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ObjectiveTo determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.MethodsIn a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.ResultsA total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; p < 0.0001) and 38 miles per visit (95% CI 36-56; p < 0.0001).ConclusionsProviding remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience.Clinicaltrialsgov identifierNCT02038959.Classification of evidenceThis study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

BackgroundPrevious small-scale studies have demonstrated the feasibility of providing remote specialty care via virtual visits. We assessed the feasibility and benefits of a one-time consultation between a remote Parkinson Disease (PD) specialist and an individual with PD at home on a larger scale.MethodsWe conducted a multicenter noncontrolled cohort of virtual visits administered over videoconferencing between remote PD specialists and individuals with PD in their home. Specialists performed a patient history and a PD-specific physical examination and provided recommendations to patients and their local physicians. The primary outcome measures were feasibility, as measured by the proportion of visits completed as scheduled, and the 6-month change in quality of life, as measured by the Parkinson's Disease Questionnaire 39. Additional outcomes included satisfaction with visits and interest in future virtual visits.ResultsA total of 277 participants from 5 states enrolled, 258 participants completed virtual visits with 14 different physicians, and 91% of visits were completed as scheduled. No improvement in quality of life was observed at 6 months (0.4-point improvement; 95% confidence interval -1.5 to 0.6; p = 0.39). Overall satisfaction with virtual visits was high among physicians (94% satisfied or very satisfied) and patients (94% satisfied or very satisfied), and 74% of participants were interested in receiving future care via virtual visits.ConclusionsProviding specialty care remotely into the homes of individuals with PD is feasible, but a one-time visit did not improve quality of life. Satisfaction with the visits was high among physicians and patients, who were interested in receiving such care in the future.Classification of evidenceThis study provides Class IV evidence that for patients with PD, remote specialty care is feasible but does not improve quality of life.Clinicaltrialsgov identifierNCT02144220.

BackgroundDelivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited.Materials and methodsConnect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study.ResultsDuring recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year.ConclusionsAmong individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.

Category: Ankle; Trauma Introduction/Purpose: Social media has had a significant impact on medical education. YouTube has been an established platform and has recently expanded into short form videos (YTS) that receives over 50 billion views per day, approximately 625% of the World population. Prior investigations have shown that the quality of education on the YouTube platform is unregulated, lacking in quality measures and content delivery. To date YTS has not been investigated in the field of orthopedic surgery. Our study analyzes the quality of ankle fracture education on YTS and the distribution of the topic’s video creators. Methods: For this analysis, we acquired the top 75 videos on YTS with the search query "#anklefracture + shorts." Duplicate shorts, shorts containing irrelevant material, and shorts without measurable content were excluded. Videos that met the inclusion criteria were then scored using previously verified scoring systems: GQS Score, PEMAT Understandability %, PEMAT Actionability %, and JAMA Score. The following continuous variables were acquired: Views, Date Posted, Likes, Comments, Followers, Video Engagement Rate (VER). Categorical variables were acquired: Advertisement Status, Verified Account, Creator Type. The authorship of each channel was identified based on American Board of Orthopedic Surgery (ABOS) certification. We compared two groups, American Board-certified channels vs channels of any other education level. All variables were analyzed utilizing a one-way ANOVA for significance. Results: Of the top 75 videos, 21 meet our inclusion criteria. Only 3 authors, 27.2%, had ABOS certification. Of the 6 verified YT channels none were orthopedic surgeons. 9 videos were created by ABOS certified channels and 12 by other channels. The video upload date ranged from February-2021 to January-2023. The average scores for ABOS authors were likes 666, 11.4 comments, 359666 followers, 0.448% engagement rate, GQS score 3.67, JAMAScore 3, PEMATUnderstandability 91.9%, and PEMATActionability 14.8%. Average scores for authors of any other education level: 403 likes, 11.3 comments, 140856 followers, 3.61% engagement rate, GQS score 3.83, JAMAScore 3.08, PEMATUnderstandability 94.5%, PEMATActionability 50%. Followers and Actionability were the only significant variables (p < 0.05); ABOS channels had more followers while other channels had higher actionability. Conclusion: Directing the online message in orthopedic patient care and education is important. This study emphasizes that orthopedic surgeons are skilled at capturing followers but fall short when compared to other channels in calling their viewers to action. It also shows how Orthopedic surgeons are equivalent when it comes to educating viewers in an understandable and verified manner. In order to lead ankle fracture education on YTS and other social media platforms, orthopedic surgeons need to utilize the popularity of their following to deliver actionable educational content and improve in categories that non-orthopedic surgeons dominate on YouTube Shorts.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length. Methods: The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test. Results: In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p < 0.05). Conclusion: Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.

