Physical Organization Research Articles

Characterization of an embedded clinical oncology pharmacy model across the State of Michigan.

58 Background: The oncology pharmacist role has evolved to address implications of newer cancer therapies by increased integration in direct patient care and management of cancer therapy side effects and adherence. Despite the ability of oncology pharmacists to provide high-value, high-quality care to patients with cancer, it remains difficult for community oncology practices to justify the cost of the pharmacist. The purpose of this study is to characterize a model, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), that supports the integration of clinical oncology pharmacists into community practices via financial support to the practices, clinical support to the pharmacist team, and outcomes assessment. The results will provide insight into how pharmacists support patient care and how to substantiate a pharmacist in practices. Methods: This multicenter, retrospective analysis was conducted between October 2020 – March 2022. POEM pharmacists received support in the development of collaborative practice agreements, billing guidance, and ongoing oncology continuing education. Practices received support via a percentage of salary support for the pharmacist the first 3 years and value-based reimbursement for participation. A standardized method for collecting patient demographics, pharmacist encounter characteristics, and intervention information was created via RedCap. Patients receiving care by the pharmacist were provided a 4-item survey to rate their experience. Results: As of March 2022, POEM has 6 clinical oncology pharmacists representing 8 physician organizations, 24 oncology clinics, and 72 physicians. 1944 patients have been seen via 4296 encounters and 4380 interventions. 49% of patients were female, 93% white, and 74% > 60 years. The primary reasons for pharmacist care were treatment with oral anticancer agents (OAA) (52%), non-immunotherapy IV (22%), and immunotherapy (20%). Pharmacists recorded an average of 77 patient encounters/week over the last year and 108/week over the past quarter. 47% of these encounters were billed using care management codes. Additionally, pharmacists recorded an average of 82 interventions/week over the past year and 101/week over the last quarter. Interventions were Education and Referrals (49%), Medication Modification (24%), and Comprehensive Medication Review or Medication Reconciliation (20%). Patients were satisfied with the pharmacists’ care and felt it was important to meet with a pharmacist before beginning their cancer treatment. Conclusions: Early results indicate positive patient experiences from education sessions and medication interventions to improve patient symptoms. Future outcome analyses will quantify the return on investment of clinical pharmacist integration into oncology community practices by measuring pre- and post-intervention healthcare utilization and patient clinical outcomes.

Domestic Space, Access Analysis, and Social Transformations: Houses in Iron Age and Roman Mediterranean Gaul

Studies investigating changes in domestic architecture from the Iron Age to the Roman period in the northwestern provinces of the Roman empire have often suggested an important degree of continuity in domestic social relations, although the province of Mediterranean Gaul, Gallia Narbonensis, has been underrepresented in these studies. This article employs access analysis to compare domestic space in Mediterranean Gaul at three preconquest Iron Age settlements (ca. 500–50 BCE) and five Roman-period houses from the first–second centuries CE. This analysis suggests that many Roman houses in Gallia Narbonensis helped structure quite different forms of daily social interactions and encounters through important changes in the physical organization of domestic space. In particular, the communitarian organization of domestic space for the Iron Age settlements seems to have encouraged daily encounters within and between domestic groups through shared, communal spaces, rather than separating social units into coherent sets of rooms that in a modern setting we would consider “houses.” By contrast, in the Roman period internally organized domestic spaces emphasized specialization and internal divisions, structuring socioeconomic distinctions, and in doing so, signaled an important social rupture that contrasts with other provinces of Gaul.1

Review on Invasive Alien Species (IAS): Challenge and Consequence to the Aquatic Ecosystem Services

The invasive alien species (IAS) are widely recognized as a significant threat to marine biodiversity and severely affect ecosystem services. There has been no measurable global assessment of their impacts and routes of introduction. This review highlights some aspects of invasive species and their impacts on the ecosystem in general. For many roots like global transportation, biological pest control, climate changes, and sometimes commercial, invasive species are introduced into the new environments. Afterward, the invasive species are rapidly dominant over the indigenous species because of their first growth, rapid reproduction, ecological competence, and phenotypic plasticity, consequently, altering the structure of Ecosystems and deterring the biological and physical organization of the system. Many policies have been introduced to stop the destruction produced by invasive animals and plants and to prevent upcoming invasions. Some critical components of getting rid of invasion are concern about transporting wildlife to new areas, Ballast water in tankers, aquarium species, and shipping.

