Patient Perspectives on Telemedicine During the COVID-19 Pandemic.

BACKGROUND: Patients received care over telemedicine during the COVID-19 pandemic, and their perspective is useful for hand surgeons. METHODS: Online surveys were sent October-November 2020 to 497 patients who received telemedicine care. Questions were free-response and multi-item Likert scales asking about telehealth in general, limitations, benefits, comparisons to in-person visits, and opinions on future use. RESULTS: The response rate was 26% (n = 130). Prior to the pandemic, 55% had not used telemedicine for hand surgery consultation. Patients liked their telemedicine visit and felt their provider spent enough time with them (means = 9/10). In all, 48% would have preferred in-person visits despite the pandemic, and 69% would prefer in-person visits once the pandemic concludes. While 43% had no concerns with telemedicine, 36% had difficulties explaining their symptoms. Telemedicine was easy to access and navigate (M = 9/10). However, 23% saw telemedicine of limited value due to the need for an in-person visit soon afterward. Of these patients, 46% needed an in-person visit due to inadequate physical examination. Factors that make telemedicine more favorable to patients included convenience, lack of travel, scheduling ease, and time saved. Factors making telemedicine less favorable included need for in-person examination or procedure, pain assessment, and poor connectivity. There was no specific appointment time the cohort preferred. Patient recommendations to improve telemedicine included decreasing wait times and showing patient queue, wait time, or physician status online. CONCLUSIONS: Telemedicine was strongly liked by patients during the COVID-19 pandemic. However, nearly 70% of patients still preferred in-person visits for the future.

Influence of Perioperative COVID-19 Infection on Surgical Outcomes and Risk Adjustment for Quality Assessment in the American College of Surgeons NSQIP.

BACKGROUND: Surgical patients with perioperative coronavirus disease 19 (COVID-19) infection experience higher rates of adverse events than those without COVID-19, which may lead to imprecision in hospital-level quality assessment. Our objectives were to quantify differences in COVID-19-associated adverse events in a large national sample and examine distortions in surgical quality benchmarking if COVID-19 status is not considered. STUDY DESIGN: Data included 793,280 patient records from the American College of Surgeons NSQIP from April 1, 2020, to March 31, 2021. Models predicting 30-day mortality, morbidity, pneumonia, and ventilator dependency greater than 48 hours, and unplanned intubation were constructed. Risk adjustment variables were selected for these models from standard NSQIP predictors and perioperative COVID-19 status. RESULTS: A total of 5,878 (0.66%) had preoperative COVID-19, and 5,215 (0.58%) had postoperative COVID-19. COVID-19 rates demonstrated some consistency across hospitals (median preoperative 0.84%, interquartile range 0.14% to 0.84%; median postoperative 0.50%, interquartile range 0.24% to 0.78%). Postoperative COVID-19 was always associated with increased adverse events. For postoperative COVID-19 among all cases, there was nearly a 6-fold increase in mortality (1.07% to 6.37%) and15-fold increase in pneumonia (0.92% to 13.57%), excluding the diagnosis of COVID-19 itself. The effects of preoperative COVID-19 were less consistent. Inclusion of COVID-19 in risk-adjustment models had minimal effects on surgical quality assessments. CONCLUSIONS: Perioperative COVID-19 was associated with a dramatic increase in adverse events. However, quality benchmarking was minimally affected. This may be the result of low overall COVID-19 rates or balance in rates established across hospitals during the 1-year observational period. There remains limited evidence for restructuring ACS NSQIP risk-adjustment for the time-limited effects of the COVID-19 pandemic.

Telemedicine Use during the COVID-19 Pandemic: Results of an International Survey

Objective  The aim of the study is to survey hand surgeons' perspectives on telemedicine during the coronavirus disease 2019 (COVID-19) pandemic and intended applications after the pandemic. Methods  Online surveys were sent to 285 Canadian and American surgeons in late April and early May 2020. Results  Response rate was 63% (180)—84% (152) American and 16% (28) Canadian. Forty-three percent (76) of respondents were in private practice, 36% (64) academics, 13% (24) privademics, and 6% (12) hospital employed. The most common telemedicine platform was Zoom. During the pandemic, 42% of patient visits were conducted via telemedicine;however, 37% required a subsequent in-person office visit. The most common complaint by surgeons was the inability to provide routine in-office procedures. The most beneficial feature was ease of use, and the most frustrating feature was connectivity difficulty. Time spent was similar to in-person visits, and surgeons were likely to recommend their platforms. Surgeons were neutral about using telehealth in the future and were most likely to use it for follow-up visits. New patient visits for traumatic injuries or fractures were of limited value. Canadians used telemedicine for a greater proportion than Americans (50 vs. 40%, p <0.05) and spent more time than in-person visits (7/10 vs. 5/10, p <0.05). Americans were more likely to use telemedicine for postoperative follow-up visits (6/10 vs. 4/10, p <0.05) and in mornings before clinic opens (4/10 vs. 2/10, p <0.05). Private practices were more likely to use telemedicine for future allied health provider visits than all other practice types ( p <0.05). Conclusion  Telemedicine comprised nearly half of patient encounters during the COVID-19 pandemic, but limitations remain.

