conducted a retrospective survey of neuro-vascular complications of LSDs in a university hospital-based stroke service within Kentucky Appalachia. Methods: Consecutive hospital admissions and consultations were retrospectively surveyed from January 2012 to January 2017. Inpatient medical records were reviewed to accumulate laboratory data and neuro-imaging studies. Diagnoses of SLE and other LSDs conformed to Systemic Lupus International Collaborating Clinics criteria. Results: During this 5-year survey, 10,953 cases of ischemic or hemorrhagic stroke were admitted or consulted and 75 patients (0.7%) met criteria for LSD. Female:male ratio favored women over men (4:1) and the median age was 48 years (range 22 - 87). The most common LSD was SLE and/or APS (n = 61; 81.3% total). The most frequent neuro-vascular complication was acute thrombo-embolic stroke (n = 30; 40%). Among 42 (56%) ischemic stroke patients, 17 had multifocal infarcts, 11 had isolated cortical strokes, and 7 had lacunes in the subcortical structures or brainstem. The majority of ischemic stroke patients (n = 48; 64%) did well and were ultimately discharged to home; 19 (25.3%) were re-admitted with recurrent stroke. Four patients had vasculitis (5.3%) and three had moyamoya syndrome (4%). Intracranial hemorrhage affected four patients (5.3%); hemorrhagic cerebral micro-angiopathy occurred in three (4%). Two patients had CVST (2.7%). Conclusion: Neuro-vascular complications of LSDs are heterogeneous and affect youthful patients with female preponderance. The large proportion of thrombo-embolic stroke in our population may be attributed to immune-mediated arterial coagulopathy or cardiac structural disease. Most patients with LSD complicated by ischemic stroke had good outcome, but there was high risk of readmission due to recurrence.

Mental Health Diagnoses and Seasonal Trends at a Pediatric Emergency Department and Hospital, 2015-2019.

Increasingly, youth with mental health disorders and suicidality are presenting to emergency departments (EDs) and requiring hospitalization. For youth with suicidality, studies reveal seasonal variations in frequency of presentations but do not identify associated diagnoses or whether other primary mental health complaints also reveal seasonal variations. Data were collected between January 2015 and December 2019 by a child and adolescent psychiatry consultation-liaison service in a pediatric ED and hospital. Descriptive analysis and multiple linear regression were performed to assess volume over time, seasonal trends, and associated diagnoses. A total of 2367 patients were included, with an average age of 13.9 years and female predominance (62.3%). During the study period, annual ED consultations increased 87.5% and hospital consultations increased 27.5%. Consultations revealed seasonal trends, with highest volumes during January, April, May, October, and November (P < .001; adjusted R 2 = 0.59). The most frequent diagnostic categories were depressive disorders and trauma- or stressor-related disorders. Thirty-six percent of patients presented after a suicide attempt, with the highest rates in spring (P = .03; adjusted R 2 = 0.19). Boarding rates revealed significant seasonality, with higher instances in February, March, April, May, and October (P = .009; adjusted R 2 = 0.32). Mental health presentations to a pediatric ED and hospital reveal seasonal trends, with the highest volumes in fall and spring and the most common diagnoses being depressive and trauma-related disorders. Suicide attempts are highest in late spring. Knowledge of these trends should inform hospitals, mental health services, and school systems regarding staffing, safety, surveillance, and prevention.