Cooperation of Sports Communities with the Government Apparatus in Poland in the Years 1945–1989

After the Second World War, Poland became a country ruled by the Communists at the service of the Soviet Union. Many Poles were passive towards the new government, forced to accept the imposed order. Some of them supported political and social change. Sports communities were among the beneficiaries of the new system. State offices, trade unions and workplaces supported and financed physical culture clubs and organizations. They were a part of the state system of good distribution and depended on the decisions of the ruling party. The cooperation of representatives of sports community, however, often went beyond the ritual behavior demonstrated at mass events. Some decided to cooperate with the secret services by reporting on their sports colleagues.

Physician Practice Consolidation: Considerations for the Remaining Independents

Summary As independent physician practices face continuing financial pressures, integration with other organizations offers a mix of advantages and drawbacks. Practices may be acquired by hospitals, health plans, physician organizations, and/or private equity firms. Integration can lead to administrative efficiency, leveraged purchasing power, improved care coordination and clinical integration, and better contracting. In this article, the author provides a roadmap for those considering acquisition and shares insights on the processes and the pros and cons of the types of arrangements.

Methodological approaches in aggregate formation and microscopic analysis to assess pseudoislet morphology and cellular interactions.

Microscopy has revolutionised our view on biology and has been vital for many discoveries since its invention around 200 years ago. Recent developments in cell biology have led to a strong interest in generating spheroids and organoids that better represent tissue. However, the current challenge faced by many researchers is the culture and analysis of these three-dimensional (3D) cell cultures. With the technological improvements in reconstructing volumetric datasets by optical sections, it is possible to quantify cells, their spatial arrangement, and the protein distribution without destroying the physical organization. We assessed three different microwell culture plates and four analysis tools for 3D imaging data for their applicability for the analysis of 3D cultures. A key advantage of microwell plates is their potential to perform high-throughput experiments in which cell cultures are generated and analysed in one single system. However, it was shown that this potential could be impacted by the material composition and microwell structure. For example, antibody staining was not possible in a hydrogel microwell, and truncated pyramid-structured microwells had increased background fluorescence due to their structure. Regarding analysis tools, four different software, namely CellProfiler, Fiji/ImageJ, Nikon GA3 and Imaris, were compared for their accuracy and applicability in analysing datasets from 3D cultures. The results showed that the open-access software, CellProfiler and Fiji, could quantify nuclei and cells, yet with varying results compared to manual counting, and may require post-processing optimisation. On the other hand, the GA3 and Imaris software packages showed excellent versatility in usage and accuracy in the quantification of nuclei and cells, and could classify cell localisation. Together these results provide critical considerations for microscopic imaging and analysis of 3D cell cultures.

Human trafficking in the health care setting: recommendations for the physical medicine and rehabilitation provider

Purpose This study aims to provide trauma informed recommendations for screening and discusses responsibilities of the physical medicine and rehabilitation (PM&R) provider for responding and advocating for patients experiencing human trafficking. Materials & methods Existing literature relating to human trafficking across rehabilitation settings was reviewed. In addition, two cases of human trafficking in the rehabilitation setting are presented, including a confirmed case of human trafficking in an adult and a suspected case of human trafficking in a child. Results No literature describing human trafficking in the PM&R setting was found. Four articles were found focusing on human trafficking in occupational health settings as opposed to physiatry, which were published in occupational health journals. Conclusions There is a paucity of literature offering recommendations for screening and responding to suspected human trafficking situations in rehabilitation settings. Policies on human trafficking are needed in areas of rehabilitation such as polytrauma, brain injury, spinal cord injury, and musculoskeletal impairments in the adult and pediatric population. Those working with potential victims of human trafficking should employ a patient-centered, trauma-informed approach in which the patient’s freedom of choice is emphasized. IMPLICATIONS FOR REHABILITATION Human Trafficking • There are no official policy statements on human trafficking by physical medicine & rehabilitation organizations. • Trafficked persons often present with impairments that may be treated in the rehabilitation setting. • Physiatrists may play a powerful role in identifying the needs of trafficked persons. • We recommend a trauma-informed, multidisciplinary approach to managing these patients throughout their rehabilitation.

