TMS 2023 BACK TO BUSINESS AT TMS2023

With nearly 4,500 attendees gathered in San Diego CA, the TMS 2023 Annual Meeting & Exhibition (TMS2023) was the fourth best-attended meeting in TMS history, marking a return to business as usual (more or less) after two decidedly unusual years for the Society's biggest event. By comparison, approximately 2,600 individuals came together in person for TMS2022 in Anaheim CA. One year earlier, TMS2021--held as a fully virtual conference--attracted 2,967 attendees from around the world. This year's event, held Mar 19-23 in one of TMS's most popular meeting locations, brought the conference back closer to its pre-COVID participation numbers. The last time TMS met in San Diego was in 2020 (shortly before widespread pandemic shutdowns began) when more than 4,600 individuals came together for the largest meeting in the Society's history.

Strategies and Challenges to Teaching Students with Special Needs during a Pandemic

The COVID-19 pandemic has led to immediate school closures resulting in online learning. Online learning under such circumstances has presented challenges for teachers of students with mild to extensive support needs. The current study interviewed twenty special education teachers about the strategies they used when teaching online and the challenges they faced. Teachers discussed several strategies including the use of direct instruction, providing active engagement, caregiver involvement, and their frequent use of informal assessments. Challenges included time constraints and student inattention. Findings of this study can be used to inform strategies to use when teaching students with special needs online and in future online emergency teaching environments.

Moving Clinical Operations Forward During Pandemic

In the short and long term, sponsors should think through: * Protocol modifications to incorporate remote patient and site assessments or other virtual elements. * Patient visit requirements and anticipated data collection challenges. * Effective resumption of activities when the pandemic situation improves. * Improvements to risk management planning.8 * Overall impact on clinical trial and clinical program timelines (including time to approval). [...]each passing day brings new information about the spread of COVID-19 globally. [...]to plan for the short and long term, sponsors should go back to the drawing board and reevaluate overall clinical study design, including patient eligibility, feasibility, enrollment, timelines, and budgets against the evolving global landscape. [...]alarming projections indicate that socialdistancing countermeasures may need to be in place well into 20219, which means that biopharmaceutical sponsors should make urgent decisions now to plan for continued clinical research in the coming months.

So, You Want to Build a Program?

This article will help dementia care service organizations develop and evaluate intervention programs in the absence of evidence-based solutions, which is key, given: the limited access family caregivers have to evidence-based intervention programs;and the need for organizations to use limited resources to develop and test new programs to serve families living with dementia. It draws upon two case studies of interventions developed at an academic-service center: KINDER and Ayudando a Quien Ayuda;evaluates lessons learned in assessing the two programs to refine them by applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, and recommends ways organizations can refine interventions prior to efficacy-testing.

Flipping the Frame: How Rudy Gobert Went From an Episodic Bad Actor to a Thematic Hero

Rudy Gobert's positive COVID-19 diagnosis in March of 2020 started the process that led to American sports shutting down in the early days of the pandemic. After the diagnosis, video of him touching reporters' voice recorders at a press availability went viral. This framing analysis in five mainstream newspapers finds that over the course of 72 hours, Gobert went from a bad actor to a hero in news copy as an episodic frame focusing on his actions gave way to a thematic frame about the virus and its effects on the country.

Collaborative research services: a peer-led cohort approach

PurposePrior to 2020, University of California, Los Angeles (UCLA) Library's research services spanned multiple service points. Multiple locations were staffed by Library Student Research Assistants (LSRAs) and each location was supervised independently. While efforts to increase collaboration had been underway, much of the work and services remained siloed and often duplicated training and service hours.Design/methodology/approachWith the onset of coronavirus disease 2019 (COVID-19), UCLA Library rapidly transitioned from entirely in-person to entirely online services. With multiple service points pivoting, UCLA was redundant to have multiple online desks providing Zoom appointments and that quickly became apparent. Moreover, transitioning in-person student work to remote work was paramount to providing both normal services to users and allowing LSRAs to keep jobs during a time of uncertainty and insecurity.FindingsWhile the authors' original consolidation of services and implementation of shared supervision was a result of the pandemic and primarily involved online services, the authors have maintained this shared approach and collaborative vision in returning to in-person services. For the past year, the authors have offered shared in-person (at two library locations) and online services. As subject-specific library locations begin to reopen their desks, the authors continue to identify ways to leverage shared supervision and a robust referral model for those on-site services while negotiating student staffing and the need for both general and subject-specific services.Originality/valueThe authors present a novel approach to peer-to-peer teaching and learning and research services and shared student worker supervision with services coordinated across multiple locations and disciplines within a large academic library serving a large student population.