Abstract P275: Predicting Stroke Mimics in Telestroke Consultations

Background: Telestroke consultation is increasingly used to provide stroke care. Much like in-person stroke consults, stroke mimics are common. This study sought to identify patient and hospital characteristics more likely to be associated with a Telestroke diagnosis of stroke mimic. Methods: We analyzed 2 years of video consults by the VA National Telestroke Program (NTSP). Stroke mimic was defined as a Telestroke consult coded as a diagnosis of “other.” Text responses for “other” diagnoses were grouped into clinical categories. We used Chi-squared and t-tests analysis to compare characteristics of patients with a stroke mimic diagnosis and those without. Co-variates studied included age, gender, co-morbid conditions (history of dementia, cancer, or alcohol abuse), NIHSS, time of consult (night/weekend vs day), location of consult (emergency department vs inpatient), hospital rurality; hospital consult volume, and duration of institutional participation in NTSP at time of consult. Variables with a p-value &lt; 0.25 in the bivariate analysis were included in the multivariate model. Results: There were 561 stroke mimics. The most common mimics were toxic metabolic encephalopathy (19%) and seizure (12%). Variables significantly associated with stroke mimic in bivariate analyses were age, gender, history of alcohol abuse, history of atrial fibrillation, history of dementia, NIHSS, nights/weekend consults, and hospital rurality. In multivariate analyses, female sex [OR=1.63, p=0.001], inpatient consultations [OR=1.55, p= 0.019], history of dementia [OR=1.85, p=0.0002], and alcohol abuse [OR=1.42, p=0.002] were associated with a stroke mimic. Consults during nights/weekends [OR=0.76, p=0.001], and patients with atrial fibrillation [OR=0.81, p=0.031], increasing age [OR=0.90, p=0.019], and increasing NIHSS [OR=0.97, p=0.0042] were less likely to be a mimic. Conclusion: Patient and consult characteristics influenced the likelihood of a stroke mimic diagnosis. Medical history may reflect conditions likely to cause neurologic symptoms, and patients hospitalized who have new symptoms represent a challenging subset to accurately distinguish stroke from mimics. Awareness of these factors may alert providers to diagnoses other than stroke.

Parasitosen im Kindesalter

Parasitoses are a frequent occurrence in pediatric consultations in both hospitals and private practices. Responsible for this are parasites that permanently infest human skin, such as Sarcoptes scabiei hominis and Pediculus humanus capitis (persistent parasites) as well as those that only attack the skin for feeding, such as Pulex irritans, Cimex lectularius und Neotrombicula autumnalis (transient parasites). The main symptom of parasitoses is pruritus, which is caused by a delayed allergic reaction to proteins in the saliva of the parasites. In some parasitoses, such as scabies, the pruritus is typical, occurs particularly at night and is associated with a considerable impairment in the quality of life due to the resulting lack of sleep, whereas the pruritus is often absent in the case of pediculosis capitis. In this article persistent and transient parasitoses are characterized based on the patient history, morphology and symptoms.

Digitalisation provisions for controlling depression in developing countries: Short review.

Depression is a global health issue which is associated with disability, absenteeism, decreased productivity and high suicide rates. It is the fourth most common cause of disability globally and by the year 2020 it will be the second leading cause of disease burden. In Pakistan, the prevalence of depression is 45.9%. A unique and promising method for addressing the issue is mobile health (m-health). It refers to the utilisation of mobile technology to support various aspects of healthcare. Electronic record, SMS, internet, wearable devices and mobile applications are some of the digitalisation approaches used to bridge the treatment gap in depression through assuring privacy of patients, improving accessibility, reducing taboos related to depression, save cost for patients and reduce hospital burden and consultation time; these will be accessible in remote areas as well. Therefore, this short review is aimed to highlight the m-health forecasting for controlling depression and positional use in developing countries.

Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool

Background: The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. Aim: This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times. Design: An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency. Setting/Participants: Intake officers (n = 28) with a minimum of 2 years palliative care experience and expert clinicians (n = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia. Results: The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall’s Tau rank correlation coefficients ranged from 0.68 to 0.83). Conclusion: The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services.

ENeuroIntensive Care in India: The Need of the Hour.

As ICU consultants in smaller hospitals may not be familiar with neurocritical care and with current travel restrictions due to the COVID-19 pandemic, one needs to relook at how neurocritical care can be provided. This article reviews the authors' experience of providing remote neurointensive care, from a non-specialist ICU over a 16-month period. 61 neuro consultations were provided for 56 patients admitted in remote ICU's, including five repeat consultations. Most teleconsultations were from three rural hospitals. The central command center has monitored remote patients with neurological conditions, in 23 ICUs. Providing real-time virtual neuro intensive advice to ICU's in smaller cities even without dedicated neuro-intensive units is feasible in India. eNeuroIntensive care is particularly necessary in the current "New Normal" era.