Status of cancer treatment by radiotherapy and requirement of radiation oncology medical physicists in Asia Oceania federation of organizations for medical physics region.

Cancer is a major health problem worldwide including Asian-Pacific region. The region hosts over 4.5 billion people, over 60% of the world population and very divergent socioeconomically. The major cancers in the region in male include lung, stomach, liver, colorectal and esophagus and in female breast, lung, cervix, colorectal, and stomach. Over 60% of cancer patients need radiotherapy alone or in combination with surgery and/or chemotherapy, and therefore, radiotherapy is the main and essential modality of cancer treatment. Radiation oncology medical physicists play a pivotal role in efficient implementation of radiotherapy. This study was aimed to assess the status of cancer treatment by radiotherapy and the requirement of radiation oncology medical physicists in the region. To access the status and requirement of radiotherapy machines, availability of radiation oncology physicists in the region of Asia Oceania Federation of Organizations for Medical Physics (AFOMP), we have carried out a survey by sending questioners to AFOMP National Medical Physics Organizations (NMO). We received response from 21 countries, 100% response, regarding availability of teletherapy units, number of medical physicists working in radiotherapy and related information. Using GLOBOCAN cancer incidence data and considering 62.5% of cancer patients need radiotherapy treatment and up to 500 cancer patients can be treated in a year on one teletherapy machine, the gap between the available and required teletherapy machine to treat all the cancer patients requiring radiotherapy is estimated. Further, we estimated the gap between radiotherapy medical physicists available and required as per International Atomic Energy Agency and European Society for Therapeutic Radiology and Oncology guidelines. It was observed that availability of teletherapy machines in AFOMP region is 0.21-14.0 teletherapy machine/million population and radiotherapy medical physicist are 0.82-2.43/teletherapy unit.

Physician organizations' use of behavioral nudges to influence physician behavior.

Because physicians' decisions drive health care costs and quality, there is growing interest in applying behavioral economics approaches, including behavioral nudges, to influence physicians' decisions. This paper investigates adoption of behavioral nudges by health system-affiliated physician organizations (POs), types of nudges being used, PO leader perceptions of nudge effectiveness, and implementation challenges. Mixed-methods study design (PO leader survey followed by in-depth qualitative interviews). Purposive sample of 30 health system-affiliated POs in 4 states; POs varied in size and quality performance. We collected data between October 2017 and June 2019. The survey asked PO leaders to report their organization's use of 5 categories of nudges to influence primary and specialty physicians' actions. We conducted semistructured phone interviews to confirm survey responses, elicit examples of the nudges that POs reported using, understand how nudges were structured, and identify implementation challenges. We present descriptive tabulations of nudge use and effectiveness ratings. We applied thematic analysis to the interview data. Almost all POs in this study reported nudge use. Clinical templates, patient action lists, and altered order entry were most commonly used. However, PO leaders reported that nudge use was limited to a narrow range of clinical applications, not widespread across the organization, and mostly structured as suggestions rather than default actions or hard stops. Nudge use remains limited in practice. Opportunities exist to expand use of nudges to influence physician behavior; however, expanding use of behavioral nudges will require PO investment of resources to support their construction and maintenance.

Resilience of supply-chain systems under perturbations: A network approach.

