Referral Source Research Articles

Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis

ObjectivesTo examine indirect impacts of the COVID-19 pandemic on neonatal care in low-income and middle-income countries.DesignInterrupted time series analysis.SettingTwo tertiary neonatal units in Harare, Zimbabwe and Lilongwe, Malawi.ParticipantsWe included a...

1116-P: Enrollment of Racial/Ethnic Minorities in the Rare and Atypical Diabetes Network (RADIANT)

RADIANT is an NIH study of people with uncharacterized forms of atypical diabetes mellitus (DM) in the US. RADIANT participants consent online and progress through three sequential stages of study procedures, as eligible. DM in underrepresented minorities (URM) is rapidly increasing in incidence and has worse outcomes than DM in non-Hispanic whites. RADIANT pre-set targets proportionate to ethnic/racial distribution in the US to enroll individuals from a wide racial/ethnic spectrum. We aimed to study the URM participation in RADIANT across study stages. Enrollment rate for URM was significantly below pre-set targets at consent and across most stages (Table 1) . Referral sources significantly differed by races (p=0.003) but not ethnicities (p=0.16) . Most African-Americans (54%) were referred by RADIANT investigators but flyers, news, social media and family or friend were the major sources of referral for whites (30%) . Some of the initiatives to increase URM in RADIANT include engaging with clinics serving URM, working with local clinics/hospitals, electronic medical record screening approaches, increased focus on DM types more frequent in URM, providing culturally competent study coordination and targeted advertisement. In sum, enrollment rate of URM in RADIANT is suboptimal. Investigating barriers and facilitators for minority recruitment in RADIANT, with implications for other studies, is warranted. Disclosure M. Tosur: Advisory Panel; Provention Bio, Inc. A. Balasubramanyam: None. R.N. Naylor: None. T.I. Pollin: Research Support; Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. N. Rasouli: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Allergan, Eli Lilly and Company, Novo Nordisk. J.B. Buse: Consultant; Alkahest, Anji, AstraZeneca, Boehringer Ingelheim International GmbH, Cirius Therapeutics, Inc., Eli Lilly and Company, Fortress biotech, GentiBio, Glycadia, Glyscend, Janssen Pharmaceuticals, Inc., Mellitus Health, Moderna, Inc., Pendulum Therapeutics, Praetego, LLC, Stability Health, Valo, Zealand Pharma A/S. Research Support; AstraZeneca, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, vTv Therapeutics. Stock/Shareholder; Glyscend, Mellitus Health, Pendulum Therapeutics, PhaseBio Pharmaceuticals, Inc., Praetego, LLC, Stability Health. Other Relationship; Adocia, AstraZeneca, Eli Lilly and Company, Intarcia Therapeutics, Inc., MannKind Corporation, Novo Nordisk, Sanofi, Senseonics, vTv Therapeutics. M.J. Redondo: Advisory Panel; Provention Bio, Inc. Funding National Institutes of Health (U54, DK118638-01)

SHPEP and NAAHP: An Ongoing Partnership To Increase Diversity in the Health Professions

Abstract The Summer Health Professions Education Program (SHPEP), a grant-funded initiative by the Robert Wood Johnson Foundation (RWJF), is a free six-week summer enrichment program for college freshman and sophomore students interested in the health professions. Since its first cohort of scholars in 1989, SHPEP has impacted the lives of more than 30,000 pre-health students. With direction and technical assistance provided by the Association of American Medical Colleges (AAMC) and the American Dental Education Association (ADEA), SHPEP exposes students to a range of health professions because it is imperative for health professionals to know how to learn and work together across disciplines to help build a culture of health. The aims of SHPEP and pre-health advisors are aligned—focused on preparing students from underrepresented communities for matriculation to health professions schools. Pre-health advisors also serve as the top referral source of applicants for SHPEP. Through a partnership with the NAAHP, the SHPEP National Program Office (NPO) has developed resources pre-health advisors can leverage to support their work and advisees. The programmatic overview summarizes SHPEP’s application logistics, resources created for pre-health advisors that support DEI initiatives, and the relationship between the SHPEP NPO and NAAHP.

