Specialist Consultation Research Articles

Overuse of diagnostic, therapeutic, and consultative services among hospitalized patients approaching the end of life.

e23093 Background: Patients with cancer approaching the end of life (EOL) often undergo multiple diagnostic and therapeutic interventions, many of which do not contribute to improved patient outcomes or quality of life, and may cause unintended harm. Hospitalizations at the EOL are associated with costly and aggressive treatment. This study aims to evaluate the extent of overuse of procedures among hospitalized patients with cancer and identify factors contributing to non-beneficial care at the end of life. Methods: A retrospective cohort study was conducted at Columbia University from May 1, 2023 to June 30, 2024. We included patients with cancer age 18 or older who died during or within 14 days of hospitalization on the solid tumor oncology service. Data were collected on interventions received during the final hospitalization of life, including laboratory tests, imaging studies, intravenous chemotherapy, parenteral nutrition, subspecialist consultations, and documentation of advanced directives. Overuse was defined as interventions that did not result in clinically meaningful benefit or direct changes in management. Descriptive statistics were used to report frequencies of interventions, while [bivariate analyses assessed associations with patient characteristics (e.g., cancer type, age, performance status)]. Results: A total of 261 patients with cancer were included in the study. On average, patients received multiple and often repetitive interventions in the final two weeks of life. In total the cohort underwent 101,452 individual laboratory tests (maximum tests for an individual during a 14-day period = 2769); the mean, was 21.5 laboratory tests per-day (maximum 128 tests per day). A total of 16 patients (6.1%) received chemotherapy during their hospitalization and 15 (5.7%) received parenteral nutrition. Specialist consultations (excluding Palliative Care) were requested for 202 patients(77.0%, maximum unique consultations 10). Conclusions: Diagnostic, therapeutic, and consultative overuse is common in the final two weeks of life for hospitalized patients with cancer. These interventions, often not aligned with end-of-life care goals, may contribute to patient distress without improving outcomes. There is a need for clearer guidelines and directed clinician education on appropriate scope and frequency of interventions during hospitalizations at the EOL for patients with advanced malignancy.

Bridging the gap: Cancer care outcomes and social determinants of health in the Rio Grande Valley (RGV), a south Texas border region—A county-level analysis (2017-2021).

e13801 Background: The Rio Grande Valley (RGV), a region in South Texas along the U.S.-Mexico border encompassing Cameron, Hidalgo, Starr, and Willacy counties, faces significant disparities in cancer outcomes, driven by inequities in social determinants of health (SDOH). Limited access to cancer care, fueled by poverty and unemployment, contributes to higher mortality-to-incidence ratios (MIR). This study examines the relationship between SDOH and cancer outcomes to inform targeted interventions aimed at reducing disparities. Methods: Using data from the Texas Cancer Registry and the American Community Survey (2017–2021), we analyzed MIR alongside SDOH indicators, including poverty (< 150% FPL), unemployment, broadband access, education, housing cost burden, and single-parent households. Statistical analyses, including correlation and regression (SPSS), were conducted to identify significant SDOH-MIR relationships (p < 0.05). Results: Poverty (r = 0.85, β = 0.45, p< 0.001) and limited broadband access (r = 0.75, β = 0.25, p= 0.005) emerged as the strongest predictors of elevated MIR, with unemployment (β = 0.35, p< 0.001) and low education (β = 0.20, p= 0.010) also contributing. Willacy County had the highest MIR (0.40), driven by extreme poverty (42.4%) and broadband gaps (32.3%). Hidalgo County, despite high poverty (42.8%), had the lowest MIR (0.31), likely due to better broadband access (23.6%). Starr County’s extreme poverty (50.0%) and unemployment (12.1%) contributed to its MIR (0.32), while Cameron County’s MIR (0.33) aligned with mid-range SDOH metrics. Conclusions: This study highlights the critical role of SDOH in shaping cancer outcomes, emphasizing the need for integrated, equity-focused interventions. Expanding broadband infrastructure to enable telemedicine—such as remote screenings and specialist consultations—can address access barriers in underserved areas. Additionally, addressing low educational attainment, as seen in areas with high percentages of individuals without a high school diploma, is crucial for improving health literacy and enabling patients to navigate complex cancer care systems. Poverty-alleviation strategies, including financial navigation and Medicaid expansion, are essential to reduce treatment delays and financial toxicity. By embedding SDOH screening into oncology workflows and leveraging data-driven tools for risk-stratified care, we can advance health equity in high-risk regions. Initiatives like Project ECHO, which create hub-and-spoke telehealth networks to mentor local providers, can strengthen capacity for early detection and treatment in rural and underserved areas. These findings provide a scalable blueprint for reducing late-stage diagnoses and improving survival, offering a pathway to eliminate disparities in cancer care in the RGV.