Supply-chain systems (SCSs) are an indispensable part of our daily infrastructures. Note that a small perturbation in a SCS can be amplified, eliciting cascading failures. It is of significant value to ensure a high resilience of SCSs. However, due to the complexity of SCSs, it is quite challenging to study their resilience under conditions of perturbations. In view of this, this paper presents a complex network perspective toward the resilience of SCSs. To achieve this goal, a complex SCS is modeled as a multilayer supply-chain network (SCN) with physical organizations being modeled as nodes and interactions among them as edges. A modeled SCN contains three types of nodes, i.e., suppliers, manufacturers, and retailers. An algorithm is proposed to construct a multilayer SCN. For each layer of a multilayer SCN, two kinds of networks, i.e., networks with Poisson degree distributions and networks with power-law degree distributions, are considered. For a given multilayer SCN, a ripple-effect network model is proposed to analyze its resilience under perturbations. Regarding the perturbations, two scenarios, i.e., random node failures and target node failures, are adopted in this research. In order to validate the effectiveness of the proposed network perspective, simulations on computer-generated SCNs are carried out. Interestingly, it is found that the resilience of SCNs under both random and target perturbations presents a discontinuous phase-change phenomenon, which indicates that SCNs are quite fragile under perturbations. It is further noticed that SCNs with power-law degree distributions are relatively more robust than SCNs with Poisson degree distributions. Although SCNs are found to be fragile, it has been discovered that denser interactions between different system organizations can enhance the network's resilience.

Telehealth Delivery Of Therapeutic Exercise For Musculoskeletal Disorders During A Global Pandemic

The COVID-19 pandemic has globally disrupted the delivery of healthcare services, particularly for interventions that traditionally require face-to-face interactions, such as manual techniques and therapeutic exercise. Telehealth provides a potential alternative to in-clinic care. However, it has not been well-studied for delivering therapeutic exercise in patients with musculoskeletal (MSK) disorders and little guidance is available on implementation. PURPOSE: The purpose of this paper was to describe the implementation process of a telehealth program for delivering therapeutic exercise in patients with MSK disorders during a global pandemic. METHODS: A quality project was conducted to implement a telehealth program in an outpatient physical therapy organization in the United States. Various implementation outcomes were assessed, such as adoption, adherence, barriers and facilitators, safety, and satisfaction. Representative cases of patients with MSK disorders were also reviewed to illustrate challenges and solutions when administering a telehealth plan of care including exercises. RESULTS: A telehealth program to deliver therapeutic exercise was successfully implemented for patients with MSK disorders presenting for outpatient physical therapy. Barriers, such as limited exercise equipment, technology difficulties, and fall risk safety, were addressed through creative approaches in the home setting. Adherence was high and no adverse events were reported. At its peak, approximately 900 patient visits per month were conducted via telehealth, representing approximately 7% of the total volume. Review of cases suggested good functional outcomes and high satisfaction. CONCLUSION: This project provided insight about implementing a telehealth program focusing on therapeutic exercise for the management of patients with MSK disorders. The findings of this project indicate that telehealth delivery in a physical therapy plan of care is safe, enhances patient access, and allows for continuity of care, which may result in improved functional outcomes. Research is needed to determine the effectiveness of telehealth and updated regulations are needed to clarify roles of providers who are qualified to deliver therapeutic exercises via telehealth.

Effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and traumatology in Germany : Anationwide survey.

BackgroundThe spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements.AimThe aim of this study was to evaluate the effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and trauma surgery in Germany.MethodologyAn online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021.ResultsA total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic.ConclusionThe COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.Supplementary InformationThe online version of this article (10.1007/s00132-022-04295-w) contains the german and english version of the survey.

