Improving Access to Osteoporosis Specialists Using Electronic Consultations.

OBJECTIVE: To identify the types of osteoporosis-related questions being asked by primary care providers (PCPs) and describe the impact of the advice provided by osteoporosis specialists using eConsult. METHODS: We performed a cross-sectional study of osteoporosis-related eConsults submitted to endocrinologists between January 2018 and December 2020 on the Champlain eConsult BASE™ Service in Ontario, Canada. Each eConsult was coded according to clinical question and answer type through consensus between 2 authors, based on predetermined taxonomies. We analyzed eConsult utilization data, including response times, PCP satisfaction, and referral outcomes (collected via PCP surveys). RESULTS: Of the 2,528 eConsults sent to endocrinologists during the study period, 408 (16%) were specific to osteoporosis. The most common questions asked by PCPs were regarding whether or not to start treatment (35%), the initial therapy choice (25%), and how often to complete bone mineral density scans (15%). The most common responses from specialists included recommendations for bone mineral density scanning (34%), recommendation to start therapy (24%), and recommendation to treat using a bisphosphonate without the dose specified (23%). The median response interval was 3.1 days. Most cases (84%) were resolved without requiring an in-person referral. Clear advice for a new course of action for PCPs to implement was provided in 54% of cases. CONCLUSION: Osteoporosis eConsults provide timely access to valuable specialist advice while avoiding unnecessary face-to-face clinic visits. We identified commonly recurring osteoporosis questions asked by PCPs, which can be used to inform planning of future continuing professional development events.

A Survey Study to Examine Willingness to Travel for Transplantation and Consider Commercial Transplantation Among a Multiethnic Cohort of Canadians.

Introduction: Travel for transplantation is the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders for transplantation purposes and is considered transplant tourism if transplant commercialism is involved. Little is known about the willingness of patients at risk for transplant tourism to engage in this practice. Methods: A cross-sectional survey of patients with end-stage renal disease was conducted in Canada to determine interest in travel for transplantation and transplant tourism, characterize patients according to their willingness to consider transplant tourism, and identify factors to deter willingness to consider transplant tourism. Surveys were conducted face-to-face and in multiple languages. Results: Among the 708 patients surveyed, 418 (59%) reported a willingness to travel outside of Canada for transplantation, with 24% reporting a strong willingness. One hundred sixty-one (23%) reported a willingness to travel and purchase a kidney overseas. On multivariate analysis, male sex, younger age, and Pacific Islander ethnicity were associated with higher odds of willingness to travel for transplant, whereas male sex, annual income greater than $100,000, and Asian and Middle Eastern ethnicity were associated with higher odds of willing to travel to purchase a kidney. Willingness reduced when respondents were informed of medical risks and legal implications related to travel for transplantation. Financial and ethical considerations were less effective at reducing willingness to travel for transplantation. Conclusion: There was a high level of interest in travel for transplantation and transplant tourism. Legal consequences and education on medical risks of transplant tourism may be effective deterrent strategies.

Levofloxacin-induced Desquamation: A Possible and Rare Case Report.

INTRODUCTION: Levofloxacin is a fluoroquinolone active against both gram-negative and gram-positive bacteria with a well-defined margin of safety and efficacy. It has various labeled adverse effects like other fluoroquinolones but its adverse effect like desquamation is rarely reported. METHODS: We present a case report of levofloxacin-induced desquamation in an Indian patient. CASE REPORT: A-38-year old female patient presented to the outpatient department, with chief complaints of peeling off her epidermal skin. Initially, Desquamation started on her greater finger, which slowly spread to her hand, feet, lower limbs as well as upper limb and neck region. She was prescribed Levofloxacin for respiratory tract infection. RESULTS AND DISCUSSION: Considering temporal relationship, upon causality assessment, (Adverse Drug Reaction) ADR was found to be likely, moderate and probable. The drug was withdrawn along with the initiation of supportive therapy and reaction subsided. CONCLUSION: Although adverse drug reactions like desquamation are not fatal, this induces anxiety in the patients and reduces patient's quality of life. This case report will help keep physicians vigilant about the current adverse drug reaction, helping in the early detection and management of ADR.

Social Networking Sites for Peer-Driven Health Communication: Diabetes-Related Communities in Google.

OBJECTIVE: Google+ is one of the most actively used Social Networking Sites in the world. The aim of our study is to characterize the Google+ communities related to diabetes and identify the factors associated with the activity level of these communities. METHODS: We conducted a systematic search for diabetes-related Google+ communities. We categorized the principal objective of eligible communities into six themes: (1) awareness creation, (2) providing support and sharing experience, (3) product or service promotion, (4) diet-related topics, (5) exercise-related topics, and (6) others. The themes for the posts were: (1) asking for information, (2) providing information, (3) expressing emotion, and (4) advertisement. RESULTS: We included 145 Google+ communities and 378 posts for analysis. Majority (80.0%) of the communities were focused on "General Diabetics", 11.8% were focused on "Type 1 diabetes", 6.2% were focused on "Type 2 diabetes", and 2.1% were focused on "Gestational diabetes". Majority of the communities (35.2%) had the principal objective "Provide support and share experience". Regarding the user-generated posts, 29.6% posts had at least one "+" ("+" is similar to "like" in Facebook), 17.7% posts had comments, and 89.2% posts had external links. Majority of the posts (69.6%) were focused on "General diabetes", 16.9% were focused on "Type 1 diabetes", 12.4% were focused on "Type 2 diabetes" and 1.15 were focused on "gestational diabetes". The top two themes of the posts were "Providing information" (72.8%) and "Advertisement" (31.5%). CONCLUSION: Our study revealed that major activity of diabetes-related Google+ communities was related to providing support and information. However, the accuracy and effectiveness of the information in the communities need to be scrutinized further from clinical perspective.