ABSTRACT
Visual impairment affects many children and can lead to blindness if untreated. The coronavirus disease 2019 (COVID-19) pandemic has led to various restrictions and other challenges accessing in-person medical care, including essential pediatric eye care. The aim of this article was to determine and quantify the effect that pandemics have on access to pediatric eye care. A systematic literature search was conducted using various databases, which yielded 257 articles; nine were included in the final review. All included studies reported a decrease in the number of children accessing eye care during COVID-19. Most studies described virtual triage systems, which restricted in-person care to emergent cases. The average decrease in daily pediatric visits was 67.32% and reached statistical significance in the meta-analysis (P < .01). However, out of all patients with ocular complaints, the proportion of pediatric visits was unchanged, suggesting that the decrease in access to eye care was not specific to pediatric patients. [Pediatr Ann. 2023;52(2):e68-e75.].
Subject(s)
COVID-19 , Telemedicine , Humans , Child , COVID-19/epidemiology , COVID-19/therapy , Pandemics , TriageABSTRACT
OBJECTIVE: We assessed the impact of the transition from a primarily paper-based electronic health record (EHR) to a comprehensive EHR on emergency physician work tasks and efficiency in an academic emergency department (ED). METHODS: We conducted a time motion study of emergency physicians on shift in our ED. Fifteen emergency physicians were directly observed for two 4-hour sessions prior to EHR implementation, during go live, and then during post-implementation. Observers performed continuous observation and measured times for the following tasks: chart review, direct patient care, documentation, physical movement, communication, teaching, handover, and other. We compared time spent on tasks during the 3 phases of transition and analyzed mean times for the tasks per patient and per shift using 2-tailed t test for comparison. RESULTS: Physicians saw fewer patients per shift during go-live (0.51 patient/hour, P < 0.01), patient efficiency increased in post-implementation but did not recover to baseline (-0.31 patient/hour, P = 0.03). From pre-implementation to post-implementation, we observed a trend towards increased physician time spent charting (+54 seconds/patient, P = 0.05) and documenting (+36 seconds/patient, P = 0.36); time spent doing direct patient care trended towards decreasing (-0.43 seconds/patient, P = 0.23). A small percentage of shifts were spent receiving technical support and time spent on teaching activities remained relatively stable during EHR transition. CONCLUSION: A new EHR impacts emergency physician task allocation and several changes are sustained post-implementation. Physician efficiency decreased and did not recover to baseline. Understanding workflow changes during transition to EHR in the ED is necessary to develop strategies to maintain quality of care.
ABSTRACT
BACKGROUND: Restless legs syndrome (RLS) and uremic pruritus reduce the quality of life in patients with end-stage kidney disease (ESKD) and current treatments are often insufficient. There is an increasing interest in using cannabinoids for symptom management, and preliminary evidence suggests cannabinoids may help alleviate RLS and pruritus. OBJECTIVES: (1) To assess the frequency and severity of RLS and pruritus in our ESKD population with the current treatment options, (2) to estimate patient use of cannabinoids for these symptoms, and (3) to determine interest in participating in future trials to treat RLS and/or pruritus. DESIGN: Survey. PATIENTS: Adult prevalent patients with ESKD treated with dialysis at the Ottawa Hospital. MEASUREMENTS: International RLS Study Group Rating Scale and visual analogue scale for symptom severity of RLS and pruritus, respectively. METHODS: Eligible patients with ESKD treated at the Ottawa Hospital were invited to complete a survey to identify symptoms and severity of RLS and pruritus using validated scales, cannabis use for management, and interest in future trials. Basic demographic statistics to describe the study population and results were used. RESULTS: Sixty-nine percent (192 of 277) of eligible patients completed the surveys, 35 declined participation, and 50 surveys were not returned. Eighty-six (45%) and 129 patients (67%) reported symptoms of RLS and pruritus, respectively. Only 18 previously symptomatic patients were relieved with current treatment. Fifteen patients reported cannabis use for symptoms; 9 noted improvement. Most (>2 of 3) symptomatic patients were interested in participating in a future trial. LIMITATIONS: Single-center study in a tertiary-care hospital in Canada limiting generalizability. Quoted prevalence of symptoms is dependent on survey return. CONCLUSIONS: A large proportion of ESKD patients suffer from RLS and/or pruritus, most of which are not relieved by existing treatments. Few patients reported trying cannabis to decrease their symptoms despite legalization. This study confirms strong patient interest for future trials regarding cannabis for symptom relief. TRIAL REGISTRATION: Not applicable.
CONTEXTE: Le syndrome des jambes sans repos (SJSR) et le prurit urémique réduisent la qualité de vie des patients atteints d'insuffisance rénale terminale (IRT), et les traitements existants pour les soulager sont souvent insuffisants. Les cannabinoïdes suscitent un intérêt grandissant à cet effet et des données préliminaires suggèrent qu'ils pourraient atténuer le SJRS et le prurit. OBJECTIFS: 1) évaluer, dans une population de patients atteints d'IRT, la fréquence et la sévérité du SJRS et du prurit avec les options de traitement existantes; 2) estimer la consommation de cannabinoïdes pour soulager ces symptômes, et 3) sonder l'intérêt des patients à participer à des essais futurs sur les traitements du SJSR et du prurit. CONCEPTION: Sondage. SUJETS: Des adultes atteints d'IRT et dialysés à l'hôpital d'Ottawa. MESURES: L'échelle d'évaluation de l'International RLS Study Group et l'échelle visuelle analogique ont été utilisées pour mesurer respectivement la sévérité du SJSR et du prurit. MÉTHODOLOGIE: Les patients admissibles atteints d'IRT et dialysés à l'hôpital d'Ottawa ont été invités à répondre au sondage. Les répondants devaient identifier leurs symptômes de SJSR et de prurit et évaluer leur sévérité à l'aide d'échelles validées. Ils devaient également mentionner s'ils consommaient des cannabinoïdes pour soulager leurs symptômes et s'ils accepteraient de participer à de futurs essais sur le sujet. Des statistiques démographiques de base ont été employées pour décrire la population étudiée et les résultats. RÉSULTATS: Le sondage a été rempli par 192 des 277 patients admissibles (69 %); 35 patients ont refusé de participer et 50 sondages n'ont pas été retournés. Des symptômes de SJSR ont été rapportés par 86 répondants (45 %), et 129 patients (67 %) ont mentionné souffrir de prurit. Seuls 18 patients préalablement symptomatiques se sont dits soulagés par les traitements existants. La consommation de cannabis pour atténuer les symptômes a été rapportée par quinze patients, dont neuf voyaient une amélioration de leurs symptômes. Plus du 2/3 des patients symptomatiques accepteraient de participer à un essai futur. LIMITES: L'étude s'est tenue dans un seul center hospitalier de soins tertiaires canadien, ce qui limite la généralisabilité des résultats. La prévalence citée dépend du retour des sondages. CONCLUSION: Une grande proportion de patients atteints d'IRT souffre du SJSR et/ou de prurit urémique, la plupart d'entre eux n'étant pas soulagés par les traitements existants. Malgré la légalisation du cannabis, seuls quelques patients en consommaient pour atténuer leurs symptômes. Cette étude confirme le grand intérêt des patients envers de futurs essais examinant la consommation de cannabis pour soulager leurs symptômes. ENREGISTREMENT DE L'ESSAI: Sans objet.