From Screening to the Receipt of Services: A Qualitative Examination

Research has focused on developing methods to facilitate screening and tracking data on social risk factors in healthcare settings. Less is known about the multiple factors that shape patients' acceptance of healthcare-based social risk programs. This qualitative study sought to elucidate the multilevel (individual, interpersonal, family/community, system, policy) factors that influence patients' acceptance of a healthcare-based social risk program within a Federally Qualified Health Center in New York City. Participants included 5 patients receiving care at the Federally Qualified Health Center who screened positive for social risks, 4 nurses who are responsible for conducting social risk screenings, and 5 Family Support Services counselors who conduct outreach to patients who screened positive. Interviews were conducted from March to June 2021 and analyzed from July to September 2021 using the constant comparative method. Analyses of the transcripts identified the following 3 themes: (1) Patients appreciated being asked about social risk factors, but there was a mismatch between their understanding of the screening process, their desire for assistance, and the support received. Although nurses and counselors described relationship-centered approaches to involve patients in the process, patients reported feeling initial discomfort and confusion; (2) Multilevel barriers inhibit patients' acceptance of assistance; and (3) Patient trust in the physician and healthcare organization serves as facilitators to acceptance. Patients' views about the purpose of a healthcare-based social risk program differed from nurses' and counselors' perspectives of the process. Although patients face multilevel challenges, strong trust in the physician and Family Health Centers served as facilitators to accepting healthcare-based assistance.

Improving the Quality of Health Care through 25 Years of Statewide Collaboration in Michigan

Summary For the past 25 years in Michigan, the Collaborative Quality Initiatives (CQIs) have taken a cooperative bottom-up approach to health care quality improvement. Made up of physician organizations and hospitals around the state and led by local clinicians who set the quality improvement agenda, the CQIs rely on an approach that uses granular data collection, analysis, and transparency to develop and implement practice improvements to support a learning health system. The quality improvement work of the CQIs is administered directly by clinician leaders who direct statewide consortiums of their peers. Each CQI is financially supported by Blue Cross Blue Shield of Michigan. There are currently 23 active CQIs, each of which focuses on a specific clinical specialty or challenge. In this article, the authors review the processes and results of this collaborative approach to health care quality improvement.

Office Work Interrupted: Evolving Understandings of Work and Organizing in the Shadow of COVID-19

For many workers, COVID-19 catalyzed a rapid disappearance of the physical organization and a dramatic rise in technologically mediated forms of organizing. Prior research on remote and virtual work has largely focused on what changes enable virtual workers to succeed, under the assumption that these virtual workers would represent a minority of the workforce and would primarily occupy specialized roles. Key questions to be asked are: do we need to revisit our thinking about virtual work in light of our changed, and changing, circumstances? And what might the recent, widespread virtualization of work teach us not just about virtual work, but, also, about workers and organizations, more broadly? Our goal with this symposium is to feature future-of-work scholars who can share their insights into the ways that we might understand virtual work anew, as well as the ways that virtualization can impact how workers understand themselves, their work, and their organizations. The presentations contained in this symposium cover newcomer socialization, the doing of virtual work, the emotional costs of that work, and workers’ reflections upon the transition to virtual work. In so doing, they invite us to question both scholarly and practitioner assumptions about virtual work and highlight the ways in which workers shape their experience of work. Benefits To Onboarding Remotely? Building Trust With Supervisors Without Face-To-Face Contact Presenter: Mailys George; IESE Business School Presenter: Kevin W. Rockmann; George Mason U. The Work Of Getting to Work: Independent Workers and The Articulation Work People Engage In... Presenter: Melissa Mazmanian; U. of California, Irvine Presenter: Ingrid Erickson; Syracuse U. School of Information Presenter: Margaret Jack; Syracuse U. School of Information The Emotional Costs Of Remote Work Arrangements Presenter: Christine Beckman; U. of Southern California Presenter: Cynthia Wilkes; U. of Southern California You Can Take It With You: Worker Adaptation To The Virtualized Organization Presenter: Julia Coff; New York U. Presenter: Frances J. Milliken; New York U. Presenter: Kevin Woojin Lee; U. of British Columbia