The burn injury transfer feedback form: A 16 year Australian statewide review of burn inter-hospital transfer

IntroductionModern burn care is centralised, and studies show that early, prompt referral to dedicated burn services improve clinical outcomes. We describe the use of a novel clinical instrument, the burn injury Transfer Feedback Form, to support and educate referring clinicians about the early assessment and management of burn injuries. Since 2005, Transfer Feedback Forms have been completed for all burn-injured patients with inter-hospital transfer to a specialised burn unit in the state of New South Wales (NSW), Australia. The aim of this study was to review physiological, procedural, and system or process issues in the care of both adult and paediatric burn-injured patients needing retrieval and transfer in NSW as identified by the Transfer Feedback Form. Secondary objectives were to determine any significant differences in these parameters between metropolitan and regional or remote referring institutions, and if any improvements occurred in these parameters over time. MethodsThis was a retrospective analysis of all patients who were transferred to a burn unit in NSW between July 2005 and July 2021 using their prospectively completed Transfer Feedback Forms. Patients were divided into metropolitan and non-metropolitan referral sources based on geographic location. Clinical issues or deficiencies identified during each patient transfer were then classified into various groups. To determine if transfer-related clinical concerns had changed with time, two distinct periods before and after 2015, when the NSW Trauma App was introduced, were analysed. We compared trends in frequency of transfer-related concerns before and after App introduction by using interrupted time series analysis. ResultsA total of 3233 patients had Feedback Forms submitted during the 16-year period. We included 929 children (28.7%) and 2304 adults (71.3%). Transfer-related clinical issues were identified in 904 adults (39.0%) and 484 children (52.0%). In both adult and paediatric patients, the most common transfer-related clinical deficiency was in relation to burn size estimation with 525 patients (43.7%) and 207 patients (30.6%), respectively. Between the time periods analysed, the number of issues arising during inter-hospital transfer fell significantly for both adults (from 46.1% to 26.1%; p < 0.05) and children (from 55.3% to 40.7%; p < 0.05). Segmented regression analysis demonstrated a significant break in the rate of transfer-related clinical issues in 2014 (p < 0.05) and 2015 (p < 0.01) for adults. Accurate body surface area estimations also increased significantly by 53% and 50% for adults and children (p < 0.05 for both), respectively, after 2015. ConclusionOur analysis indicates that the early care of burn-injured patients undergoing inter-hospital transfer is associated with clinical, technical, and logistical challenges. However, introduction of the burn injury Transfer Feedback Form has been associated with improvements in early burn care by referring centres both temporally and geographically. Smartphone-based applications such as the NSW Trauma App have also probably contributed to these findings. Adopting these simple, inexpensive strategies into burn care systems will augment inter-hospital transfer of burn-injured patients, and improve clinical outcomes.

0161 Strategies for Enhancing Recruitment of Adults for Randomized Controlled Trial Among Heterogenous Sample of Cancer Survivors with Insomnia Amid the Covid Pandemic

Abstract Introduction Challenges associated with recruiting participants in a longitudinal research study have been recognized yet remain a major barrier for researchers. The current study details strategies used in recruiting a heterogenous sample of cancer survivors with insomnia from multiple clinical sites, referral sources and outreach. Methods Enrollment goals were 158 participants over 3 years (June 2019 to May 2022). Recruitment strategies included 1) face-to-face (FTF) recruitment at hospital clinics; 2) posting recruitment flyers in clinical settings; 3) completion of insomnia screening instrument at community clinic sites; 4) research registries; 5) institutional social media outreach; 6) community events; 7) PI interview and request for study volunteers in local newspaper; and 8) ongoing engagement and communication with recruited participants. Results 108 of 158 participants have been recruited and completed baseline surveys; 9 participants dropped out. To date, 42 of 49 (85.7%) participants have completed the 12-month study. June 2019 through December 2019 FTF recruitment occurred, where 104 were eligible and 32 (30.76%) were enrolled. Due to changes in study personnel and the COVID pandemic restricting access to in-person recruitment and enrollment, the study pivoted to develop protocols for electronic consent and enrollment using video conferencing. In addition, research databases, institutional social media, community events and local newspaper were utilized, where 76 of 239 (31.79%) interested participants enrolled. The most effective recruitment strategies included on-site FTF recruitment (57.9%) and local newspaper interview (13.88%). The local newspaper interview was the most cost-effective considering personnel costs associated with FTF recruitment. Conclusion Despite the onset of the COVID pandemic during the recruitment phase, we were able to pivot and employ innovative techniques to meet our targeted enrollment goal for the projected study deadline. FTF recruitment, perceived value by clinic staff in benefitting cancer survivors, and participants’ acceptance of video-conferencing were significant contributors. The importance of building and maintaining relationships with providers and nurses in local clinical sites cannot be underestimated. Support (If Any) This research was funded by R01 NR018215 (Dean) by the National Institute of Nursing Research.