Extended Reality International Grand Rounds: An Innovative Approach to Medical Education in the Pandemic Era.

PROBLEM: While bedside training has always presented its own unique challenges, the COVID-19 pandemic era has intensified barriers to suitable provider and trainee experiences for both patient care and medical education. APPROACH: This project introduced an innovative solution with the Extended Reality International Grand Rounds, a collaboration between the University of Michigan Center for Medical and Surgical Extended Reality and Imperial College London. Three complex cases were presented to trainees through a wireless, extended reality (XR) headset and augmented by holographic visual aids and expert commentary. This pilot rounding experience was performed through the first-person view of one clinician at the bedside. OUTCOMES: In 2020, 140 attendees participated in XR International Grand Rounds, and 82 (59%) and 61 (44%) completed pre- and postsurveys, respectively. Survey analysis showed that the majority of respondents (65, 79.3%) had very little to no baseline experience with XR technologies and nearly all (75, 91.5%) agreed that the development and implementation of XR curricula are important in medical training, indicating an unmet need. Nearly all respondents (59, 96.7%) found value in the ability to visualize patients' clinical findings in the XR rounding experience and 60 (98.4%) found value in the ability to visualize patient-specific imaging and test findings in an XR format. Limiting exposure to high-risk patients and care team members with this innovative format was believed to be important to 79 (96.3%) respondents at baseline and that perception was unchanged following the event. NEXT STEPS: This solution to a long-standing dilemma, newly stressed by a unique era in medicine, was a successful collaboration using state-of-the-art XR technology. Next steps will include introducing more advanced physical exam visualization and detection and comprehensive evaluation of the patient experience, as well as expanding the international experience in a format that is scalable to other interested institutions.

International Mixed Reality Immersive Experience: Approach via Surgical Grand Rounds.

BACKGROUND: Coronavirus disease 2019 created unintended but significant experiential barriers for surgical learners to interact at the bedside for teaching/case presentations. We hypothesized that an international grand rounds using the Microsoft HoloLens 2 extended reality (XR) headset would create an improved bedside-learning experience compared to traditional grand rounds formats. STUDY DESIGN: From December 2020 to March 2021, the world's first 2 international mixed reality grand rounds events using the HoloLens 2 headset were held, broadcasting transatlantically (between the University of Michigan and the Imperial College of London) bedside rounding experiences on 5 complex surgical patients to an international audience of 325 faculty, residents, and medical trainees. Participants completed pre- and post-event surveys to assess their experience. RESULTS: Of the 325 participants, 267 (80%) completed pre-surveys, and 95 (29%) completed both the pre- and post-surveys. Respondents (average age, 38 y; 44% women, 56% men; 211 US, 56 UK) included 92 (34%) medical students and residents and 175 faculty and staff. In the pre-event survey, 76% had little or no earlier experience with XR devices, and 94% thought implementation of XR into medical curricula was valuable. In the post-survey, 96% thought telerounding using XR technology was important for the current era, and 99% thought the ability to visualize the examination, imaging, and laboratory results at bedside via XR rounding was highly valuable and that this format was superior to traditional grand rounds. CONCLUSIONS: Almost all of the participants in the mixed reality international grand rounds felt the immersive XR experiences-allowing visualization of clinical findings, imaging, and laboratory results at the patient's bedside-were superior to a traditional grand rounds format, and that it could be a valuable tool for surgical teaching and telerounding.

Quantitative assessment of changes in surface particulate matter concentrations and precursor emissions over China during the COVID-19 pandemic and their implications for Chinese economic activity

Sixty days after the lockdown of Hubei Province, where the coronavirus was first reported, China's true recovery from the pandemic remained an outstanding question. This study investigates how human activity changed during this period using observations of surface pollutants. By combining surface data with a three-dimensional chemistry model, the impacts of meteorological variations and variations in yearly emission control are minimized, demonstrating how pollutant levels over China changed before and after the Lunar New Year from 2017 to 2020. The results show that the reduction in NO2 concentrations, an indicator of emissions in the transportation sector, was clearly greater and longer in 2020 than in normal years and started to recover after 15 February. By contrast, PM2.5 emissions had not yet recovered by the end of March, showing a reduction of around 30 % compared with normal years. SO2 emissions were not affected significantly by the pandemic. An additional model study using a top–down emission adjustment still confirms a reduction of around 25 % in unknown surface PM2.5 emissions over the same period, even after realistically updating SO2 and NOx emissions. This evidence suggests that different economic sectors in China may be recovering at different rates, with the fastest recovery in transportation and a slower recovery likely in agriculture. The apparent difference between the recovery timelines of NO2 and PM2.5 implies that monitoring a single pollutant alone (e.g., NOx emissions) is insufficient to draw conclusions on the overall recovery of the Chinese economy.