Factors affecting turnaround time in the emergency room

Objectives Timely and efficient treatment of patients with acute medical disorders depends on the efficient management of emergency healthcare services in the emergency room (ER). Turnaround time (TAT), which is the amount of time between a patient’s arrival and their discharge or admission, is a crucial indicator of the overall efficacy of the emergency care system because longer hospital stays are associated with higher treatment costs and worse patient satisfaction, particularly when they are exacerbated by an increase in the number of patients receiving care.The aim of this study was to conduct a thorough analysis of the ER TAT, pinpoint the underlying reasons, and provide evidence-based tactics for streamlining and improving the process. Material and Methods A cross-sectional observational study was conducted on patients who were admitted to the emergency department of a tertiary care private teaching hospital during the study period. TATs were computed using time-stamped data, electronic health records, and patient information. To better understand the difficulties related to workflow and potential areas for improvement, a questionnaire-based interview of ER staff members, which included physicians, nurses, and administrative workers, was done. Results The average length of stay (LOS) of the study population in the ER was under the recommended standard of 4 hours. The patient’s third-party administrator (TPA) status had influenced the patient’s response time for decision-making resulting in longer LOS of the patient in the ER. A delay in receipt of test results from the central laboratory and specialists’ consultation has been observed. A communication gap between the emergency staff and specialists for consultation has been reported by the staff. Conclusion Based upon these observations, we conclude that TAT can be shortened by introducing small reforms such as enhancing duty rosters for improved collaboration, continuous training for emergency staff proficiency, and establishing a satellite laboratory for expedited test results

The views of women and their physicians on decision-making for stress urinary incontinence

IntroductionTreatment decisions for stress urinary incontinence (SUI) are preference sensitive, because the disease is non-lethal and there are multiple reasonable treatment options. However, little is known about patients’ and physicians’ preferred decision-making styles for SUI. To aid physicians in their counselling and decision-making in consultations for SUI, we studied patients’ and physicians’ preferred and perceived decision-making in medical specialist consultations for SUI. MethodsThis mixed-methods study combined the validated control preference scale (CPS) and the CPS perception version, and semi-structured, in-depth interviews with both patients and physicians. This study took place in Canada, the United Kingdom and the Netherlands. Sixteen physicians from all three countries and seventeen women from the Netherlands and Canada were interviewed.ResultsAll women expressed a preference for being involved in the decision-making process, either by informative or shared decision-making (SDM) in the CPS, because they valued the autonomy to make their own choice regarding treatment for SUI and appreciated receiving information and advice from their doctor. Physicians also preferred an involved patient, but used medical expertise to steer towards their preferred treatment option. Physicians found SDM difficult to understand, expressing different interpretations.ConclusionsSDM is not a precise concept either for patients or physicians, with multiple interpretations. All patients with SUI want to be involved in the decision-making process, either by informative or by shared decision-making. Physicians both express the desire to involve patients in their decision making, but conversely to steer patients towards the decision that they feel suits them best.

The Impact of Epidemiological Trends and Guideline Adherence on Candidemia-Associated Mortality: A 14-Year Study in Northeastern Italy.