SeroNet Pooling Project of immunocompromised populations

Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.

Peter Sleight: visionary cardiologist and inspiring leader

Mervyn George Bishop/Fairfax Media/Getty Images Peter Sleight, a professor at Oxford University, helped to transform heart attack treatment and prevent cardiovascular disease with angiotensin converting enzyme inhibitors and statins. Isis methodology influenced the design of studies into other conditions, including the Recovery trial, which showed that dexamethasone reduces covid-19 mortality. [...]unlike many eminent men, he was able, endearingly, to laugh at himself—for example, when medical students lampooned him as Professor BA Flight after he had flown to Tokyo for the day. In the last 10 years of his life, he generated global media interest after demonstrating with his Italian colleague Luciano Bernardi that certain musical rhythms lowered blood pressure.

Guest editorial: The peer-led library

In an autoethnographic-inspired approach to their Library Student Ambassador Program, Pham and Muralles explore in their case study "Reimagining Peer Support and Engagement,” the growth and development of their program at California State University, East Bay and share recommendations and reflections from their ambassadors. Scripa and Spencer discuss the challenges and successes the team at the Pellissippi State Community College Libraries have had in launching their Pellissippi Ambassadors for Library Success program in "Introducing peer-to-peer reference services in a community college library.” Peer learning as a high impact practice As I and the authors within this issue agree, peer-led programs demonstrate key connecting points to high impact teaching and learning practices, allow opportunities for student employees to engage in career and professional formation activity, enhance a library's ability to engage with and provide outreach to underserved or underrepresented communities and break down traditional power structures, or barriers, that can be created by our traditional service models. In their article, "Shifting to a High Impact Practice-centered Student worker staffed Research Desk: a Hispanic Serving Institution Perspective,” Elizabeth DeZouche and Denise Santos discuss how their changes to the traditional desk model not only provided student consultants with a meaningful role but also helped them bridge the gap to their campus's mostly Hispanic, first-generation population.

Updated Real-World Safety of the Pfizer-BioNTech COVID-19 Vaccine in Pregnancy: Data from the Organization of Teratology Information Specialists (OTIS) Pregnancy Registry

Purpose: Preliminary data indicate that pregnant women infected with COVID-19 are at increased risk of pregnancy complications (US Centers for Disease Control and Prevention, October 2022). Information on the real-world safety of COVID-19 vaccination in pregnancy is essential. We sought to describe preliminary results for pregnancy status among pregnancy registry participants enrolled in an ongoing safety study of the Pfizer-BioNTech COVID-19 vaccine to date. Method(s): This study uses data from the Organization of Teratology Information Specialists (OTIS) Pregnancy Registry as part of the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) which enrolls pregnant women residing in the US or Canada. Data are captured through maternal interviews and the ion of medical records. The study population for this descriptive analysis includes Registry participants who met eligibility criteria on or after December 11, 2020, the date the US Food and Drug Administration granted emergency-use authorization for the Pfizer-BioNTech vaccine. The target sample size is 1,100 pregnant women who received any dose of the Pfizer-BioNTech vaccine from 30 days prior to the last menstrual period through the end of pregnancy, and 900 comparison women who received no COVID-19 vaccine in pregnancy. Result(s): Among pregnant women participating in the Registry between 11 December 2020 and 22 July 2022, 1,100/1,100 participants (100.0% of the target sample) were enrolled as part of the Pfizer-BioNTech COVID-19 vaccine exposure cohort, and 635/900 participants (70.6% of the target sample) were enrolled in the comparator cohort. As of 22 July 2022, 858 (78.0%) in the vaccine exposure cohort and 313 (34.8%) in the comparator cohort had completed pregnancies. Descriptive data indicated numerically similar percentages of pregnancies ending in at least one liveborn infant, spontaneous abortions, stillbirths, and elective terminations across the exposed cohort stratified by trimester of the earliest dose of the Pfizer-BioNTech COVID-19 vaccine received in pregnancy, and overall in the unexposed comparator cohort. Conclusion(s): Preliminary data have not identified any new safety concerns thus far for pregnant women who receive the Pfizer-BioNTech COVID-19 vaccine during pregnancy. Funding(s): This study was conducted as a collaboration between the University of California San Diego and Pfizer. Pfizer is the study sponsor.