Abstract We present a case study involving an elderly patient who experienced dislodgement of a recently implanted WATCHMAN device. Initially, the patient exhibited multiple musculoskeletal symptoms, which raised concerns about alternative causes such as cauda equina syndrome or spinal epidural hematoma. Despite vascular surgery removing the device, the patient's condition deteriorated due to ischemia leading to multisystem organ failure. This case highlights the critical need for emergency physicians to promptly diagnose acute aortic obstruction caused by embolization, given the increasing use of the WATCHMAN device in the aging population to reduce the reliance on anticoagulation. The potential for significant ischemic consequences necessitates immediate intervention to mitigate complications.

The posterior distribution (PD) of random parameters in a distributed parameter-based population model for biosensor measured transdermal alcohol is estimated. The output of the model is transdermal alcohol concentration (TAC), which, via linear semigroup theory can be expressed as the convolution of blood or breath alcohol concentration (BAC or BrAC) with a filter that depends on the individual participant or subject, the biosensor hardware itself, and environmental conditions, all of which can be considered to be random under the presented framework. The distribution of the input to the model, the BAC or BrAC, is also sequentially estimated. A Bayesian approach is used to estimate the PD of the parameters conditioned on the population sample's measured BrAC and TAC. We then use the PD for the parameters together with a weak form of the forward random diffusion model to deconvolve an individual subject's BrAC conditioned on their measured TAC. Priors for the model are obtained from simultaneous temporal population observations of BrAC and TAC via deterministic or statistical methods. The requisite computations require finite dimensional approximation of the underlying state equation, which is achieved through standard finite element (i.e., Galerkin) techniques. The posteriors yield credible regions, which remove the need to calibrate the model to every individual, every sensor, and various environmental conditions. Consistency of the Bayesian estimators and convergence in distribution of the PDs computed based on the finite element model to those based on the underlying infinite dimensional model are established. Results of human subject data-based numerical studies demonstrating the efficacy of the approach are presented and discussed.

B-cell non-Hodgkin lymphoma (B-NHL) encompasses multiple clinically and phenotypically distinct subtypes of malignancy with unique molecular etiologies. Common subtypes of B-NHL, such as diffuse large B-cell lymphoma, have been comprehensively interrogated at the genomic level, but rarer subtypes, such as mantle cell lymphoma, remain less extensively characterized. Furthermore, multiple B-NHL subtypes have thus far not been comprehensively compared using the same methodology to identify conserved or subtype-specific patterns of genomic alterations. Here, we employed a large targeted hybrid-capture sequencing approach encompassing 380 genes to interrogate the genomic landscapes of 685 B-NHL tumors at high depth, including diffuse large B-cell lymphoma, mantle cell lymphoma, follicular lymphoma, and Burkitt lymphoma. We identified conserved hallmarks of B-NHL that were deregulated in the majority of tumors from each subtype, including frequent genetic deregulation of the ubiquitin proteasome system. In addition, we identified subtype-specific patterns of genetic alterations, including clusters of co-occurring mutations and DNA copy number alterations. The cumulative burden of mutations within a single cluster were more discriminatory of B-NHL subtypes than individual mutations, implicating likely patterns of genetic cooperation that contribute to disease etiology. We therefore provide the first cross-sectional analysis of mutations and DNA copy number alterations across major B-NHL subtypes and a framework of co-occurring genetic alterations that deregulate genetic hallmarks and likely cooperate in lymphomagenesis.