Invasive candidiasis represents a major global health concern, with incidence and mortality rates expected to rise due to medical advancements and unavoidable risk factors. This retrospective, multicentric study was conducted in eight hospitals in a northeastern Italian region, enrolling adult patients diagnosed with candidemia from 1 January 2018 to 31 December 2022. Epidemiological trends and clinical characteristics were analyzed and compared to those from a prior regional study (2009-2011), allowing a fourteen-year comparative evaluation. A shift in species distribution was observed, with a decline in Candida albicans (from 65.7% to 57.8%) and a rise in non-albicans species, particularly the Candida parapsilosis complex (from 16.1% to 18.2%). Guideline adherence was assessed applying the EQUAL Candida score; scores ≥ than 11.5 were independently associated with improved in-hospital survival (HR 3.51, p < 0.001). Among individual score components, empiric echinocandin therapy and central venous catheter removal correlated with better outcomes. Centers with routine infectious disease (ID) consultations showed higher survival and adherence, reinforcing the value of specialist involvement. These findings support local epidemiological and management practice surveillance program adoption to address context-specific gaps, promote the adoption of best practices in Candida BSI management-as expanded ID specialist consultations and education programs-and, ultimately, reduce candidemia-related mortality rates.

Data-Driven Defragmentation: Achieving Value-Based Sarcoma and Rare Cancer Care Through Integrated Care Pathway Mapping.

Sarcomas, a rare and complex group of cancers, require multidisciplinary care across multiple healthcare settings, often leading to delays, redundant testing, and fragmented data. This fragmented care landscape obstructs the implementation of Value-Based Healthcare (VBHC), where care efficiency is tied to measurable patient outcomes.ShapeHub, an interoperable digital platform, aims to streamline sarcoma care by centralizing patient data across providers, akin to a logistics system tracking an item through each stage of delivery. ShapeHub integrates diagnostics, treatment records, and specialist consultations into a unified dataset accessible to all care providers, enabling timely decision-making and reducing diagnostic delays. In a case study within the Swiss Sarcoma Network, ShapeHub has shown substantial impact, improving diagnostic pathways, reducing unplanned surgeries, and optimizing radiotherapy protocols. Through AI-driven natural language processing, Fast Healthcare Interoperability Resources, and Health Information Exchanges, HIEs, the platform transforms unstructured records into real-time, actionable insights, enhancing multidisciplinary collaboration and clinical outcomes. By identifying redundancies, ShapeHub also contributes to cost efficiency, benchmarking treatment costs across institutions and optimizing care pathways. This data-driven approach creates a foundation for precision medicine applications, including digital twin technology, to predict treatment responses and personalize care plans. ShapeHub offers a scalable model for managing rare cancers and complex diseases, harmonizing care pathways, improving precision oncology, and transforming VBHC into a reality. This article outlines the potential of ShapeHub to overcome fragmented data barriers and improve patient-centered care.

Hidden MODY in Young Lean Women with Mild Glucose Intolerance Detected During Health Check-ups: Potential for Improved Pregnancy Outcomes Through Preconception Care

Mild glucose intolerance (positive urine glucose or mild hyperglycemia) during health checkups in young, lean women may require specialist consultation. We herein report a 31-year-old Japanese woman with mild hyperglycemia detected during a checkup who was diagnosed with overt diabetes in pregnancy and HNF4A-MODY postpartum, without prior follow-up. This case highlights the following: MODY may be present in young, lean women with mild glucose intolerance, and preconception care may improve pregnancy outcomes. Fetal outcomes vary with MODY subtype. Preconception care is important.

Performance of AI-Chatbots to Common Temporomandibular Joint Disorders (TMDs) Patient Queries: Accuracy, Completeness, Reliability and Readability.