Avoiding Allostatic Load: Black Male Collegians and the Quest for Well-Being

The literature suggests that African American/Black males are less likely to seek professional assistance for mental health and other personal concerns than African American/Black females and that they are more likely to seek informal help for mental health problems than professional help. Are there circumstances where African American/Black males would seek professional help over informal help? This research updates what is currently known about African American/Black male collegians’ help-seeking behaviors and the circumstances or conditions that might influence professional help-seeking. Secondary data illustrating the help-seeking behaviors of African American/Black male collegians at an urban HBCU was examined to identify patterns or trends during the first semester of 2018 and 2019. De-identified data sheets for 103 African American/Black males were examined to identify referral sources, current mental health concerns, and past mental health concerns. African American/Black male and female collegians sought professional assistance for similar concerns: family problems, couples problems, peer interpersonal problems, depression, anxiety, and stress. Black males were more likely to self-refer for professional assistance than seek informal assistance. Implications for university counseling centers are explored.

Referral patterns to a pediatric orthopedic clinic: pediatric orthopedic surgeons are primary care musculoskeletal medicine physicians

In 2004, Reeder and in 2012, Schwend reported that inappropriate nonsurgical referrals to pediatric orthopedic clinics create a misuse of resources. Additional authors have called for re-emphasis and additional training in musculoskeletal medicine for primary care physicians (PCP) to improve the confidence, knowledge and performance when managing musculoskeletal conditions. The current study compares the diagnoses referred to a pediatric orthopedic clinic with diagnoses recommended for referral by the American Academy of Pediatrics (AAP) guidelines to determine if any improvement in the quality of referrals has occurred since Reeder and Schwend's article. A chart review of new referrals to a pediatric orthopedic clinic during a 3-month-period was performed. Data were collected on age, sex, referring diagnosis, referral source, final diagnosis and treatment. In total 230 new consults were evaluated. The referral source was a PCP in 169 (73.5%) cases, 30 (13%) self-referrals by a parent, 19 (8.3%) from another orthopedic surgeon, 9 (3.9%) from a neurologist and 3 (1.3%) from another specialist. Fifty percent of referrals met the criteria outlined in the AAP guidelines for referral to a pediatric orthopedic specialist and 48% were classified as primary care musculoskeletal conditions. During the 15 years since the publication of Reeder's study and despite a limited re-emphasis on musculoskeletal education, the percent of inappropriate referrals to a pediatric orthopedic clinic remains unchanged at 50%. We support an expanded musculoskeletal educational effort aimed at the medical, resident and pediatrician level, online decision-making aids, and implementation of a standardized referral form with the specific criteria of the AAP included.

The Economic Growth Resilience Analysis Of Papua Province During The Covid-19 Pandemic

This study is: 1) To analyze the economic growth trends (PDRB ADHK 2010) of Papua Province during the Covid-19 pandemic, namely from 2020 to 2021. 2) To compare the economic growth of Papua province with other provinces during the period. This study used secondary data obtained through the website of the Central Statistics Agency, as well as Bank Indonesia. The analytical method used in this study is a qualitative descriptive analysis method. This research utilizes literature research to retrieve data and takes various sources of referrals that support this study. The results show that: 1) GDP growth rate from 2010 to 2020 was 2.39 percent, and 15.11 percent in 2021. The growth is significantly rapid when compared to 2019 at -15.74 percent. 2) Papua's economic growth is experiencing growth far beyond other provinces in Indonesia. Supported by the primary sector, namely mining and quarrying, which jumped by a high percentage of 29.92 percent. Not only from the primary sector, it turns out that the tertiary sector also contributed to growth, namely information and communication (5.35 percent), health services (5.17 percent), and the secondary sector, namely construction which grew 3.84 percent.Keywords: Economic growth rate, GDP, Covid-19.