BACKGROUND: Patients with asthma are particularly susceptible to serious complications from influenza. The Chief Medical Officer recommends annual influenza vaccination for adult patients with asthma. The uptake of influenza vaccination by patients with asthma is only 40% and, unlike other high-risk groups, has failed to increase in recent years. AIM: To investigate the contribution of sociodemographic factors, asthma morbidity, and health beliefs to influenza vaccination uptake in patients with asthma. Design of study: Cross-sectional questionnaire study. SETTING: Single urban British general practice, Exeter, UK. METHOD: A questionnaire survey was sent to adult patients with asthma. Participants were aged 16-65 years, were receiving beta(2) agonists and inhaled steroids, and had been invited for influenza vaccination in September 2003. Data were examined using univariate analysis and logistic regression. RESULTS: A total of 136/204 (66.7%) patients responded to the survey. Influenza vaccination uptake in the study population was 40%. Younger patients were less likely to have undergone vaccination than older patients. There was no difference in vaccination uptake rates between groups of patients defined by other sociodemographic factors. Asthma morbidity was similar in vaccinated and non-vaccinated groups of patients. Vaccinated individuals had a greater belief in the efficacy of the vaccination and medical advice regarding the vaccination, and felt more susceptible to influenza and its complications when compared with non-vaccinated individuals. A fear of side-effects was associated with declining the invitation for vaccination. These health beliefs were the only independent predictors of uptake of influenza vaccination among this group of patients with asthma. CONCLUSION: Improving vaccination uptake in patients with asthma is unlikely unless individual health beliefs are taken into account. [ABSTRACT FROM AUTHOR]

Kristin E White1, Paul M Szumita1, Nicki Gilboy2, Hillary A Keenan3, Christian Arbelaez21Department of Pharmacy Services, 2Department of Emergency Medicine, 3Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USAPurpose: When emergency department (ED) overcrowding includes admitted mechanically ventilated (MV) critically-ill patients without an open intensive care unit (ICU) bed, emergency providers must deliver ICU level care in the ED. Implementing standardized hospital based clinical guidelines may help providers achieve uniform care standards for assessing and managing pain and sedation for the MV patient.Objective: This paper is a description of a hospital performance improvement project that was implemented in the ED. The objective of this study was to measure the degree of adoption of a hospital-wide clinical guideline for the management of pain, sedation and neuromuscular blockade in MV patients into clinical practice in the ED.Methods: A retrospective analysis was performed for all mechanically ventilated patients who were admitted from ED to an Intensive Care Unit (ICU). Patient charts were reviewed before (December 2005) and after the implementation of the guideline (June, August, and December 2006). Data was collected and analyzed for the ED visit only and no ICU data was used. The primary outcome was the degree of adoption of the guideline by emergency providers into their daily clinical practice.Results: A convenience sample of 170 adult MV patients who were admitted to the ICU during the preselected time period was analyzed. There were no demographic differences between groups of patients observed during each month interval, age (P = 0.34), gender (P = 0.40), race (P = 0.14), and Hispanic ethnicity (P = 0.84). Overall, there was an increase in the provider use of propofol (P < 0.01), RASS sedation scale (P < 0.01), and a decrease in the use of a paralytic agent (P < 0.01).Conclusion: There was partial adoption of a guideline into their clinical practice by emergency providers in a busy urban emergency department. Across the 12-month implementation period, there was improvement in the assessment of and use of analgesia and sedation for MV patients.Keywords: clinical guideline, critical care, ICU, emergency department, sedation, pain, neuromuscular blocker