POST-IMPRESSIONISM AND VIRGINIA WOOLF S EXPERIMENTATION WITH LITERARY FORMS

Virginia Woolf as one of the leading figures of modernist literature was in pursuit of challenging the so-called limitations of form in fiction. Triggered by the intellectual discussions in the Bloomsbury Group, formed by a group of intellectuals and artists in England, she attempted to redefine literary form by reorganizing her fiction to oppose the painters in the group who believed that literary form is restricted because of the nature of language. Influenced by her discussions with post-impressionist artists such as Vanessa Bell, Clive Bell and Roger Fry, Woolf acknowledged that artistic creativity is intermingled by “a myriad impressions” of an “ordinary mind on an ordinary day” with its own peculiarities and dissonances. Similarly, post-impressionism rejects objectivity as a necessity in realist painting and embraces spiritualism and personality in artistic expression. Knowing that literature is not solely composed of abstract ideas, Woolf even tested new printing techniques. In her novels, not only content and narrative techniques but also the norms regarding physical organization of a book are challenged. Therefore, Woolf greyed the lines between form and content by rendering the book itself as a fragmented material. Consequently, this paper aims to discuss Woolf’s experimentalism in her selected works as a modernist attempt to blur the borders of the two edging literary components—form and content—by looking into the influences of post-impressionist art on her fiction.

Viral Complexity.

Although traditionally viewed as streamlined and simple, discoveries over the last century have revealed that viruses can exhibit surprisingly complex physical structures, genomic organization, ecological interactions, and evolutionary histories. Viruses can have physical dimensions and genome lengths that exceed many cellular lineages, and their infection strategies can involve a remarkable level of physiological remodeling of their host cells. Virus–virus communication and widespread forms of hyperparasitism have been shown to be common in the virosphere, demonstrating that dynamic ecological interactions often shape their success. And the evolutionary histories of viruses are often fraught with complexities, with chimeric genomes including genes derived from numerous distinct sources or evolved de novo. Here we will discuss many aspects of this viral complexity, with particular emphasis on large DNA viruses, and provide an outlook for future research.

Physicians urge stakeholders to advance BH integration plans

Having already embarked on an initiative two years ago to provide support to physicians and help them combine mental health and physical health in their medical practices, the American Medical Association (AMA) and other leading physician organizations are taking those efforts a step further. They have announced a new call‐to‐action urging health care system stakeholders to support equitable, whole‐person care for patients and their families.

Methodological approaches in aggregate formation and microscopic analysis to assess pseudoislet morphology and cellular interactions

Microscopy has revolutionised our view on biology and has been vital for many discoveries since its invention around 200 years ago. Recent developments in cell biology have led to a strong interest in generating spheroids and organoids that better represent tissue. However, the current challenge faced by many researchers is the culture and analysis of these three-dimensional (3D) cell cultures. With the technological improvements in reconstructing volumetric datasets by optical sections, it is possible to quantify cells, their spatial arrangement, and the protein distribution without destroying the physical organization. We assessed three different microwell culture plates and four analysis tools for 3D imaging data for their applicability for the analysis of 3D cultures. A key advantage of microwell plates is their potential to perform high-throughput experiments in which cell cultures are generated and analysed in one single system. However, it was shown that this potential could be impacted by the material composition and microwell structure. For example, antibody staining was not possible in a hydrogel microwell, and truncated pyramid–structured microwells had increased background fluorescence due to their structure. Regarding analysis tools, four different software, namely CellProfiler, Fiji/ImageJ, Nikon GA3 and Imaris, were compared for their accuracy and applicability in analysing datasets from 3D cultures. The results showed that the open-access software, CellProfiler and Fiji, could quantify nuclei and cells, yet with varying results compared to manual counting, and may require post-processing optimisation. On the other hand, the GA3 and Imaris software packages showed excellent versatility in usage and accuracy in the quantification of nuclei and cells, and could classify cell localisation. Together these results provide critical considerations for microscopic imaging and analysis of 3D cell cultures.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.