Numerical Study of Airborne Droplets Propagation Inside a Hospital Consulting Room

The outbreak of Corona Virus (COVID-19) has spread over a large number of countries The virus is typically transported inside liquid droplets produced by human beings As a result, doctors operating in the consulting rooms of hospitals are potentially exposed to high risk Taking into account the evaporation of droplets and using a hybrid Eulerian-Lagrangian framework to determine the airflow pattern and corresponding motion of droplets, in the present study, the motion of droplets is investigated with regard to the situation in which doctors check patients in front of their bed A turbulence model (RNG k-ɛ) is used The purification capacity of different ventilation systems is compared The risk of cross-infection between doctors and patients is also evaluated

Evaluación endometrial vía histeroscopia en pacientes con cáncer de mama – receptores hormonales positivos, tratadas con hormonoterapia

Objective: To know via hysteroscopy the endometrial pathology associated with the use of hormone therapy in patients with breast cancer. Methods: Research design: non-experimental, longitudinal, trend; based on patients who come randomly, from January to July 2014, to the consultation of Los Andes University Hospital. Results: The mean age of the patients was 55.3 years, mean time of menopause 8.03 years; 8 (26.6%) patients had associated chronic arterial hypertension and diabetes mellitus II, and 10% of the patients had arterial hypertension. The most common endometrial alterations were: 46.7 % endometrial polyps, 13.3 % simple hyperplasia without atypia, 6.6 % leiomyomas. Among 5 (16.6%) users of exemestane (all with normal ultrasound), 3 (10%) had endometrial polyps and 2 (6.7%) negative biopsies. Among the 23 (76.7%) patients taking tamoxifen, 9 (30%) had thickened endometrium, 12 (40%) normal ultrasound and 2 (6.7%) other findings; 10 (33.3 %) had polyps (6 with normal ultrasound and 4 with endometrial thickening) and 3 endometrial hyperplasia (all with thickened endometrium). Two patients receiving both treatments, one had hyperplasia and one had polyps (both with thickened endometrium). The population studies in 60% were luminal B breast cancer; 1 (3.3 %) patient had a vagal reflex as a complication of the procedure. Conclusion: Histeroscopic findings most often diagnosed were endometrial polyps, simple hyperplasia without atypia and submucosal myomas. Keywords: Hysteroscopy, endometrium, tamoxifen, cancer, breast.

PNS126 Simpli – a Capacity Simulator for Evaluating Measures to Reduce the Backlog of Hospital Services after the COVID-19 Pandemic

In Portugal, due to the COVID-19 pandemic, almost 1.4 million hospital consultations were not conducted at public hospitals and the number of surgeries was reduced by 40% in comparison with 2019. Local safety measures applied by hospitals reduced hospital capacity by 1/3. SimPLI - Simulating Capacity Performance Leading to Impact, a capacity simulator to test the effectiveness of measures to reduce the hospital backlog within capacity constraints, is hereby introduced. A proof of concept was presented for a hospital ophthalmology service. A spreadsheet-based simulator was developed for testing measures to accelerate the realization of delayed external consultations and outpatient surgeries. Inputs include the number of rooms and operation times, waiting room capacity, and allocation of healthcare professionals (HCP) to multiple roles. The impact of several measures was simulated namely the reorganization of HCP schedules and hiring, patient prioritization criteria, the specific allocation of rooms, and increasing teleconsultations. The baseline backlog is represented by the number of delayed procedures. The time to eliminate this backlog was calculated and compared with the output for scenarios where one or more measures were implemented. The implementation of telemedicine for subsequent ophthalmology consultations and the reduction in 10 minutes in the time of face to face consultations would allow eliminating the consultations backlog in 9.3 months vs 16.7 months without any measures. Pertaining to surgeries, allocating an additional room for ophthalmology outpatient surgery and hiring a medical doctor were predicted to reduce the time to perform all backlog surgeries by four months (7.6 vs 11.3 months). SimPLI is invaluable for planning the investment in efficient actions towards optimization of hospital capacity in a post-COVID era in Portugal. The proof of concept demonstrates that the proposed measures could bring significant savings to the hospital by lowering the number of outsourced surgeries.