TMDs are a common group of conditions affecting the temporomandibular joint (TMJ) often resulting from factors like injury, stress or teeth grinding. This study aimed to evaluate the accuracy, completeness, reliability and readability of the responses generated by ChatGPT-3.5, -4o and Google Gemini to TMD-related inquiries. Forty-five questions covering various aspects of TMDs were created by two experts and submitted by one author to ChatGPT-3.5, ChatGPT-4 and Google Gemini on the same day. The responses were evaluated for accuracy, completeness and reliability using modified Likert scales. Readability was analysed with six validated indices via a specialised tool. Additional features, such as the inclusion of graphical elements, references and safeguard mechanisms, were also documented and analysed. The Pearson Chi-Square and One-Way ANOVA tests were used for data analysis. Google Gemini achieved the highest accuracy, providing 100% correct responses, followed by ChatGPT-3.5 (95.6%) and ChatGPT-4o (93.3%). ChatGPT-4o provided the most complete responses (91.1%), followed by ChatGPT-03 (64.4%) and Google Gemini (42.2%). The majority of responses were reliable, with ChatGPT-4o at 93.3% 'Absolutely Reliable', compared to 46.7% for ChatGPT-3.5 and 48.9% for Google Gemini. Both ChatGPT-4o and Google Gemini included references in responses, 22.2% and 13.3%, respectively, while ChatGPT-3.5 included none. Google Gemini was the only model that included multimedia (6.7%). Readability scores were highest for ChatGPT-3.5, suggesting its responses were more complex than those of Google Gemini and ChatGPT-4o. Both ChatGPT-4o and Google Gemini demonstrated accuracy and reliability in addressing TMD-related questions, with their responses being clear, easy to understand and complemented by safeguard statements encouraging specialist consultation. However, both platforms lacked evidence-based references. Only Google Gemini incorporated multimedia elements into its answers.

Retaining doctors in organisations in socioeconomically deprived areas in England: a qualitative study.

To identify factors that improve retention in under-doctored areas that experience difficulties in maintaining sufficient medical workforce. Qualitative study based on semi-structured interviews, collected as part of a larger study. Four purposely sampled geographic case study sites in England. Three case study sites were selected as areas that struggled to recruit and retain doctors and one as an area that is oversubscribed. This comprised 27 NHS Trusts, plus 1449 GP practices. 100 National Health Service (NHS)-employed doctors (including general practitioners, consultant specialists, specialty and specialist doctors, resident doctors/doctors in postgraduate training and locally employed doctors) were interviewed between December 2022 and March 2024. Participants shared their experiences of organisational levers that impact on decisions about working life and retention in the workforce. Two key themes explained factors influencing retention. First, participants discussed feeling valued by the organisation, both in terms of material circumstances and in relationships with colleagues. Second, the theme of autonomy and opportunity explored why doctors chose to stay in areas that typically experience difficulties in maintaining sufficient staffing. Many studies focusing on workforce examine why staff leave, but by focusing on factors that influence retention, greater understanding of specific facets of organisational culture can be used to inform policy and practice. ISRCTN95452848.

Impact of time-of-shift on diagnostic service requests in a pediatric emergency department: a retrospective study.

The demand for medical services and its burden on the healthcare system is worldwide increasing. Factors influencing service requests are still partially unknown. Extended shifts may impair decision-making, potentially affecting the request for ancillary diagnostic procedures. This study aimed to investigate the association between the time-of-shift and the rate of diagnostic service requests in pediatric emergency settings. This single-center observational study was conducted at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The study included patient visits on weekends and public holidays. Data on blood tests, specialist consultations, and imaging requests were extracted. The shift was divided into the first 8h and the last 4h, and diagnostic service requests were analyzed using mixed-effects logistic regression models, adjusting for patient urgency and number of patients per shift. A total of 5370 visits were analyzed. At least one ancillary diagnostic procedure was requested in 31% of the visits. There was a 14% higher probability (p = 0.04) of requiring ancillary diagnostic procedures during the last 4h of shifts compared to the first 8h. This probability increased to 20% (p = 0.02) considering exclusively the dayshift. These findings suggest a potential role of shift duration on diagnostic service requests, warranting further multicenter studies to explore this association across various healthcare settings.

