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Supplemental Digital Content is Available in the Text., COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.

The successes of local therapy for oligometastatic cancers cannot be extrapolated to oligoprogressive disease (OPD) because they are distinct clinical entities. Given the limited prospective data on OPD to date, summative analyses are urgently needed.Inclusion criteria for this Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review were as follows. First, only prospective data were included. Second, progression had to have occurred on active/ongoing systemic therapy. Third, the number of progressing areas of disease had to be explicitly listed and ≤5 in number. Fourth, all progressing sites had to undergo local therapy (radiation therapy [RT] /surgery/nonradiation ablative procedures).Eight trials met criteria (summing 290 patients), the vast majority of which used stereotactic RT as the local modality (most commonly, 19-20 Gy in 1 fraction, 27-33 Gy in 3 fractions, or 35-50 Gy in 5 fractions). A study on non-small cell lung cancer (NSCLC) demonstrated that stereotactic RT improved progression-free survival (PFS) and overall survival compared with historical values with systemic therapy alone. Two additional studies on epidermal growth factor receptor mutated (EGFRm) NSCLC also showed acceptable PFS with local therapy, particularly in patients who oligoprogressed on osimertinib. The only randomized trial analyzed herein showed that local therapy improved PFS for NSCLC but not breast cancer. Two trials in castration-resistant prostate cancer illustrated that a substantial proportion of patients did not require any changes in hormonal therapy or delayed the need to change systemic therapies. Lastly, 2 trials of renal cell carcinoma showed high (90%-100%) local control and median PFS of 9 months, and potentially a prolonged time to change systemic therapy. Lastly, from all patients in all trials, local therapy was tolerated well, with only 7 instances of grade 3+ toxicities.Based on the limited data, local therapy for oligoprogression is safe and yields encouraging short-term preliminary outcomes, but trials with larger sample sizes and longer follow-up are required for more robust conclusions.

Date Presented 04/05/19 Burnout and compassion fatigue are professional hazards for OTs. This quantitative study sought to increase the understanding of their relation to professional demographic data, including gender, population served, and setting. The Maslach Burnout Inventory was used to measure burnout, and quality of life was measured by the WHOQOL-BREF and the Professional Quality of Life Scale. This research may help to improve the quality of life and service delivery of OT practitioners. Primary Author and Speaker: Yan-hua Huang Contributing Authors: Hans Kim, Monique Le, Jessica Martinez, Jordan Martin, Elmira Maghen, William Leisek

PURPOSE Performing and teaching appropriate follow-up of outpatient laboratory results (LRs) is a challenge. The authors tested peer-review among residents as a potentially valuable intervention. METHOD Investigators assigned residents to perform self-review (n = 27), peer-review (n = 21), or self- + peer-review (n = 30) of outpatient charts. They also compared residence performance with that of historical controls (n = 20). In September 2012, residents examined 10 LRs from April 2012 onward. A second review in November 2012 ascertained whether performing chart review improved residents' practice behaviors. RESULTS Initially, the least-square (LS) mean number of LRs without documentation of follow-up per resident in the self-, peer-, and self- + peer-review group was, respectively, 0.5 (SD 1.0), 1.0 (SD 1.7), and 0.9 (SD 1.3), and post intervention, this was 1.0 (SD 0.2), 0.3 (SD 0.2), and 0.6 (SD 0.2) (self- versus peer-review P = .03). Initially the LS mean follow-up time per resident in the self-, peer-, and self- + peer-review group was, respectively, 4.2 (SD 1.2), 6.9 (SD 1.4), and 5.9 (SD 1.2) days, and after the intervention, LS mean time was 5.0 (SD 0.5), 2.5 (SD 0.6), and 3.9 (SD 0.5) days (self- versus peer-review P < .01). Self-review was not associated with significant improvements in practice. CONCLUSIONS In this comparison of self- and peer-review, only residents who performed peer-review demonstrated significant improvements in their documentation practices. These findings support the use of resident peer-review in improving LR follow-up, and potentially, in other, broader resident quality improvement initiatives.

