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1.
American Journal of Gastroenterology ; 117(10 Supplement 2):S366, 2022.
Article in English | EMBASE | ID: covidwho-2326082

ABSTRACT

Introduction: In gastroenterology, telemedicine has emerged as a means for improving patient access to medical care while limiting viral transmission during the pandemic. The purpose of this study was to assess patient order compliance in the virtual vs. in-person setting during the COVID-19 pandemic for the initial evaluation of constipation. Method(s): Using natural language processing, we identified outpatient gastroenterology visits (virtual and in-person) for constipation from March 2020 through December 2021. We assessed the number of orders placed for patients during these encounters and determined compliance based on order completion. A generalized linear mixed effects model with fixed effects for visit type and random intercepts for intra-patient correlation was used. A multivariable model was built controlling for age, socioeconomic status, BMI, dementia, stroke, and congestive heart failure. Result(s): Among 4,930 patients who presented for initial constipation evaluation since the start of the pandemic, 3,515 patients were evaluated in-person and 1,415 patients were evaluated virtually. Comparing order compliance in patients seen during the pandemic, patients seen virtually were 66% less likely to complete orders in comparison to patients seen in-person (p < .001). Patients seen in a pandemic virtual setting were 43% less likely to complete imaging orders (p < 0.001), 78% less likely to complete procedure orders (p < 0.001), and 90% less likely to complete lab orders (p < 0.001) (Table). Increased lab compliance was associated with the highest socioeconomic status ($75,000-$200,000) with patients eight times more likely to complete lab orders (p=0.049) and three times more likely to complete orders overall (p=0.021). Conclusion(s): Compared with in-person visits, patients seen virtually for their first presentation of constipation were less likely to complete labs, imaging and procedure evaluation ordered. In-person visits were more successful in leading to patient order completion during the pandemic. These findings suggest that virtual visits for constipation, despite convenience, may compromise care delivery;such visits may thus require additional care coordination to achieve compliance with medical recommendations. (Figure Presented).

2.
American Journal of Gastroenterology ; 117(10):S1089-S1089, 2022.
Article in English | Web of Science | ID: covidwho-2310821
3.
Gastroenterology ; 162(7):S-857, 2022.
Article in English | EMBASE | ID: covidwho-1967378

ABSTRACT

Introduction: Telemedicine has been underscored during the COVID-19 pandemic as a way to improve healthcare access, efficiency, and reduce cost. In gastroenterology, telemedicine has been proposed as a means to optimize patient care. The purpose of this study was to assess patient order compliance in the virtual vs. in-person setting, prior to and during the COVID-19 pandemic, in the initial evaluation of abdominal pain (AP). Methods: Using natural language processing, we identified outpatient gastroenterology visits (virtual and inperson) for AP up to 1 year prior and after March 2020, labeled as pre-pandemic and pandemic visits, respectively. We assessed the number of orders placed for patients during these encounters and determined compliance based off order completion. A generalized linear mixed effects model with fixed effects for visit type, and random intercepts for intra-patient correlation was used. A multivariable model was built controlling for age, socioeconomic status, BMI, dementia, stroke and congestive heart failure. Results: Among 20,356 patients with AP at their initial visit, 16,089 patients (79%) had orders placed, 7,569 patients (47%) had pandemic in-person visits, 2,109 patients (13.1%) had pandemic virtual visits, and 6,409 patients (39.8%) had pre-pandemic in-person visits (Table 1). Comparing order compliance in patients seen during the pandemic, patients seen virtually were 38.3% less likely to complete orders in comparison to patients seen in-person (p < 0.0001). Patients seen in a pandemic virtual setting were 58.1% less likely to complete imaging orders (p < 0.0001), 73.9% less likely to complete procedure orders (p < 0.0001), and 47.8% less likely to complete lab orders (p = 0.0086) (Table 2). Lack of procedure compliance was compounded by low socioeconomic status ($25,000-$50,000) with patients 48.7% less likely to complete procedure orders (p <0.0264). Comparing compliance between pre-pandemic in-person visits with pandemic in-person visits, patients were 10% less likely to complete orders prior to the pandemic (p = 0.0151). Patients were 63.6% less likely to complete imaging orders (p < 0.0001), 68.8% less likely to complete procedures (p < 0.0001), and 38.7% less likely to complete lab orders (p=0.0002). Conclusion: Compared with in-person visits, patients seen virtually for their first presentation of abdominal pain were less likely to complete labs, imaging, and endoscopic evaluations. In-person visits were more successful at getting patients to complete orders prior to, and during, the pandemic. These findings highlight that virtual visits for abdominal pain, despite convenience, may be detrimental to care coordination and compliance. (Table Presented) (Table Presented)