Treatment Barriers for Pediatric and Adult Patients with Chronic Granulomatous Disease

Introduction The lifespan of patients with chronic granulomatous disease (CGD) has increased with the use of prophylactic medications. Despite a reduction in infections, however, patients rely on lifelong medications and remain at risk of severe infections and immune dysregulation. While hematopoietic stem cell transplantation (HSCT) and gene therapy now offer curative options with improved safety profiles, barriers to accessing these definitive therapies remain poorly characterized. Objective This study aimed to determine the rates of prophylactic and definitive treatment therapies in pediatric and adult patients with CGD and identify barriers to their implementation. Methods We conducted an IRB-approved cross-sectional survey study of 76 CGD patients (41 adults and 35 children). Participants were recruited through national patient advocacy organizations (Immune Deficiency Foundation and CGD Association of America) and an academic immunology center in Northern California. The survey, created with input from AAAAI PID committee, patients, and advocates, assessed treatment history, healthcare experiences, and perceived barriers to care. Descriptive statistics and chi-square analyses were performed. Results Mean ages were 12 years (pediatric) and 40 years (adult). Notably, 15.5% (n = 11) of patients lacked antimicrobial prophylaxis, and 32.9% (n = 25) had never received IFNg therapy, with 48% (n = 12) reporting no provider discussion. Only 17.3% (n = 13) of participants had undergone HSCT, predominantly children (69.2%, n = 9). Among the non-transplanted subjects, 68.3% (n = 43) had never received transplant specialist consultation. Despite the limited racial and ethnic diversity, 43% (7/16) of non-white participants considered HSCT unlikely for them. Primary barriers included physician expertise (32.0%), cost (28.0%), and equally distributed factors (12% each), including lack of information, geographic distance, physical limitations, and medication side effects. Conclusion Despite advances in HSCT safety and efficacy, significant disparities exist in accessing definitive therapy for CGD, particularly among adults and racial/ethnic minorities. Identified barriers suggest the need for improved provider education, healthcare navigation support, and targeted interventions to address demographic disparities. Future research should focus on developing systematic approaches to expand access to transplant evaluation and address socioeconomic barriers to definitive therapy.

The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study.

The benefits of a fully integrated electronic medical record (EMR) system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians, specialist physicians, and other health care providers. This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination. A comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians' perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings. The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (P<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08% and 39.7%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37). Our study's results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature.

Cost-effectiveness analysis of child development evaluation test (CDE test or Prueba EDI) in children under 5 years old in Mexico: a simulation model study.

The Health Ministry has incorporated the Child Development Evaluation test (CDE test) as the national screening tool for children < 5 years old. The aim of this study is to analyze the cost-effectiveness of the CDE test compared to standard medical consultation in Mexico. The study was conducted with information available until 2020. A cost-effectiveness analysis was conducted from perspective of the public/social sectors in Mexico with a decision tree model to evaluate the strategies. The time horizon was set at 1 year, no discounting applied. Costs were calculated in Mexican pesos (MXN) at 2019 prices and included both direct/indirect costs. Direct costs encompassed CDE test administration, specialist consultations, and rehabilitation sessions. Indirect costs considered transportation expenses and lost wages related to caregiving. To account for variability and uncertainty, a Monte Carlo simulation with 10,000 iterations was performed. Probabilistic sensitivity analysis was conducted to test robustness of the results. The results confirm that the CDE test consistently outperforms the standard approach, delivering improved outcomes at reduced costs in the majority of scenarios. The incremental net monetary benefit of implementing CDE screening was $44,608 MXN (2019 value), providing additional evidence of its cost-effectiveness. This study suggests that the CDE test is cost-saving from the public and social sector perspective, generating a net increase in both monetary benefits and health outcomes. Furthermore, its implementation is feasible within the Mexican healthcare system, particularly considering its potential to enhance long-term efficiency.

Examination of Plastic Surgery Clinical Questions and Responses via an Electronic Consultation (eConsult) Service.

