ABSTRACT
As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to "serve all who have served" regardless of their socioeconomic and geographic circumstances. Having begun conducting "virtual care" in the 1960s when doctors first communicated with patient's via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA's strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.
ABSTRACT
The COVID-19 global pandemic and resulting effects on the economy and society (e.g., sheltering-in-place, alterations in transportation, changes in consumer behaviour, loss of employment) have yielded some benefits and risks to biodiversity. Here, we considered the ways the COVID-19 pandemic has influenced (or may influence) freshwater fish biodiversity (e.g., richness, abundance). In many cases, we could only consider potential impacts using documented examples (often from the media) of likely changes, because anecdotal observations are still emerging and data-driven studies are yet to be completed or even undertaken. We evaluated the potential for the pandemic to either mitigate or amplify widely acknowledged, pre-existing threats to freshwater fish biodiversity (i.e., invasive species, pollution, fragmentation, flow alteration, habitat loss and alteration, climate change, exploitation). Indeed, we identified examples spanning the extremes of positive and negative outcomes for almost all known threats. We also considered the pandemic's impact on freshwater fisheries demand, assessment, research, compliance monitoring, and management interventions (e.g., restoration), with disruptions being experienced in all domains. Importantly, we provide a forward-looking synthesis that considers the potential mechanisms and pathways by which the consequences of the pandemic may positively and negatively impact freshwater fishes over the longer term. We conclude with a candid assessment of the current management and policy responses and the extent to which they ensure freshwater fish populations and biodiversity are conserved for human and aquatic ecosystem benefits in perpetuity.
ABSTRACT
Introduction: Covid-19 has helped drive all forms of medicine away from traditional brick and mortar medical interactions. Given the availability of online services to obtain treatments for ED, we developed a website to facilitate patient education, triage and men's health appointment scheduling. Objective: We sought to assess characteristics of men who utilized a novel website to treat their ED. Methods: We report on 50 patients who ultimately booked and attended appointments (video or in person) for erectile dysfunction. Patients found our website through our institution's main informational ED pages or through youtube links from our men's health video playlist library. Patients create an institutional account and are then asked a series of MD created questions designed to streamline patient triage and complete the majority of chart documentation ahead of the appointment. Patients are then sent videos relevant to their condition and future appointment options. Results: 2300 users investigated the ED portion of the website with 1.8% of patients ultimately following through with an appointment. 13% of patients who explored the ED portion of the site created a user account that allows a questionnaire to be taken. 90% of men who began the ED questionnaire completed with a mean time of 11 minutes. 52% of men offered an appointment based on their responses completed the patient scheduling form. 71% of traffic was on mobile devices with 29% on desktop/tablet. Site use by time of day is shown in figure 1. Mean age of patients was 53. 92% of patients had ED that occurred > 6 months. Mean SHIM score was 8.2 (IQR 4-12). 80% of participants had both desire and opportunity for sexual activity, 20% did not meet both criteria and thus SHIM scores were less valid for these men. Of the users 28% had never tried pde5s, 32% had partial success with pde5s, 24% could not tolerate or afford pde5s and 42% had unsatisfactory results with pde5s. PDE5 naïve patients were seen by an internal medicine MD specializing in men's health, 10 were seen by surgeons as they requested IPPs and the rest were seen by a combination of men's health APPS and urology attendings for second line treatments and penile doppler. Interestingly, 66% of men were interested in undergoing penile doppler to better understand the etiology of their ED. Hypertension (40%) and diabetes (22%) were the most common medical comorbidities. 36% of the cohort had a strong family history of cardiac disease. Conclusions: Men with ED can be effectively triaged through a website application. Most men with pde5 refractory ED wish to pursue penile doppler. The majority of patients seen had watched educational video material ahead of time, facilitating a more sophisticated and streamlined patient interaction. Disclosure: No
ABSTRACT
Background/Case Studies: RHD genetic variation includes over 100 different partial alleles and over 150 different weak alleles. The most common RhD variant antigens found in Caucasians with a serologic weak D phenotype are Weak D Types 1, 2 and 3. It is well appreciated that patients who carry these alleles are not at risk for alloimmunization (Sandler et al. Transfusion 2015 55(3):680-689). Patients with these alleles are often identified based on typing discrepancies between different typing methods or use of different anti-D reagents. This report describes a new allele in the Weak D type 1 family. Study Design/Methods: A 50-year old Caucasian male with COVID-19 was referred for RHD genotyping -the patient had previously typed D negative in tube and currently typed mixed field in gel (Ortho). There was no evidence of recent transfusion. A history of anti-M was noted. Genomic DNA was extracted from peripheral blood mononuclear cells and was tested by RHD BeadChip (Immucor), PCR-RFLP for c.809 T>G and Sanger sequencing of RHD exon 5. Variants were compared to the RHD allele tables of the ISBT Working Party for Red Cell Immunogenetics and Blood Group Allele Terminology (https://www.isbtweb.org/working-parties/ red-cell-immunogenetics-and-blood-group-terminology/). Results/Findings: The patient was found to be hemizygous or homozygous for RHD c.667G (p.223Val) and c.809G (p.270Gly). The presence of c.809C was confirmed by RFLP. The presence of c.667G was confirmed by Sanger sequencing. Conclusions: There are currently three weak D type 1 alleles in the ISBT database (see Table 1 above). Whereas RHD∗01 W.01 carries only c.809G (p.270Gly), RHD∗01 W.1.1 carries c.809G and c.52G (p.18Val) and RHD∗01 W.1.2 carries c.809G and c.712A (p.238Met). Here we describe another allele in the RHD∗01 W family that was found in a patient with an RhD typing discrepancy. We propose that the allele that contains c.667G and c.809G be assigned allele name RHD∗01 W.1.3.