4.
Journal of Adolescent Health ; 70(4):S19-S20, 2022.
Article in English | EMBASE | ID: covidwho-1936659

ABSTRACT

Purpose: Eating disorders in male populations are underrecognized and undertreated, leading to delays in identification, diagnosis, and treatment. Although male adolescents and young adults generally have greater energy requirements than females due to greater body weights, metabolic response, and exercise, current inpatient nutritional refeeding protocols support a single caloric prescription regardless of sex. The objective of this study was to determine sex differences in nutritional refeeding outcomes among adolescents and young adults hospitalized for eating disorders. Methods: We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to a tertiary care center for medical and nutritional management, between May 2012 and August 2020. We collected demographic, clinical, and nutritional characteristics (including initial calorie prescription, discharge kilocalories [kcals], weight change, and length of stay) from the electronic medical record. Descriptive statistics, unadjusted, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes, as well as length of stay. Results: A total of 588 adolescents and young adults met eligibility criteria, [16% male, mean (SD) age 15.96±2.75, 71.6% anorexia nervosa, admission percent median body mass index (%mBMI) 87.1±14.1]. In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980 kcal, P=0.188);however, males had higher Estimated Energy Requirements (EER) (3694 vs. 2925 kcal, P<0.001). In linear regression models adjusting for potential confounders including age, race/ethnicity, and diagnosis, male sex was associated with higher prescribed kcals at discharge (B=855 kcal, p<0.001), greater weight change (B=0.50 kg, p=0.016), and longer length of stay (B=1.83 days, p=0.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in linear regression models. In these adjusted models, every 1000 lower kcal prescribed at admission was associated with a 3.99 day longer length of stay while every 1000 greater kcal in the EER was associated with a 1.61 day longer length of stay. Conclusions: We report for the first time that males hospitalized for eating disorders require higher kcal/day at discharge than females despite clinical protocols that standardize the beginning kcal/day regardless of sex. This may lead to longer hospitalizations for male adolescents and young adults with eating disorders. These findings suggest that current refeeding approaches may be insufficient for male patients and support the development of individualized treatment protocols for males with eating disorders. Given the rise in hospitalizations for eating disorders during the COVID-19 pandemic, these findings can improve quality of care and healthcare efficiency among an underserved population in a post-pandemic world. Sources of Support: K08HL159350.

5.
Frontiers in Education ; 6, 2021.
Article in English | Scopus | ID: covidwho-1504909

ABSTRACT

Lockdowns and “stay-at-home” orders, starting in March 2020, shuttered bench and field dependent research across the world as a consequence of the global COVID-19 pandemic. The pandemic continues to have an impact on research progress and career development, especially for graduate students and early career researchers, as strict social distance limitations stifle ongoing research and impede in-person educational programs. The goal of the Bioinformatics Virtual Coordination Network (BVCN) was to reduce some of these impacts by helping research biologists learn new skills and initiate computational projects as alternative ways to carry out their research. The BVCN was founded in April 2020, at the peak of initial shutdowns, by an international group of early-career microbiology researchers with expertise in bioinformatics and computational biology. The BVCN instructors identified several foundational bioinformatic topics and organized hands-on tutorials through cloud-based platforms that had minimal hardware requirements (in order to maximize accessibility) such as RStudio Cloud and MyBinder. The major topics included the Unix terminal interface, R and Python programming languages, amplicon analysis, metagenomics, functional protein annotation, transcriptome analysis, network science, and population genetics and comparative genomics. The BVCN was structured as an open-access resource with a central hub providing access to all lesson content and hands-on tutorials (https://biovcnet.github.io/). As laboratories reopened and participants returned to previous commitments, the BVCN evolved: while the platform continues to enable “a la carte” lessons for learning computational skills, new and ongoing collaborative projects were initiated among instructors and participants, including a virtual, open-access bioinformatics conference in June 2021. In this manuscript we discuss the history, successes, and challenges of the BVCN initiative, highlighting how the lessons learned and strategies implemented may be applicable to the development and planning of future courses, workshops, and training programs. © Copyright © 2021 Tully, Buongiorno, Cohen, Cram, Garber, Hu, Krinos, Leftwich, Marshall, Sieradzki, Speth, Suter, Trivedi, Valentin-Alvarado and Weissman.

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