Trends in dementia consultations in two psychiatric hospitals in Mexico City: 2010‐2018

AbstractBackgroundThe analysis of the information about the use of health services is a key input for understanding infrastructure and planning requirements, as well as for contributing to the identification of deficiencies and opportunities aimed at improving the provision of services. Dementia is a condition that is increasing in Mexico; however, the health system lacks long‐term care services, being psychiatric hospitals one of the main centers for providing services to the population affected by this disease. That is why this research aims to identify trends in dementia care for adults over 60 years who were attended in two psychiatric hospitals in Mexico City between 2010–2018.MethodWe used records of the psychiatric hospitals "Fray Bernardino Álvarez" and "Samuel Ramírez Moreno", during the period 2010‐2018. The annual proportion of first and subsequent consultations for dementia (according to ICD‐10, code F00) in both men and women was estimated. The Joinpoint Trend Analysis Software version 4.1.0 was used to explore the change in time trends of care. Trend changes are presented as Annual Percent Change (APC) and was considered statistically significant when p&lt;0.05.ResultOn average, both psychiatric hospitals recorded 9000 dementia consultations per year. Statistically significant increases are observed by sex. Among women, first‐time consultations were recorded with a 16.8% (CI: 5.5‐29.4) and subsequent consultations (APC: 13.4%, CI: 6.2‐21.2). And in men it is only significant in subsequent consultations (APC: 19.5%, CI: 6.6‐34.1).ConclusionThe number of hospital consultations for dementia has increased significantly; however, the health system in Mexico is limited in resources and infrastructure that could guarantee long‐term care services, so it should restructure services and promote other instances that would allow for quality care to be provided to people affected by the disease, as well as their caregivers.

Hospital Consultation From Outpatient Clinicians for Medically Complex Children

Children with medical complexity (CMC) frequently experience fragmented care. We have demonstrated that outpatient comprehensive care (CC) reduces serious illnesses, hospitalizations, and costs for high-risk CMC. Yet continuity of care for CMC is often disrupted with emergency department (ED) visits and hospitalizations. To evaluate a hospital consultation (HC) service for CMC from their outpatient CC clinicians. Randomized quality improvement trial at the University of Texas Health Science Center at Houston with an outpatient CC clinic and tertiary pediatric hospital (Children's Memorial Hermann Hospital). Participants included high-risk CMC (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrolling in our clinic) receiving CC. Data were analyzed between January 11, 2018, and December 20, 2019. The HC included serial discussions between CC clinicians, ED physicians, and hospitalists addressing need for admission, inpatient treatment, and transition back to outpatient care. Usual hospital care (UHC) involved routine pediatric hospitalist care. Total hospital days (primary outcome), PICU days, hospitalizations, and health system costs in skeptical bayesian analyses (using a prior probability assuming no benefit). From October 3, 2016, through October 2, 2017, 342 CMC were randomized to either HC (n = 167) or UHC (n = 175) before meeting the predefined bayesian stopping guideline (>80% probability of reduced hospital days). In intention-to-treat analyses, the probability that HC reduced total hospital days was 91% (2.72 vs 6.01 per child-year; bayesian rate ratio [RR], 0.61; 95% credible interval [CrI], 0.30-1.26). The probability of a reduction with HC vs UHC was 98% for hospitalizations (0.60 vs 0.93 per child-year; RR, 0.68; 95% CrI, 0.48-0.97), 89% for PICU days (0.77 vs 1.89 per child-year; RR, 0.59; 95% CrI, 0.26-1.38), and 94% for mean total health system costs ($24 928 vs $42 276 per child-year; cost ratio, 0.67; 95% CrI, 0.41-1.10). In secondary analysis using a bayesian prior centered at RR of 0.78, reflecting the opinion of 7 experts knowledgeable about CMC, the probability that HC reduced hospital days was 96%. Among CMC receiving comprehensive outpatient care, an HC service from outpatient clinicians likely reduced total hospital days, hospitalizations, PICU days, other outcomes, and health system costs. Additional trials of an HC service from outpatient CC clinicians are needed for CMC in other centers. ClinicalTrials.gov Identifier: NCT02870387.

