Inequity in Telemedicine Use Among Patients with Cancer in the Deep South During the COVID-19 Pandemic.

BACKGROUND: Telemedicine use has increased significantly during the COVID-19 pandemic. It remains unclear if its rapid growth exacerbates disparities in healthcare access. We aimed to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective cohort study was performed at the only National Cancer Institute designated-cancer center in Alabama March 2020 to December 2020. With a diverse (26.5% Black, 61% rural) population, this southeastern demographic uniquely reflects historically vulnerable populations. All non-procedural visits at the cancer center from March to December 2020 were included in this study excluding those with a department that had fewer than 100 visits during this time period. Patient and clinic level characteristics were analyzed using t-test and Chi-square to compare characteristics between visit types (in-person versus telemedicine, and video versus audio within telemedicine). Generalized estimating equations were used to identify independent factors associated with telemedicine use and type of telemedicine use. RESULTS: There were 50 519 visits and most were in-person (81.3%). Among telemedicine visits, most were phone based (58.3%). Black race and male sex predicted in-person visits. Telemedicine visits were less likely to have video among patients who were Black, older, male, publicly insured, and from lower income areas. CONCLUSIONS: Telemedicine use, specifically with video, is significantly lower among historically vulnerable populations. Understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure the continued evolution of telemedicine is equitable.

Evaluation of surgical oncology fellowship websites: Are we showing what applicants need to see?

BACKGROUND: The Internet is a major resource for surgery fellowship applicants, especially during the COVID-19 pandemic. Online information for surgical oncology and breast oncology training programs can be found on the Society of Surgical Oncology's webpage and fellowship institution websites. The goal of this study was to analyze the comprehensiveness of complex general surgical oncology and breast oncology fellowship websites. MATERIALS AND METHODS: A list of all accredited surgical oncology and breast oncology fellowships was recorded from the Society of Surgical Oncology website and stratified by region. Then, a Google search was performed on each fellowship program to determine each institution's webpage. Two of the authors then analyzed 2 web resources, institutional website and Society of Surgical Oncology webpage, for each fellowship program to determine if information valued by applicants was provided. RESULTS: Online information of 29 surgical oncology fellowships and 59 breast oncology fellowships was analyzed. Statistical differences were found among criteria in major information categories between Society of Surgical Oncology and institutional webpages for both fellowship types. Detailed criteria were more present on institutional rather than Society of Surgical Oncology webpages. CONCLUSION: For applicants to surgical oncology fellowships, institutional webpages provided the most pertinent information and may be used as a primary resource to guide fellowship application. For applicants to breast oncology fellowships, Society of Surgical Oncology webpages may be used as a primary resource to guide fellowship application. Both Society of Surgical Oncology and institutional pages lacked pertinent information regarding interview dates, and these resources should be updated to reflect program highlights as well as pertinent information for applicants.

Clinical profile of presentation of pediatric scrub typhus in post-lockdown era in Tamil Nadu, India

BackgroundScrub typhus is an important differential diagnosis of acute febrile illness in rural portions of south India. It is caused by Orientia tsutsugamoshii and spreads thru mites. Prior studies have documented various its prevalence between 19–32% in Tamil Nadu, India with a wide spectrum of clinical manifestation. Due to COVID restrictions and lockdowns, there has been a reduced emphasis and under-diagnosis of non-coronavirus illnesses across the world.ObjectivesThis study aims to study the clinical profile of Presentation of Scrub Typhus in pediatric population at a tertiary care hospital in Tamil Nadu, IndiaMethodsThe study was conducted as a prospective, observational hospital based study at a tertiary care hospital in Tamil Nadu, India. As an institutional protocol, Scrub Typhus IgM ELISA is done for all cases with a history of fever more than 5 days in addition to cases with a strong clinical suspicion due to presence of eschar. Since the COVID-19 pandemic, RT-PCR has been done for all cases of Acute febrile illness. The study included 134 cases that were Scrub IgM positive among children aged 2–12 years between October-December 2020. 4 children who were both Scrub Typhus IgM positive and COVID RT-PCR positive were excluded from the study The children were treated as per the IAP Consensus statement guidelines on Scrub Typhus with first line therapy by Doxycycline and second line therapy of Azithromycin in addition to symptomatic management. Demographic details, symptoms, course in hospital and outcome were tabulated.Results132 children presented with fever, 56 with headache, 44 with myalgia, 67 with complaints of cough, 48 had rash. 80 children had a typical eschar out of which 44 were on limbs, 20 were over trunk, 6 over scrotum, 5 behind ear and 5 near perineum. 127 children responded to Doxycycline within 48 hours, 3 children responded to doxycycline within 72 hours and 4 cases responded to combination therapy of Doxycycline and Azithromycin.ConclusionsScrub typhus remains an important disease in children with variable presentations even in post-coronavirus lockdown era. There is a need to focus on these illnesses as the world is recovering from the pandemic.

Does health literacy impact technological comfort in cancer patients?

INTRODUCTION: As healthcare systems are adapting due to COVID-19, there has been an increased need for telehealth in the outpatient setting. Not all patients have been comfortable with this transition. We sought to determine the relationship between health literacy and technological comfort in our cancer patients. METHODS: We conducted a survey of patients that presented to the oncology clinics at a single-center over a 2-month period. Patients were given a voluntary, anonymous, survey during their visit containing questions regarding demographics, health literacy and technological comfort. RESULTS: 344 surveys were returned (response-rate 64.3%). The median patient age was 61 years, 70% of responders were female and the most common race was White (67.3%). Increasing patient age, male gender, Black and Native-American race, decreased health literacy and lack of home broadband were associated with lower technological comfort score. CONCLUSION: In our cohort, patients with lower health literacy scores, older and male patients, or who have poor internet access showed a lower level of technological comfort. At risk patients can be identified and provided additional support in their use of telehealth services.