Identifying key risk factors for premature discontinuation of opioid use disorder treatment in the United States: A predictive modeling study

BackgroundTreatment for opioid use disorder (OUD), particularly medication for OUD, is highly effective; however, retention in OUD treatment is a significant challenge. We aimed to identify key risk factors for premature exit from OUD treatment. MethodsWe analyzed 2,381,902 cross-sectional treatment episodes for individuals in the U.S., discharged between Jan/1/2015 and Dec/31/2019. We developed classification models (Random Forest, Classification and Regression Trees (CART), Bagged CART, and Boosted CART), and analyzed 31 potential risk factors for premature treatment exit, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. We stratified our analysis based on length of stay in treatment and service setting. Models were compared using cross-validation and the receiver operating characteristic area under the curve (ROC-AUC). ResultsRandom Forest outperformed other methods (ROC-AUC: 74%). The most influential risk factors included characteristics of service setting, geographic region, primary source of payment, and referral source. Race, ethnicity, and sex had far weaker predictive impacts. When stratified by treatment setting and length of stay, employment status and delay (days waited) to enter treatment were among the most influential factors. Their importance increased as treatment duration decreased. Notably, importance of referral source increased as the treatment duration increased. Finally, age and age of first use were important factors for lengths of stay of 2–7 days and in detox treatment settings. ConclusionsThe key factors of OUD treatment attrition identified in this analysis should be more closely explored (e.g., in causal studies) to inform targeted policies and interventions to improve models of care.

Trajectory of patients consulting the emergency department for high blood pressure values

ObjectivesEmergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients’ trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values.MethodsBetween 2018 and 2020, patients who presented to the Montreal Heart Institute’s ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals.ResultsA total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88–98%) possessed a home blood pressure device, among which 46% (95% CI 36–56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43–63%), advice of a lay person (19%, 95% CI 11–27%) or a nurse (13%, 95% CI 6–20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34–54%), having followed the recommendation of a third party (33%, 95% CI 24–42%), or having concerns about their medication (6%, 95% CI 1–11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64–83%) said yes.ConclusionsMost patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results.

The Relationship Between Body Mass Index and the Magnitude of Curve at Diagnosis of Adolescent Idiopathic Scoliosis: A Retrospective Chart Review.

PurposeTo evaluate the relationship between body mass index (BMI) and spinal curvature in patients presenting with idiopathic scoliosis at a major pediatric tertiary care centre.Patients and MethodsRetrospective chart review (2015–2019). Data extracted from patient’s first visit included age, sex, height, weight, spinal curvature (magnitude, location), referral source, physical activity participation (yes/no), pain (yes/no). Demographics were analyzed descriptively. The relationship between BMI and spinal curve magnitude was analyzed using Spearman correlation coefficient. Linear regression was applied to determine the relationship between BMI, curve magnitude, and curve location. Exploratory univariate analyses were conducted for BMI and referral source, pain, and skeletal maturity, and physical activity and pain.ResultsA total of 206 patient charts were included (177 females, 29 males). Patients presented with double major (41.3%), thoracic (26.7%), thoracolumbar (22.8%), and lumbar (9.2%) curves. Mean (SD) BMI percentile was 48.3 (30.5). No relationship existed between BMI percentile and curve magnitude with curve locations combined. However, a test for interaction revealed a positive relationship between BMI percentile and curve magnitude for adolescents with double major curves, and a negative relationship for adolescents with thoracic curves. Exploratory analyses suggested a relationship between BMI percentile and presence of pain, and between referral source and curve magnitude. No relationship was observed between BMI and skeletal maturity, or physical activity and pain.ConclusionThe relationship between BMI varied by curve location within this cohort, in which most patients presented with a BMI <85th percentile. Findings highlight the importance of sensitive history taking and careful physical examination for early detection of scoliosis.

