ABSTRACT
Purpose of Study As a result of the coronavirus disease 2019 (COVID-19) pandemic and physical distancing, telehealth has been scaled up as a key strategy to address the need for virtual access to medical services. Previous studies have examined use of web-portals for accessing health information, but data on the use of live video telemedicine for disease management across different ethnicities is limited. The objective of this study is to determine if disparities exist among different ethnic groups in accessing live video telemedicine services. Methods Used A literature review was conducted using databases such as PubMed and Google Scholar. Key search terms included: telehealth, telemedicine, ethnicity, and disparities. Studies were included if a) they were conducted in the United States, b) patients used a live video telehealth service with a provider, c) focused on telemedicine use across different racial and ethnic groups, and d) investigated completed access to live video telemedicine at the individual level, and not potential access at the aggregate level. Summary of Results Of 25 articles found, 5 met our inclusion criteria. Overall, white patients had higher rates of telehealth visit completion and video telehealth use than non-white patients. Studies that used telehealth visits for diabetes education and glycemic control showed that self-care improved in all ethnic groups, but despite tailored intervention, minority groups never achieved the same level of self-care as whites. Conclusions Our review suggests that overall white patients have better access to live video telemedicine, and use the services at higher rates compared to non-white patients. However, since this trend was not seen in every study, it is likely that other factors beyond race and ethnicity play a role in access to telemedicine. Effective strategies are needed to mitigate disparities to ensure equitable telemedicine access.
ABSTRACT
Purpose of Study: The post-acute sequelae of COVID-19, as a multisystemic disease have been described in adults. Although some studies have described the pulmonary complications up to 3 months post-COVID infection, longitudinal data on pulmonary sequalae are sparse. The objective of this review was to summarize the findings of studies that included a longitudinal follow-up of patients with moderate to severe pulmonary COVID-19 infection. Methods Used: We performed a literature search using Pubmed, Google Scholar and Medline using key words: "pulmonary function test", PFT?, "long-COVID", longitudinal? and sequalae?. We included studies of adult patients (>18 years of age) who had been hospitalized with acute COVID-19 infection and had at least two follow-ups with PFT measurements, including one follow-up at least 6 months post-infection. Studies that did not account for co-morbidities and other lung diseases or those which only included one-time follow-up were excluded. Summary of Results: Five studies satisfied our inclusion criteria (See Table). The studies showed persistent lung injury for at least 3 months after discharge, with decreased forced expiratory volume (FEV1), total lung capacity (TLC), forced vital capacity (FVC), diffusion vital capacity of the lungs for carbon monoxide (DCLO) and carbon monoxide transfer coefficient (KCO). Although these values improved at 6 and 12 months of follow-up, those with more severe disease continued to have decreased DLCO suggestive of restrictive lung damage. Studies that included symptomatic assessment revealed that a minority of patients continued with fatigue and dyspnea uf to 12 months after the infection. The limitations of the studies include availability of data from a single center, small sample size and the variability in controlling for different co-morbidities. In addition, baseline PFT measurement before COVID-19 infection was not available for most patients. Most of the studies were done at the time that the Delta variant was dominant, therefore the data may not be applicable to other variants. Conclusion(s): Our literature review shows that some adult patients hospitalized with acute covid pulmonary infection continue to have abnormal PFTs for up to 12 months after infection. Although PFTs improve overtime, a minority of patients with more severe disease on admission continue with abnormal functional abnormalities, specifically restrictive ventilatory pattern with impaired DLCO at 12 months of follow-up. It is important that patients hospitalized with moderate to severe pulmonary COVID-19 infection be followed up and managed for at least 12 months after the initial infection. Larger prospective studies including different variants of COVID-19 that take into account various co-morbidities and different management strategies are warranted.
ABSTRACT
Purpose of Study Treatment outcomes of children diagnosed with MIS-C are unclear and warrant investigation. The purpose of this study is to investigate the characteristics of pediatric patients diagnosed with MIS-C and their treatment outcomes with an emphasis on fatalities associated with MISC. Methods Used A literature review using Google Scholar and Pubmed using keywords such as 'Multisystem Inflammatory Syndrome in Children', 'Pediatric Inflammatory Multisystem Syndrome', and 'Coronavirus Disease 2019' was conducted. We included studies of hospitalized MIS-C patients with a sample size of more than 15. Summary of Results Of ten studies published before August 2020, five reported hospitalized MIS-C cases in the United States and five in Europe. A total of 514 hospitalized patients were reported with a sample size of 15 to 186 in various studies. Of 514 patients, 431 (84%) tested positive for SARS-CoV-2 via RT-PCR or serology. In different studies, 50% to 100% of MIS-C patients required PICU admission, 10% to 54% were intubated, and up to 80% required vasopressors. In studies that reported echocardiogram results, coronary artery dilations or aneurysm were noted in up to 93%, and depressed cardiac function was reported in 51- 100% of MIS-C patients. Treatment of MIS-C patients included intravenous immunoglobulins (IVIG) 388/514 (75%) plus steroids 288/514 (56%), along with anticoagulants and Anakinra 26/514 (5%). In total, 23 patients were put on ECMO, and of those, 16 (70%) survived. The larger studies reported fatality rate of 2% to 3% in hospitalized MIS-C patients. A total of 10 deaths were reported. Of the fatality causes that were described, 3 were associated with cerebral infarction after ECMO, 2 had not received IVIG, systemic glucocorticoids, or immunomodulators, and another 2 had co-morbidities. Conclusions Our review suggests that children with MIS-C who are hospitalized typically have a severe disease course. The outcome in vast majority of patients is favorable but death can occur, most likely as a result of cardiac dysfunction or cerebral infarction. Larger studies are needed to identify clinical features as well as laboratory and diagnostic parameters that predict disease severity and outcome.
ABSTRACT
Purpose of Study: Telemedicine has become a common option for healthcare delivery in the post-COVID-19 era. There are advantages, but the barriers to care for children with medical complexity (CMC) and marginalized populations have not been well-described. This study assessed parental perception of telemedicine in the care of their children. Methods Used: A REDcap survey was distributed to parents of hospitalized patients close to discharge to examine their attitudes regarding outpatient telemedicine with a focus on the post-discharge follow-up visit. Summary of Results: A total of 78 parents responded to our survey. A majority (58%) identified themselves as an ethnic minority. About 47% of parents completed college or postgraduate education;the rest had a high school diploma or some college education. Half (50%) of the parents reported a family income of <$100,000. Of the 78, 50% had used telemedicine previously, and a majority (76%) preferred in-person visits. Of those who belonged to a minority population, 80% preferred in-person visits after hospital discharge. Fifty-seven of the parents answered further questions about telemedicine and their child's medical complexity. Of these 57, 53% had a CMC, requiring specialized care and only 20% agreed or strongly agreed that it was difficult to take their child to in-person visits. Fifty-three out of the 78 parents provided a free text response about their thoughts on telemedicine visits. Common themes about advantages of in-person visits were a) preference for a physician's physical exam b) in-person visits were more personal and facilitated clearer communication and c) in-person visits provided more accurate? care compared to telemedicine (See Figure). Internet or computer access as a barrier was only mentioned by 3 parents. The main advantage of telemedicine mentioned was convenience. Conclusion(s): Our study shows that most parents prefer in-person visits, especially after hospital discharge. Our results may not apply to other populations as most of our patients were medically complex and belonged to a minority population. To increase parental support of telemedicine, techniques to improve family confidence in visual assessment and communication are required. Larger studies are needed to identify the needs of patients and families with a focus on the child's medical needs.