Authors Reply: We agree with Drs. Pincavage, Ratner, and Arora that resident patients are indeed often at higher risk for missing appointments. We did not in our study look at the issue of prior behavior with respect to missed appointments, but in a sample of ten patients in our study population, six of the ten had missed several appointments in the years preceding their resident PCP’s graduation. In our practice in general, resident patients are more likely to miss scheduled appointments than faculty patients; indeed, resident patients missed 17% of appointments as compared to 7% missed appointments for faculty patients in the past year. We suspect that residents were particularly concerned about patients who missed appointments and may have explicitly listed these patients as high risk for that reason. We agree that handoffs in these patients are likely to be more risky than in patients who generally keep appointments and that special outreach efforts should be made to these patients. This is particularly problematic since the graduated residents most familiar with these at-risk patients and their medical problems are no longer available to detect missed opportunities for care such as overdue radiology studies or blood tests. We analyzed visits to our own emergency room for this sample of ten patients and found that only a single patient had an ER visit within the year after their resident’s graduation. We are unable to capture ER visits and admissions to other hospitals and agree that ER utilization would indeed be a useful variable to examine in future studies of this phenomenon. We agree that a year is a longer than desired interval for follow-up of many patients and that many of these patients should have had multiple visits during this study year. We set the year as an intentionally long period. We agree that a future study of diabetics in which there are clear guidelines for intervals of visits might indeed look at shorter intervals between visits. Finally, we were similarly intrigued with the study by Young and colleagues in which case loads were rebalanced, though note that the number of trainees in that program was much smaller. Young described 16 graduating residents having a mean of only 18–22 patients in each psychiatry resident’s case load compared to our population of 46 residents. These investigators did not report on patient retention, so it is not clear that rebalancing loads will indeed improve patient follow-up. We have attempted rebalancing of case loads to a small degree for certain target diagnoses for educational reasons, but many of our patients who do follow up return to see a different resident PCP than our assignment due to a variety of factors. We are skeptical as to whether rebalancing will improve retention unless it is coupled with early intensive outreach from a new provider.

the previous 3 years. Among these patients, we identified those who might be asplenic or hyposplenic by creating a subset of patients with electronic medical records problem list entries related to asplenia, sickle cell disease, and Hodgkin lymphoma. We distributed lists of patients to physicians for review and obtained information directly from patients. On the basis of their feedback, we revised our registry.

Translumbar embolization was used to treat 11 type 2 endoleaks in nine patients with the liquid embolic agent n-butyl cyanoacrylate (NBCA). Nine of the embolizations were performed with a combination of stainless-steel coils and NBCAJ and the other two were performed with NBCA alone. There was complete occlusion on initial computed tomographic (CT) angiography in six of nine patients (66%), including the two cases treated with NBCA alone. Persistent endoleak on initial CT angiography occurred in three of nine patients (33%). Two of these patients underwent successful repeated embolization with NBCA. Aneurysm size remained unchanged in four patients (44%), decreased in four patients (44%), and increased in one patient (11%). No complications occurred. Initial results with the use of NBCA for endoleak embolization are encouraging.

The binding of 2-[(2-bis[carboxymethyl]amino-5-methylphenoxy)-methyl]-6-methoxy-8-bis[carboxymethyl] aminoquinoline, the fluorescent calcium probe Quin2, to serum albumin and several other proteins has been investigated. Changes in fluorescence emission spectra and fluorescence anisotropy revealed interactions between Quin2 and several proteins including human serum albumin, bovine serum albumin, aldolase, phosphoglucose isomerase, glyceraldehyde-3-phosphate dehydrogenase, and alkaline phosphatase. Protein-probe interactions were inhibited by the presence of calcium. Binding was also measured by resonance energy transfer and gel permeation chromatography. Equilibrium binding constants for Quin2 were quantitated by the application of the recently-developed ‘SPECTRABIND’ program to spectroscopic data (D. Toptygin and L. Brand. Anal. Biochem., 224 (1995) 330–338). Binding of Quin2 to human serum albumin is discussed in terms of the published X-ray crystal structure of human serum albumin (X.M. He and D.C. Carter, Nature, 358 (1992) 209–215).