Introduction: Average wait times for plastic surgery depend on priority, but access to specialist consultation can be upwards of 1-2 years for elective referrals. The Champlain eConsult BASE™ system was developed in 2010 and is a PHIPA-compliant system that allows primary care providers to electronically send specialists questions about specific patients, potentially avoiding the need for a formal in-person consultation. Methods: Electronic Consults (eConsults) through the Champlain eConsult BASE™ system to plastic surgery from January 2021 to December 2022 were assessed by 2 reviewers. A standardized data extraction form was used, categorizing consults for question type and clinical problem. A mandatory close-out survey allowed for analysis on referring physician satisfaction, referral outcome, and impact on patient care. Results: Three hundred and thirty-one eConsults were included and were answered in an average of 2.1 ± 3.1 days. Specialists spent a mean of 14.0 ± 5.7 minutes per case. The most common content of the consults was related to hand trauma (37%), non-hand skin/soft tissue lesions (13%), and hand masses/lesions (bony or soft tissue) (8%). A formal consultation was avoided in 32%. Thirty-nine percent of cases resulted in a change in management: a referral to plastic surgery was avoided but originally contemplated by the family physician in 32%, and a referral was recommended but not originally contemplated in 7%. Conclusions: Our study demonstrates the potential of eConsults to facilitate timely consultation and avoid unnecessary formal consultations with plastic surgeons. This may reduce wait times and improve access to plastic surgeon services.

Teleconsultations' Impact on Referral Streamlining and Waitlist Reduction: A Large-Scale Retrospective Cohort Study of Over 200,000 Cases.

Introduction: Long waiting lists for elective medical consultations present significant challenges within health care systems globally. Remote consultation (teleconsultation) between a primary care physician and a specialist doctor can resolve some of these demands, reducing waiting lists. This study aims to evaluate the effectiveness of teleconsultations in reducing unnecessary specialist referrals and waitlist time within the referral process with primary care doctors. Methods: A retrospective cohort study was conducted from January 2017 to December 2019. The regulation process of specialized consultations waiting lists was made by two groups: (1) those regulated by RegulaSUS associated with the provision of teleconsultation and (2) those regulated by the usual procedures of the Ambulatory Regulation Center of the State of Rio Grande do Sul (contemporaneous controls group). The primary outcome evaluated the proportion of patients managed within primary health care (PHC) without requiring in-person specialist care, and the waitlist times during the regulation process were compared between the different groups. Results: The analysis encompassed 245,643 referral requests for specialized consultations across 23 medical specialties. The RegulaSUS project reduced the need for in-person specialized medical consultation by 29% (31.6% vs. 44.5%, p < 0.001). The median waitlist time was 1,140.4 (interquartile range [IQR], 1,393.6-476.6) days in individuals in the RegulaSUS and 1,271.0 (IQR, 778.4-1,723.0) control (p < 0.0001). Discussion: The RegulaSUS teleconsultations demonstrated an effective approach to increasing the resolution of primary care physicians, reducing unnecessary specialist referrals, and reducing waitlist time for specialized medical consultations. This initiative is a model for efficient referral management, prioritizing patients needing specialized care while optimizing health care resource allocation in PHC settings.

Health care organization for gynecologic oncology patients fleeing Ukraine: Insights from the European Network of Young Gyne Oncologists survey during the first six months of the military conflict.

Health care organization for gynecologic oncology patients fleeing Ukraine: Insights from the European Network of Young Gyne Oncologists survey during the first six months of the military conflict.