Pathogen genomics in public health laboratories: successes, challenges, and lessons learned from California's SARS-CoV-2 Whole-Genome Sequencing Initiative, California COVIDNet.

The capacity for pathogen genomics in public health expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, but many public health laboratories did not have the infrastructure in place to handle the vast amount of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequence data generated. The California Department of Public Health, in partnership with Theiagen Genomics, was an early adopter of cloud-based resources for bioinformatics and genomic epidemiology, resulting in the creation of a SARS-CoV-2 genomic surveillance system that combined the efforts of more than 40 sequencing laboratories across government, academia and industry to form California COVIDNet, California's SARS-CoV-2 Whole-Genome Sequencing Initiative. Open-source bioinformatics workflows, ongoing training sessions for the public health workforce, and automated data transfer to visualization tools all contributed to the success of California COVIDNet. While challenges remain for public health genomic surveillance worldwide, California COVIDNet serves as a framework for a scaled and successful bioinformatics infrastructure that has expanded beyond SARS-CoV-2 to other pathogens of public health importance.

The Reentry Health Care Hub: Creating a California-Based Referral System to Link Chronically Ill People Leaving Prison to Primary Care.

People released from prison experience high health needs and face barriers to health care in the community. During the COVID-19 pandemic, people released early from California state prisons to under-resourced communities. Historically, there has been minimal care coordination between prisons and community primary care. The Transitions Clinic Network (TCN), a community-based non-profit organization, supports a network of California primary care clinics in adopting an evidence-based model of care for returning community members. In 2020, TCN linked the California Department of Corrections and Rehabilitation (CDCR) and 21 TCN-affiliated clinics to create the Reentry Health Care Hub, supporting patient linkages to care post-release. From April 2020-August 2022, the Hub received 8420 referrals from CDCR to facilitate linkages to clinics offering medical, behavioral health, and substance use disorder services, as well as community health workers with histories of incarceration. This program description identifies care continuity components critical for reentry, including data sharing between carceral and community health systems, time and patient access for pre-release care planning, and investments in primary care resources. This collaboration is a model for other states, especially after the Medicaid Reentry Act and amid initiatives to improve care continuity for returning community members, like California's Medicaid waiver (CalAIM).

Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Method(s): Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Result(s): In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65;data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion(s): In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.

Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).

The state of teacher evaluations in California k-12 public schools during COVID-19

Three key aspects were revealed through the literature review of teacher evaluations. First, teacher evaluations have been controversial nationwide and revised from the outset. Second, the COVID-19 pandemic added a layer of complexity. Third, research on the state of teacher evaluations was minimal, particularly for California K-12 public schools. This mixed methods non-experimental case study employed a grounded theory research approach to gain an understanding of teacher evaluations during the COVID-19 pandemic. To conduct the study, human resource administrators in public school districts serving K-12 students across all 58 counties in California were invited to participate in an online survey. A total of 134 respondents representing 36 counties completed the survey, and some participated in a semi-structured interview. The data was analyzed, and a theme emerged, which was confirmed by the semi-structured interviews. This study unearthed a substantive theory: Collaboration overcomes adversity. Collaboration made supposedly impossible situations manageable. The substantive theory and findings are currently limited to education and teacher evaluations. Further exploration is recommended for policy, research, and practice. Some limitations include single-source information and limited participation from urban school districts. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Machine learning with spatial interpolation techniques for constructing 2-dimensional ozone concentrations in Southern California during the COVID-19 shutdown.

In this study, we combine machine learning and geospatial interpolations to create a two-dimensional high-resolution ozone concentration fields over the South Coast Air Basin for the entire year of 2020. Three spatial interpolation methods (bicubic, IDW, and ordinary kriging) were employed. The predicted ozone concentration fields were constructed using 15 building sites, and random forest regression was employed to test predictability of 2020 data based on input data from past years. Spatially interpolated ozone concentrations were evaluated at twelve sites that were independent of the actual spatial interpolations to find the most suitable method for SoCAB. Ordinary kriging interpolation had the best performance overall for 2020: concentrations were overestimated for Anaheim, Compton, LA North Main Street, LAX, Rubidoux, and San Gabriel sites and underestimated for Banning, Glendora, Lake Elsinore, and Mira Loma sites. The model performance improved from the West to the East, exhibiting better predictions for inland sites. The model is best at interpolating ozone concentrations inside the sampling region (bounded by the building sites), with R2 ranging from 0.56 to 0.85 for those sites, as prediction deficiencies occurred at the periphery of the sampling region, with the lowest R2 of 0.39 for Winchester. All the interpolation methods poorly predicted and underestimated ozone concentrations in Crestline during summer (up to 19 ppb). Poor performance for Crestline indicates that the site has a distribution air pollution levels independent from all other sites. Therefore, historical data from coastal and inland sites should not be used to predict ozone in Crestline using data-driven spatial interpolation approaches. The study demonstrates the utility of machine learning and geospatial techniques for evaluating air pollution levels during anomalous periods.