16687 The economic value of dermatology resident consultations: A retrospective multi-institutional evaluation of hospital-based consultation

Medicare funding for graduate medical education has been threatened, despite the important role residents play in academic medical centers. We sought to characterize the total amount and type of consultation work performed by dermatology residents, and compare that with the amount of Medicare funding hospitals receive for training residents. Hospital-based consults provided by Harvard dermatology residents at Brigham and Women’s Hospital and Massachusetts General Hospital from March 1 to May 31, 2018 were reviewed. Procedures were coded according to the Current Procedural Terminology and converted into work relative value units (wRVUs), which were multiplied by the 2018 rate of $35.999. This value was then multiplied by 4 to generate annual estimates. The annual amount was divided by the number of residents on call, and compared with the Medicare Graduate Medical Education funding of $117,000/resident/year. There were 754 encounters on 389 patients from March 1 to May 31, 2018. The total wRVU during the 3-month period was 1094.9 which represented $40,014.29. For the whole year, the extrapolated wRVU was 4379.6 and corresponding value was $160,057.16. The most common payers were private insurance (48.5%), Medicare (33.2%), and Medicaid (13.9%). The overall financial value generated per resident was $80,028.58, which represented 68.4% of the Medicare stipend. This study suggests that hospital consult services led by residents may substantially offset costs associated with resident training. Future prospective studies may provide additional insight into total economic value generated by dermatology residents on call and underscore the importance of continuing to fund robust graduate medical education programs.

Implementation of a pharmacy e-interconsultation integrated in patient medical record

ObjectiveTo describe the phases of development and the success of implementation of the pharmacist non-face-to-face consultation in primary and hospital setting.MethodA descriptive and retrospective study was conducted to implement pharmacist...

Status of astronomy outreach in Chile

Using videography, a cross-sectional descriptive-multivariate study was carried out, consisting of 61 patients with clinical, neurological and genetic diagnosis of Spinocerebellar Ataxia (SCA) and Cerebrovascular Accidents (CVA), as well as 51 healthy individuals chosen at random, attended in the Neurology consultation of the General Teaching Hospital Dr. Juan Bruno Zayas Alfonso in Santiago de Cuba. The results of the metrological evaluations performed on the instrumental proposal are included in the work, and the behavior of the kinematic variables (gait speed, excessive increase in step width and lateral oscillations of the hip) are analyzed, for 3 manifestations of the movement of the groups of healthy and sick subjects. Finally, the discriminant linear models obtained for different groups of healthy and sick subjects whose validation reveals their potential usefulness for the study of normal and pathological movement are included.

Early Occupational Intervention for People with Low Back Pain in Physically Demanding Jobs: 1-year Follow-up Results of the Randomized Controlled GOBACK Trial.

Randomized controlled trial with 1-year follow up. The aim of this study was to assess whether people with low back pain (LBP) and self-reported physically demanding jobs, benefit from an occupational medicine intervention, in addition to a single hospital consultation and a magnetic resonance imaging, at 1 year of follow-up. Secondly, to examine whether the positive health effects, found in both groups at 6 months, persist at 1-year follow-up. The prevalence of LBP is high in the working population, resulting in a substantial social and economic burden. Although there are many guidelines available on the management of LBP, including multidisciplinary biopsychosocial rehabilitation, they provide limited guidance on the occupational medicine aspects. As reported previously, 305 participants with LBP and self-reported physically demanding jobs were enrolled in the randomized controlled study and randomly allocated to clinical care with additional occupational medicine intervention or clinical care alone. Data were collected at baseline, 6 months, and 1 year. Outcomes included in the present 1-year follow-up study are changes in neuropathic pain (painDETECT questionnaire), severity of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), fear-avoidance beliefs (FABQ), physical, and mental quality of life (short-form 36). The study showed no effect of an occupational intervention on neuropathic pain, fear-avoidance beliefs, physical and mental quality of life nor disability measured after 1 year. The positive effects found at 6 months in both groups, remained at 1-year follow-up. The results suggest that a thorough clinical consultation, with focus on explaining the cause of pain and instructions to stay active, can promote long-lasting physical and mental health in individuals with LBP. Therefore, additional occupational interventions could focus on altering occupational obstacles on a structural level.Level of Evidence: 2.