602 Delayed in Specialized Acute Burn Care in a Single Hospital in Puerto Rico

Abstract Introduction Puerto Rico currently faces a critical gap in burn care resources and specialized professional personnel. Despite a population of 3.2 million people, there is no centralized burn care facility on the island, and only four healthcare professionals are certified in Advanced Burn Life Support (ABLS). Moreover, there is a shortage of burn-fellowship trained surgeons. US national guidelines recommend one to two burn surgeons per 500,000 to 1 million people and at least one burn center per 1 million people to adequately address burn care needs, but Puerto Rico falls significantly short of these standards of care. On top of this, there is little to no research documenting the burn incidence in Puerto Rico, though it is likely to be higher than in the mainland U.S. This lack of research and centralized resources directly impacts the timely care and recovery of burn patients, who often face delays in obtaining both acute treatment and necessary reconstructive surgery. Non profit organizations are left with the burden of addressing these gaps to improve the quality of burn care in Puerto Rico. Methods This retrospective cohort study included 51 patients who visited a single hospital for burn care between February 2023 and September 2024. Statistical analysis was conducted using SPSS (v28). Demographic data, including age, gender, and hometown, were recorded, along with burn size (TBSA), time to initial healthcare visit, and time to evaluation by a burn surgeon. For patients who developed hypertrophic scars, the study recorded whether they received reconstructive treatment, and the type of treatment—split thickness skin graft (STSG), full thickness skin graft (FTSG), laser, or Kenalog injections. Results The cohort consisted of patients with a mean age of 40-49 years, with 54.9% identified as female. Most patients were from the municipalities of San Juan, Vega Baja, Dorado, and Bayamon. The mean burn size was recorded at 3% of the total body surface area. On average, patients consulted a burn surgeon 6.3 days post-injury, with one visit other healthcare provider prior to burn surgeon specialist consultation. Among the 4 patients presenting with hypertrophic scars, 3 (75%) underwent burn reconstruction procedures: 3 received Kenalog injections, and 1 were not treated. Conclusions There is a delay in acute burn care, with no correlation to burn size. There is also a delay to access burn surgeons of 6 days, demonstrating a need to improve timely access to specialized burn care. Most patients visited at least one health care facility prior to receiving definitive burn care. Limitations of this study include small sample size, referral bias, and retrospective nature of data. Applicability of Research to Practice Delay in burn care is observed in Puerto Rico and there is a need to centralized burn care and increase the number of burn specialists in the island to improve access to timely burn care. Better triage of burn patients is needed as well as increased burn care education in Puerto Rico. Funding for the Study N/A

Increasing evidence-based care practices for patients with Staphylococcus aureus bacteraemia through required infectious diseases consultation in a tertiary care hospital: a quality improvement initiative

BackgroundStaphylococcus aureus bacteraemia had a higher mortality rate than average at Kingston Health Sciences Centre (KHSC). Infectious diseases specialist consultation has been shown to improve outcomes for S. aureus bacteraemia...

All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020–2023

Background The clinical and economic burden of long COVID is poorly understood. We aim to assess all-cause healthcare resource utilization (HCRU) and costs in the primary care setting among adults with long COVID in France. Methods A retrospective cohort study using the electronic healthcare records (EHRs) of confirmed and/or probable COVID-19 patients from The Health Improvement Network (THIN) data between March 2020 and December 2022 was conducted. Long COVID was identified per World Health Organization (WHO) definition as suggestive symptoms present ≥3 months following acute SARS-CoV-2 infection. Patients’ characteristics, HCRU, direct healthcare and indirect costs (National Health Insurance-based prices) were summarized. Costs between patients with previous SARS-CoV-2 infection who developed long COVID, patients with previous SARS-CoV-2 infection who did not develop long COVID (COVID only), and contemporaneous controls without SARS-CoV-2 infection were compared (Non-COVID). Results Long COVID developed among 30,122 (11.6%) adults; mean (SD) age was 50 (17) years, 63.6% were female and 27.5% had a Charlson Comorbidity Index score >2. During the post-infection follow-up (mean = 13 months), 97.3% of patients had general practitioner consultations (GP) and 62.4% had nursing care. Costs were highest during the first post-diagnosis year with per patient per year costs of €2,443 (total cost of €52 million), including costs for GP (€208) and specialist (€170) consultations, outpatient procedures (€413), retail pharmacy use (€595), biological testing (€147), and medical device usage (€172). Patients with long COVID had additional costs of €163 and €176 when compared to patients in the COVID only and Non-COVID cohorts, respectively. Limitations Since the THIN database is generated from GP EHRs, there is the possibility of measurement/documentation errors and missing values which could compromise the validity and accuracy of certain results. Conclusion Long COVID was associated with non-negligible HCRU, direct and indirect costs to the French healthcare system. These findings reinforce the importance of optimizing long-term resource allocation for patients infected with SARS-CoV-2.

Reach-back to subject matter experts improves healthcare quality, influences the decision to evacuate and reduces costs: an observational study of the UK Defence Medical Services Deployed Telemedicine System

IntroductionThe UK Defence Medical Services (DMS) have used the medical instant messaging application Pando (Forward Clinical, London) since 2019. This application is used to deliver a deployed telemedicine system comprising...