Impact of the first lockdown related to the COVID-19 pandemic on ophthalmic emergencies in a French University Hospital

IntroductionAt the beginning of the COVID-19 pandemic, the French government implemented its first national lockdown between March and May 2020 in order to limit the dissemination of the virus. This historic measure affected patients’ daily lives and transportation, resulting in changes in the delivery of medical care, particularly emergency care. This study aimed to assess the impact of this restriction policy on the number and severity of ophthalmic emergencies seen in an ophthalmology emergency department.MethodsThis retrospective study conducted at the regional university Hospital of Tours included all patients presenting to the ophthalmology emergency department over four periods: lockdown (03/16/2020 to 05/10/2020), post-lockdown (05/11/2020 to 06/12/2020) and the two corresponding periods in 2019. The following data were recorded: sex, age, time of visit, reason for visit, diagnosis, severity of emergency graded on the BaSe SCOrE, time from first symptoms until visit, existence of a work-related injury, and referral source (ophthalmologist or other).ResultsA total of 1186 and 1905 patients were respectively included during the 2020 lockdown period and the corresponding period in 2019. The study populations for the 2019 and 2020 post-lockdown periods consisted of 1242 and 1086 patients respectively. During the lockdown, the number of consultations decreased significantly (−37.7%), affecting mild and severe emergencies similarly. During the post-lockdown period, the number of emergencies gradually increased but did not reach the level of the corresponding period in 2019 (−12.6%).ConclusionThe first French lockdown resulted in a significant decrease in ophthalmic emergency visits, similar for all levels of severity. All age groups were impacted similarly, without the expected exaggerated decrease for patients over 50 years of age, who are considered to be at greater risk for developing a severe form of COVID-19. The post-lockdown period showed a gradual increase in ophthalmic emergency visits, although these remained fewer than the previous year.

Elements of Learning and Integration of Diagnostic Musculoskeletal Ultrasound Imaging Into Practice: Physical Therapists' Educational Journeys

Introduction. Physical therapists (PTs) have the autonomy and expertise to assume a more significant role in the primary care of musculoskeletal conditions, validate diagnoses, and serve as a referral source to appropriate health care providers. Ultrasound diagnostic imaging has been identified as a high-priority area to advance science and innovation in physical therapy. Yet, few PTs are certified to incorporate musculoskeletal ultrasound (MSK-US) as a diagnostic tool into their personal scope of practice. Diagnostic MSK-US has unique benefits compared with other imaging modalities, and recent technological advances have reduced its cost and improved portability. However, no research exists describing the learning experiences and decision-making process of PTs who use MSK-US for diagnostic purposes. In addition, the educational process for learning MSK-US is not standardized. The study's purpose was to describe the learning and practice-based use of MSK-US by PTs registered in musculoskeletal sonography (RMSK). Methods. Using purposive sampling, we attempted to recruit all 21 RMSK-certified PTs currently using diagnostic ultrasound in clinical practice across the United States. Sixteen PTs participated in the study. We employed a qualitative, multiple case study, phenomenological approach. Data were collected using an online demographic survey and one-on-one, semi-structured interviews. Results. Sixteen interviews were conducted with RMSK-certified PTs. Data synthesis resulted in 5 elements: 1) self-directed learning; 2) educational process; 3) honing the skill and the role of mentorship; 4) diagnostic information; and 5) clinical application. Discussion and Conclusion. Participants identified elements critical for post-entry level, life-long, applied learning and integrating diagnostic MSK-US into clinical practice. The participant learning process was self-directed and incorporated various materials and methods to improve diagnostic skills. Participants honed their skills through repetition and one-on-one mentorship. Supportive employment settings were integral for creating environments conducive to learning and integrating MSK-US into clinical practice. Our participants perceived that ultrasound imaging provided them with the missing visual dimension used to improve diagnostic capabilities, supporting the benefits of direct access.

