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A brief look back On lanuary 31, 2020, US Secretary of Health & Human Services Alex Azar declared the COVID-19 virus a public health emergency and ordered all US citizens returning from the Wuhan, China, region to quarantine for 2 weeks. Rapid diagnostic tests were quickly distributed, personal protective equipment (PPE) was secured, and vaccines were developed in record time. A recent study suggests that young children mount a T-cell activation when exposed to non-COVID-19 seasonal coronavirus infections, which either prevents COVID-19 infections or provides enough protection to render most infections mild.2 In addition, despite the endorsement of the American Academy of Pediatrics (AAP) and the CDC, not many young children were vaccinated against COVID-19 once the FDA approved it use, eventually allowing it to be administered to those as young as 6 months.
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The Great Resignation According to surveys from The Physicians Foundation in 2020 and 2021, 8% of medical practices closed, 32% of practices had to reduce staff, and 49% of physician experienced a reduction in income during the pandemic.1,2 Additionally, the US Bureau of Labor Statistics reported that health care workers were leaving the industry at a rate of 500,000 per month during 20223;Elsevier Health reports that 47% of US health care workers plan to leave their positions by 2025.4 Many physicians took government loans or pay cuts to keep practices afloat during the pandemic;when they reopened, patient volume took months to return to prepandemic levels. Over 230,000 physicians, nurse practitioners, and physician assistants quit their jobs by the end of 2021;the health care industry lost 20% of its workforce.6'7 Thus, the "Great Resignation" is considered one of the most significant sequalae of the COVID-19 pandemic. The Great Resignation today As I write this in February 2023, we continue to wear masks in our offices, work with significant clerical and clinical staff reductions, see more patients daily than we did prepandemic, and regularly see patients with mental health issues who need therapy. Many visits, such as for rashes, mental health and atten-tion-deficit/hyperactivity disorder medication checks, weight checks, conjunctivitis, and follow-up illness visits, are appropriate for virtual care.
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Patients routinely use at-home COVID-19 tests to screen for SARS-CoV-2 infections, virtual visits to obtain care from their primary care providers, and personal protective equipment to prevent the spread of disease. Neurosurgery and craniofacial centers employ hand calipers to measure the cranial index and the cranial vault asymmetry index, to determine if the skull shape is abnormal. The best resources for expediting otitis media diagnosis Although pediatric health care providers look at many tympanic membranes over the course of their careers, it is not always easy to identify acute otitis media (AOM) and distinguish it from otitis media with effusion. More frequent burnout rates were reported by female vs male physicians (69% vs 57%), and rates were high in primary care (66%) vs specialty care (59%) providers.4 It would be prudent to determine if you suffer from professional burnout or are at risk for developing burnout.
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No aspect of pediatric medicine has been as impactful on the health and wellbeing of our patients and communities as the vaccines that now routinely prevent 16 diseases that were once commonplace.1 Current vaccines include those based on live attenuated viruses (eg, varicella, rotovirus), killed whole organism (eg, rabies, hepatitis A), polysaccharide or native proteins (eg, pneumococcal, meningococcal), and recombinant or whole molecular modification (eg, hepatitis B, herpes zoster). Many of these are directed at infectious diseases, but many novel vaccines are being developed to treat or prevent allergies, autoimmune disorders, cancers, and even Alzheimer's disease.1 Following the emergence of severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2012, both deadly coronavirus infections, investigators spent subsequent years developing and perfecting innovative vaccines including adenovirus vector vaccines and messenger RNA (mRNA) vaccines. [...]Altimmune has developed an adenovirus-vectored intranasal vaccine, now in phase I clinical trials, that generates a broad IgG, mucosal IgA, and Tcell response to SARS-CoV-2 and is stable at room temperature.5 Altimmune is also in clinical trials for intranasal vaccines for anthrax and influenza.
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Government funding for immunization registries became available when President Bill Clinton included immunization registries in his Childhood Immunization Initiative in 1993.1 There are currently 63 registries, now called immunization information systems (IlSs), in the United States. IISs have many advantages;they can improve immunization rates, reduce vaccination errors, identify opportunities to vaccinate, provide epidemiological insights when there is a community outbreak of a vaccine-preventable disease, and allow access by patients, families, schools, and other health care providers. There are federal requirements for documenting vaccines established by the Centers for Disease Control and Prevention (CDC), which includes the specific vaccine, manufacturer, lot number, the date and location, and that the patient and/or family was given a vaccine information statement (VIS) to review with its publication date.3 Most IISs will permit noting if the vaccine was refused and the description of any adverse reactions.