Elimination of Routine Screening Laboratory Tests for Psychiatric Admission: A Quality Improvement Initiative.

Research has shown that routine screening laboratory tests for patients with mental health symptoms admitted to psychiatry units find little unexpected clinical abnormalities. This study examined the effects on cost of care and patient safety measures of a hospital change in policy in which such routine tests were no longer required. This retrospective cohort study analyzed data from all patients admitted from the emergency department (ED) to inpatient psychiatry at a tertiary care hospital 4 months before and 4 months after the policy change. Primary outcome measures were number and costs of laboratory tests ordered in the ED and during the inpatient stay. Secondary measures included length of stay (LOS) and number of hospital consultations during admission, patient transfers to nonpsychiatry services, and inpatient deaths. Chi-square tests and Wilcoxon rank sum tests were used to examine group differences. In total, data from 1,910 patients were included (886 preimplementation and 1,024 postimplementation). The median number of lab tests ordered during the hospital stay decreased from three (interquartile range [IQR]=3) to two (IQR=3). The median total lab charges decreased from $445 (IQR=$291) to $312 (IQR=$497). Mean ED LOS decreased by 5.5 hours, and the proportion of patients with no blood lab orders increased from 22% to 40%. No increases in consultations or transfers were noted. No patients died at any point. A policy that avoids routine laboratory screening tests for patients admitted to inpatient psychiatry can save money, improve patient care, and decrease LOS, without increasing adverse outcomes.

Long-term impact of PM2.5 on health in the city of Korhogo (Côte d’Ivoire, West africa)

Background/ Aim Air quality and it impacts capture more attention of governments and public opinion. Indeed, air pollution has consequences on the health of populations. Epidemiological studies contributed much to the understanding of the effects. In order to understand this, an epidemiological study was done in the regional hospital of Korhogo in regards to the PM 2.5 concentration levels in the city. The objective of this study was to assess the impact of PM2.5 concentration on health in Korhogo, with special attention to cardiorespiratory and skin diseases. Methodology All subjects coming to consultation in the regional hospital of Korhogo were selected in relation to the lungs, skin, and heart symptoms for 3 months beginning from December 2018 to March 2019. Patients to include were identified by a Medical Doctor tthrough a questionnaire after their informed consent. The relationship between exposure to air pollution and health was done through time series. The main outcomes of the study were the incidence of cardiorespiratory and skin diseases (95% CI) and the indicator of health impact. An existence of a significant relationship between exposure to air pollution and health outcomes was done. Results The preliminary results showed that 3410 patients consulted a physician during the 3 months visits in the regional hosptal of Korhogo. Within those patients, 527 (17.46%) were recruted for pollution issues. More than 95% of the patients had cardiopulmonary diseases in the city of Korhogo. The average of PM2.5 concentration was higher than the daily recommended by WHO. A strong relationship was seen to be associated to cardiopulmonary disease in that regional hospital Conclusion The average of PM2.5 concentration was higher than the daily recommended by WHO. A strong relationship was seen to be associated to cardiopulmonary disease in that regional hospital Where a special attention should be taken for patients

The Effect of Multi-Parametric Magnetic Resonance Imaging in Standard of Care for Nonalcoholic Fatty Liver Disease: Protocol for a Randomized Control Trial.