Use of a hybrid teledermatology model in an Australian tertiary hospital during the COVID-19 pandemic

To the Editor: The COVID-19 pandemic has led to the adoption of teledermatology by health services across the world. There is increasing support for the use of teledermatology in the outpatient setting; however, its role in inpatient and emergency settings is less established. We reported the use of teledermatology in inpatient and emergency settings at the Dermatology Department, St George Hospital, a tertiary center in Sydney, Australia. Inpatient and emergency consultations are conducted at our institution by 1 of 2 staff dermatologists per day and 1 hospital-based dermatology resident. A hybrid model of inpatient teledermatology consultations was established prior to the COVID-19 pandemic. All referrals would be seen face to face by the dermatology resident to ensure relevant history, and high-quality clinical and dermatoscopic photographs would be taken. The referrals would then be summarized and sent to the on-call dermatologist, who would provide an impression and plan for the resident to enact. For severe or life-threatening cases, the on-call dermatologist would also attend the face-to-face consultation. This system involved both synchronous and asynchronous models depending on the triaging of consultations performed by the dermatology resident. To avoid the exposure of the on-call dermatologists to COVID-19, which would subsequently shut down the provision of dermatology services to both outpatient and inpatient or emergency services, this hybrid model of inpatient teledermatology was maintained during the pandemic, and outpatient clinics were converted to teledermatology for large proportions of 2020 and 2021. Using this hybrid approach, our dermatology service avoided any shut down periods due to the exposure of the 2 on-call dermatologists to COVID-19. The main exposure site for COVID-19 was the emergency department, and this was the main source of inpatient referrals (Fig 1). There was no statistically significant difference (P > 0.05, Student t test) in the number of inpatient consultations seen between pre-COVID-19 2019 (n = 295; mean, 27 consultations per month; SD, 10.9) and 2020 (n = 305; mean, 25 consultations per month; SD, 6.3) or 2021 (n = 323; mean, 27 consultations per month; SD, 8.1).1Ho G. Blake S.C. Sheriff T. Daniel B.S. Murrell D.F. Impact of COVID-19 on inpatient dermatology consults in an Australian tertiary hospital.Australas J Dermatol. 2021; 62: 427-428Crossref PubMed Scopus (3) Google Scholar This may have been due to the establishment of the hybrid model of inpatient teledermatology. In 2021, 70% of inpatient consultations had a treatment plan provided to the referring team within the same day of referral. The role of teledermatology to increase the efficiency of inpatient consultations was described prior to the COVID-19 pandemic, with reduction in the time taken for inpatient medical teams to receive advice from dermatology consultants.2Sharma P. Kovarik C.L. Lipoff J.B. Teledermatology as a means to improve access to inpatient dermatology care.J Telemed Telecare. 2016; 22: 304-310Crossref PubMed Scopus (25) Google Scholar Concordance in investigations and treatment plans between teleconsultations and face-to-face consultations has also been described.3Keller J.J. Johnson J.P. Latour E. Inpatient teledermatology: diagnostic and therapeutic concordance among a hospitalist, dermatologist and teledermatologist using store-and-forward teledermatology.J Am Acad Dermatol. 2020; 82: 1262-1267Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar,4Gabel C.K. Nguyen E. Karmouta R. Liu K.J. Zhou G. Alloo A. Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.J Am Acad Dermatol. 2021; 84: 1547-1553Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The COVID-19 pandemic has seen wider adoption of teledermatology services.5Loh C.H. Tam S.Y. Oh C.C. Teledermatology in the COVID-19 pandemic: a systematic review.JAAD Int. 2021; 5: 54-64Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The experience of our department supports the use of teledermatology for efficient delivery of care that has been stable throughout the COVID-19 pandemic. Our experience supports use of a hybrid model of teledermatology rather than a virtual model and can be applied in other parts of the world. None disclosed.

Patient Comments on a Hospital- and University-Based Exercise Oncology Program.