The role of the California tier system in controlling population mobility during the COVID-19 pandemic.

BACKGROUND: Policies to restrict population mobility are a commonly used strategy to limit the transmission of contagious diseases. Among measures implemented during the COVID-19 pandemic were dynamic stay-at-home orders informed by real-time, regional-level data. California was the first state in the U.S. to implement this novel approach; however, the effectiveness of California's four-tier system on population mobility has not been quantified. METHODS: Utilizing data from mobile devices and county-level demographic data, we evaluated the impact of policy changes on population mobility and explored whether demographic characteristics explained variability in responsiveness to policy changes. For each California county, we calculated the proportion of people staying home and the average number of daily trips taken per 100 persons, across different trip distances and compared this to pre-COVID-19 levels. RESULTS: We found that overall mobility decreased when counties moved to a more restrictive tier and increased when moving to a less restrictive tier, as the policy intended. When placed in a more restrictive tier, the greatest decrease in mobility was observed for shorter and medium-range trips, while there was an unexpected increase in the longer trips. The mobility response varied by geographic region, as well as county-level median income, gross domestic product, economic, social, and educational contexts, the prevalence of farms, and recent election results. CONCLUSIONS: This analysis provides evidence of the effectiveness of the tier-based system in decreasing overall population mobility to ultimately reduce COVID-19 transmission. Results demonstrate that socio-political demographic indicators drive important variability in such patterns across counties.

Neighborhood Factors Associated with COVID-19 Cases in California.

BACKGROUND: There is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups. OBJECTIVE: To use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 case rates in California. DESIGN: Quasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences. MAIN MEASURES: All COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development. KEY RESULTS: The neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego. CONCLUSION: Neighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.

A Template for Video Telehealth Hand and Wrist Consultations during the Covid-19 Pandemic: A Preliminary Analysis of Patient and Provider Reported Outcomes

Purpose of Study: COVID-19 introduced a rapid shift to video telehealth patient visits. At our institution in Loma Linda, California, less than 13% of hand surgery patients were seen in person at the height of the pandemic, with the majority of patients being triaged to video telehealth appointments. This was challenging for the hand surgeon due to the complexity of a hand patient's physical examination. During this time, it was critical to rapidly develop, test, and implement a tool to assist the surgeon in evaluating and triaging patients effectively over video. The purpose of this project was to develop and implement a tool that would improve the effectiveness and efficiency of video telehealth visits for hand and wrist patients. Methods Used: We developed an informational packet that was sent to patients prior to their video telehealth visit containing a letter of explanation, a new patient questionnaire, and a step-by-step guide with photos for a virtual hand examination. The letter explained the guide's purpose and provided additional instructions to ensure visit effectiveness- remove jewelry and watches, find a space with optimal lighting, wear a short sleeve shirt, etc. In the virtual hand examination guide, we explained common physical examination maneuvers and The Ten Test to assist with virtual sensation assessment. A short "how-to" description in lay terms was given for each of the physical examination maneuvers and included corresponding photographs to maximize patient comprehension. Patients were instructed to read the guide prior to their video visit and to have it available during the visit. Summary of Results: We began to implement this tool in our hand practice for new and established patients in March 2020, and we have since found that our virtual hand examination has become more thorough and efficient. Surgeon satisfaction with this tool has been high, and patients have reported satisfaction and comfort. Patients have felt that it increased their understanding of the virtual physical examination process, decreased frustration, and have stated that they would recommend this guide to other patients scheduled to undergo a video telehealth visit. Conclusion(s): The COVID-19 pandemic necessitated a rapid shift from in-person visits to video telehealth consultations. This subsequently changed the way in which hand surgeons could evaluate their patients. The procedural changes that were adopted during the pandemic can be viewed as a sign of things to come, and we anticipate that video telehealth visits will continue to be commonplace in the future. In the wake of this change, we feel confident that this tool equips the hand surgeon well for an effective and efficient virtual examination and ultimately contributes to patient satisfaction.