BackgroundThe rising prevalence of nonalcoholic fatty liver disease (NAFLD) and the more aggressive subtype, nonalcoholic steatohepatitis (NASH), is a global public health concern. Left untreated, NAFLD/NASH can lead to cirrhosis, liver failure, and death. The current standard for diagnosing and staging liver disease is a liver biopsy, which is costly, invasive, and carries risk for the patient. Therefore, there is a growing need for a reliable, feasible, and cost-effective, noninvasive diagnostic tool for these conditions. LiverMultiScan is one such promising tool that uses multi-parametric magnetic resonance imaging (mpMRI) to characterize liver tissue and to aid in the diagnosis and monitoring of liver diseases of various etiologies.ObjectiveThe primary objective of this trial (RADIcAL1) is to evaluate the cost-effectiveness of the introduction of LiverMultiScan as a standardized diagnostic test for liver disease in comparison to standard care for NAFLD, in different EU territories.MethodsRADIcAL1 is a multi-center randomized control trial with 2 arms conducted in 4 European territories (13 sites, from across Germany, Netherlands, Portugal, and the United Kingdom). In total, 1072 adult patients with suspected fatty liver disease will be randomized to be treated according to the result of the mpMRI in the intervention arm, so that further diagnostic evaluation is recommended only when values for metrics of liver fat or fibro-inflammation are elevated. Patients in the control arm will be treated as per center guidelines for standard of care. The primary outcome for this trial is to compare the difference in the proportion of patients with suspected NAFLD incurring liver-related hospital consultations or liver biopsies between the study arms, from the date of randomization to the end of the study follow-up. Secondary outcomes include patient feedback from a patient satisfaction questionnaire, at baseline and all follow-up visits to the end of the study, and time, from randomization to diagnosis by the physician, as recorded at the final follow-up visit.ResultsThis trial is currently open for recruitment. The anticipated completion date for the study is December 2020.ConclusionsThis randomized controlled trial will provide the evidence to accelerate decision making regarding the inclusion of mpMRI-based tools in existing NAFLD/NASH clinical care. RADIcAL1 is among the first and largest European health economic studies of imaging technologies for fatty liver disease. Strengths of the trial include a high-quality research design and an in-depth assessment of the implementation of the cost-effectiveness of the mpMRI diagnostic. If effective, the trial may highlight the health economic burden on tertiary-referral hepatology clinics imposed by unnecessary consultations and invasive diagnostic investigations, and demonstrate that including LiverMultiScan as a NAFLD diagnostic test may be cost-effective compared to liver-related hospital consultations or liver biopsies.Trial RegistrationClinicalTrials.gov NCT03289897 https://clinicaltrials.gov/ct2/show/NCT03289897International Registered Report Identifier (IRRID)DERR1-10.2196/19189

Utilization of telemedicine to meet the demand throughout the COVID-19 pandemic at a community oncology practice.

263 Background: A large community oncology practice in Tennessee participates in value-based payment arrangements, the success of which depends on close patient monitoring. Telemedicine as an innovative solution was initiated in 2017. The service was limited, due to regulation, licensure requirements, and lack of reimbursement, to survivorship visits, clinical trial consent visits, rural hospital consults and genetic counseling. During the COVID pandemic and loosening of restrictions, telemedicine services were expanded. Methods: We identified a cloud-based platform that allowed patients to use any device with a camera and microphone and required no software downloads. On-line training sessions were provided to clinical staff. All training and workflow implementation were completed in a 2-week time frame. Telemedicine was expanded to include surveillance, urgent care, psychology, palliative care and post-BMT visits as well as new patient consults for medical, radiation and gynecologic oncology patients. Patient satisfaction surveys were administered. Results: Our telemedicine visits increased weekly beginning March 1, peaking in the month of April with an average of 77 scheduled telemedicine visits per day across the practice. During the month of April, our practice saw a record clinical trial accrual in our Phase-1 Drug Development Unit with a 22% increase over the previous average. Patients who responded to a satisfaction survey were highly satisfied with the telemedicine visit with a 73% positive response rate. Nearly half of our eligible patients did not have the technology or broad-band access to be able to participate in telemedicine. Conclusions: Our prior experience with telemedicine, though limited, facilitated the development of an infrastructure that provided adequate number of devices and internet bandwidth capacity to support rapid expansion of telemedicine. We were able to maintain high quality care and access to clinical trials during the pandemic and see the value of this service long-term. We hope to add tele-pharmacy and care coordination services. Political leadership and patient advocacy groups should explore ways to ensure that all patients may benefit from this technology, especially those in under-served areas.