The purpose of this study was to identify referral source and patient-reported factors that promoted follow-through and participation in exercise oncology rehabilitation programs. A three question open-ended survey was administered to patients enrolled in trainer-supervised, hospital-based (n = 101), or university-based (n = 17) cancer rehabilitation program that provided 12weeks of individualized one on one aerobic and resistance training 1-3days per week. Significant themes for each question were as follows: Question #1. Who referred you to the program/facility? Oncology team (Χ2 = 145.814 P ≤ 0.001); Question #2. What convinced you to follow through with the referral? Health, fatigue, and need for supervision (Χ2 = 74.814 P ≤ 0.001); and Question #3. What motivates you to continue in the program? Personal results, getting healthy, and the trainer (Χ2 = 108.729 P ≤ 0.001). In this study, oncology team referral confirms previous work. Patient follow-through and continuation appear largely self-motivated as patients' health and the attainment of health through personal results are primary motivators for continuation in the program. Question #3 responses note the importance of the trainer in maintaining continuation in an exercise oncology rehabilitation program.

Anatomy of a Transcatheter Mitral Valve Service.

Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of developing and running a purpose-built transcatheter mitral service. The nature and number of referral sources, the multi-disciplinary make-up of the dedicated Mitral Heart Team and the use of integrative imaging assessment with incorporation of computational solutions are discussed. In addition, a summary of the clinical decision-making process is presented. This report sets out a framework from which future clinics can evolve to improve and streamline the delivery of transcatheter mitral therapies.

Examination of care processes and treatment optimization for head and neck cancer patients in a community setting "hub and hub" model.

ObjectiveTo examine referral pattern, the timing of diagnostic/staging processes, and treatment initiation for new head and neck cancer patients in a community setting.MethodsPatients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020. Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation.ResultsOne hundred and five patients were included in the study. The primary referral sources were external general otolaryngology (56.3%). Oral surgery and dermatology obtained tissue biopsy approximately 80% of the time before referral. The average time from the ordering of initial staging positron emission tomography/computed tomography to finalized results was 14 days (range: 10–25 days). Patients referred from dermatology and oral surgery were more likely to require single modality care, namely definitive surgical management. Time to treatment initiation average was 37 days (range: 29–41 days). Patients with longer treatment times noted significantly higher times to both radiation and medical oncology consults (48.42 vs. 18.13 days; P < 0.001).ConclusionsNo notable differences in treatment initiation times were identified based on referral source or extent of workup performed before head/neck surgery consult. It appears the largest opportunities for improvement in terms of reducing overall treatment length exist in the optimization of radiation initiation time.

Submucous Cleft Palate (SMCP): Indications and Outcomes of Radical Muscle Dissection Palatoplasty in Children Under 4 Years of Age.

To delineate the indications, referral sources and outcomes of radical muscle dissection palate repair in the first 4 years of life for patients with submucous cleft palate (SMCP). This study presents a retrospective analysis of a single surgeon's management. All children were treated at Great Ormond Street Hospital, United Kingdom. Twenty-three children with nonsyndromic SMCP were included in this study. All participants underwent radical muscle dissection repair before their fourth birthday. Parameters analyzed included: referral sources, indications for referral, extent of anatomical abnormality, and postoperative outcomes. Paediatricians provided the largest proportion of referrals to the cleft lip and palate clinic (39%) due to the presence of cleft lip/palate on prenatal scans or during neonatal examination. Over half (n = 12, 52%) of patients had severe anatomical anomalies being in grade IV (score 8-9), with the classical triad present to some extent in all but 2 of the patients. The main indication for surgery was nasal regurgitation of food and liquid (n = 9, 35%) followed by hypernasality (n = 6, 21%), difficulty feeding (n = 3, 8%), and severe anatomical defect (n = 2; 4%). Postoperatively, the presenting complaint improved in the majority of cases. Nonsyndromic SMCP is often missed, though may present with nasal regurgitation, feeding problems, and/or hypernasality, though may be missed in nonsyndromic children. Early radical muscle dissection repair in the first 4 years of life is safe and effective, facilitating normal speech development.

How Does the Adoption of Ad Blockers Affect News Consumption?