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[...]individuals in low-income communities and minorities have limited access to services necessary to diagnose ASD.4 Only 60% of pediatricians screen children for developmental delays despite the recommendation from the American Academy of Pediatrics (AAP) to perform screenings at 18- and 24-month well visits. Screening for ASD Pediatricians have a plethora of ASD screening tools available, such as the Ages and Stages Questionnaires, the Communication and Symbolic Behavior Scales, the Parents Evaluation of Developmental Status, the Screening Tool for Autism in Toddlers and Young Children, and M-CHAT-R/F. Over the past few years, several AI-related technologies have been developed to improve medical care.10 Addition ally, investigators have had some promising results using sensors to analyze facial expressions, vocalizations, touch sensitivity, eye tracking, movements, and interactions with robots to try to identify children with ASD. A study published in March 2020 validated Cognoa's system on 375 patients over the course of 2 years, indicating that the system could identify children with ASD with sensitivity and specificity as high as 90% and 83%, respectively.18 More recently, the company completed a double-blind clinical trial at 14 sites around the United States, using an improved algorithm to gather data for submission to the FDA.
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The article looks at the use of artificial intelligence (AI)-based diagnostic systems and telehealth- and sensor-based technologies in autism spectrum disorder (ASD) diagnosis. Among the causes of delay in ASD diagnosis in the U.S. are limited access to the services and the COVID-19 pandemic. It describes the features of the Autism Diagnostic Observation Schedule (ADOS) test. Also noted is the use of ADOS datasets in the Canvas Dx AI-based ASD diagnostic system from Cognoa.
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[...]this did not occur until the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.2 Likewise, I predicted touch-/stylusenabled computer screens and the ability of computers to populate fields in an EHR, either via patient or staff input, and the ability of "connected" devices to rapidly take vital signs and perform patient screens. [...]we will see Drs Alexa, Siri, and Google evolve and have the ability to remind diabetic patients to measure and record their sugars, suggest healthy eating habits and exercise for children who are overweight, and remind families of upcoming health care visits. Other point-of-care technologies will facilitate diagnosis of sexually transmitted infections, pneumonias, and urinary tract infections. patients not only with genetic syndromes, but also with anxiety, depression, or attention-deficit/ hyperactivity disorder. * Artificial intelligence (AI) will figure prominently in enabling physicians to improve medical care.
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Families were advised to stay home, and pediatricians quickly altered their practices to help safeguard staff and patients. Young children unable to wear a mask are sometimes intimidated by the funny looking person doing doctor stuff, who sounds like that nice pediatrician he or she has seen before. [...]time that we can safely unmask-I now try a little harder to make my patients and parents laugh or giggle to make the office visit comforting. Going forward While the pandemic curve is flattening, there continues to be widespread COVID-19 cases in my community. [...]the crisis is behind us, I suggest that front office staff and office nurses communicate with families via video visits whenever possible.
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Compared with regulatory agencies overseas, it is a very long and very expensive proposition to gain FDA approval to market a new drug or device. [...]in the United States we don't have a POC C-reactive protein (CRP) device that could help management of respiratory infections. [...]insurance companies have restricted access to better POC diagnostic studies by refusing to pay for more accurate tests when less-expensive (and less-accurate) tests are covered.
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Coronavirus disease 2019 (COVID-19), caused by novel enveloped single stranded RNA coronavirus (SARS-CoV-2), is responsible for an ongoing global pandemic. While other countries deployed widespread testing as an early mitigation strategy, the U.S. experienced delays in development and deployment of organism identification assays. As such, there is uncertainty surrounding disease burden and community spread, severely hampering containment efforts. COVID-19 illuminates the need for a tiered diagnostic approach to rapidly identify clinically significant infections and reduce disease spread. Without the ability to efficiently screen patients, hospitals are overwhelmed, potentially delaying treatment for other emergencies. A multi-tiered, diagnostic strategy incorporating a rapid host immune response assay as a screening test, molecular confirmatory testing and rapid IgM/IgG testing to assess benefit from quarantine/further testing and provide information on population exposure/herd immunity would efficiently evaluate potential COVID-19 patients. Triaging patients within minutes with a fingerstick rather than hours/days after an invasive swab is critical to pandemic response as reliance on the existing strategy is limited by assay accuracy, time to results, and testing capacity. Early screening and triage is achievable from the outset of a pandemic with point-of-care host immune response testing which will improve response time to clinical and public health actions.Key messagesDelayed testing deployment has led to uncertainty surrounding overall disease burden and community spread, severely hampering public health containment and healthcare system preparation efforts.A multi-tiered testing strategy incorporating rapid, host immune point-of-care tests can be used now and for future pandemic planning by effectively identifying patients at risk of disease thereby facilitating quarantine earlier in the progression of the outbreak during the weeks and months it can take for pathogen specific confirmatory tests to be developed, validated and manufactured in sufficient quantities.The ability to triage patients at the point of care and support the guidance of medical and therapeutic decisions, for viral isolation or confirmatory testing or for appropriate treatment of COVID-19 and/or bacterial infections, is a critical component to our national pandemic response and there is an urgent need to implement the proposed strategy to combat the current outbreak.