Ad blockers allow users to browse websites without viewing ads. Online news publishers that rely on advertising income tend to perceive users’ adoption of ad blockers purely as a threat to revenue. Yet, this perception ignores the possibility that avoiding ads—which users presumably dislike—may affect users’ online news consumption behavior in positive ways. Using 3.1 million visits from 79,856 registered users on a news website, this research finds that ad blocker adoption has robust positive effects on the quantity and variety of articles users consume. Specifically, ad blocker adoption increases the number of articles that users read by 21.0%–43.2%, and it increases the number of content categories that users consume by 13.4%–29.1%. These effects are stronger for less-experienced users of the website. The increase in news consumption stems from increases in repeat visits to the news website, rather than in the number of page impressions per visit. These postadoption visits tend to start from direct navigation to the news website, rather than from referral sources. The authors discuss how news publishers could benefit from these findings, including exploring revenue models that consider users’ desire to avoid ads.

Addressing Access to Care in Geriatric Psychiatry through Outpatient Consultation

<h3>Introduction</h3> Article 31 clinics, under the regulation of the Office of Mental Health, have limitations in the patients that are able to be seen. In particular, patients with a primary diagnosis of neurocognitive disorder are considered ineligible for admission to such a clinic. Furthermore, many of the patients that would seek treatment at Montefiore Medical Center's Outpatient Psychiatry clinic, an Article 31 clinic, would not be able to afford private practice psychiatrists. Nevertheless, older adults with neurocognitive disorder experience symptoms that are typically managed by psychiatrists. In response to this gap in care, the Outpatient Geriatric Psychiatry team at Montefiore Medical Center developed an outpatient psychiatric consultation service to increase access to care and meet the mental health care needs of older adults living in the community. This service is provided under an Article 28 clinic, which is regulated by the Department of Health like any other medical specialty clinic. In this study, we aimed to identify which patients benefited from this service, what types of interventions were made and the impact on referring providers. This was done by collecting demographic data on patients referred for consultation and the format, frequency, and outcomes of these consultations. We also plan to collect feedback from referring providers. <h3>Methods</h3> The Geriatric Psychiatry outpatient consultation service started in December 2019 and conducted visits in person for 3 months, stopped during the 3 months of lockdown due to the COVID-19 pandemic (March to June 2020), restarted with virtual visits in July 2020 and then resumed with in person visits. Patients are referred by other providers in the Montefiore Health System or through self-referral. Patients are then screened for appropriateness for outpatient consultation. Patients who are ≥65 years old or have an underlying medical condition that contributes to their frailty, and who have a psychiatric concern are scheduled for an appointment. Efforts are made to direct those who are not appropriate for the service to more appropriate resources. In a retrospective chart review, data was gathered on patient age, referral source and reason for referral, diagnosis, format and number of visits, and outcomes of interest including medication changes, supportive services, and higher level of care. <h3>Results</h3> From December 2019 through September 2021, 38 patients were scheduled, 32 of whom presented to clinic for psychiatric evaluation. Patients ranged from 61 to 93 years old with a mean age of 79 years. A majority of patients were from ethnically diverse backgrounds with 59% Hispanic, 12.5% Black, 3% Asian and 3% American Indian. 50% of patients were Spanish speaking. About half the visits were conducted in person, with the remaining visits about evenly split between phone and video. Patients on average were seen for about 2 visits with a range from 1 to 11 visits. Most of the referrals came from primary care providers and among the reasons for referral were decline in function or cognition, behavioral concerns, depressed or anxious mood and psychosis. About 87.5% of patients had a diagnosis of major or minor neurocognitive disorder diagnosis. The most common interventions included medication changes, referral to support services, behavioral interventions, transfer to the outpatient department or sending for evaluation in the emergency department. <h3>Conclusions</h3> The Geriatric Psychiatry consultation service provided through an Article 28 clinic was primarily used by patients with neurocognitive disorders who would otherwise not be seen in Article 31 outpatient psychiatry clinics and would not be able to afford private practice. Through this service we were able to address a gap in care for a diverse and underserved patient population. In order to further assess the impact of this service, we plan to ask referring providers for feedback about the process of referral, the evaluations conducted and the recommendations received for their patients. Future studies would be helpful to collect prospective data on patients being followed by consultation service and additionally obtain patient and caregiver feedback. <h3>This research was funded by</h3> N/A Chart: https://apps.aagponline.org/abstracts/uploads/2022/gpn8zt4h8w464zu.pdf