Characterizing the Association of Race and Insurance Status with Resource Utilization in Brachial Plexopathy Surgery.

BACKGROUND: Understanding the link between socioeconomic status and immediate postoperative brachial plexus injury (BPI) management outcomes is critical to mitigating disparities and optimizing postoperative recovery plans. The present study aimed to elucidate the association between socioeconomic status and resource utilization following surgery for BPI. METHODS: We conducted a cross-sectional study of adult patients (18 years) with a BPI diagnosis from the 2002-2017 National Inpatient Sample. Primary outcomes included home discharge rates, length of stay (LOS), and cost. We used multivariable regressions to analyze outcome measures. RESULTS: A total of 23,755 BPI admissions were identified, 14.67% of whom received surgical intervention. Patients receiving Medicare had lower odds of home discharge compared with privately insured patients (adjusted odds ratio 0.65, 95% confidence interval 0.58-0.74; P < 0.001). Medicaid, Medicare, and uninsured patients had 6%-32% longer LOS than privately insured patients (P < 0.001, P = 0.004, and P = 0.006, respectively). Patients in the top income quartile had a 12% increase in costs compared with those in the bottom quartile (P < 0.001). Latinx and Other race groups had 11%-14% increased costs compared with White patients (Latinx P < 0.001, Other P = 0.003). CONCLUSIONS: Differences in BPI resource utilization and allocation exist, from increased LOS among non-privately insured and non-White patients to increased BPI treatment costs among patients in higher-income quartiles. Further research is necessary to elucidate how these disparities exist and impact functional outcomes.

Influence of synchronous primary care telemedicine versus in-person visits on diabetes, hypertension, and hyperlipidemia outcomes: a systematic review.

BACKGROUND: Telemedicine can be used to manage various health conditions, but there is a need to investigate its effectiveness for chronic disease management in the primary care setting. This study compares the effect of synchronous telemedicine versus in-person primary care visits on patient clinical outcomes. METHODS: A systematic review of studies published in PubMed and Web of Science between 1996 and January 2021 was performed using keywords related to telemedicine, diabetes, hypertension, and hyperlipidemia. Included studies compared synchronous telemedicine versus in-person visits with a primary care clinician, and examined outcomes of hemoglobin A1c (HbA1c), blood pressure, and/or lipid levels. RESULTS: Of 1724 citations screened, 7 publications met our inclusion criteria. Included studies were published between 2000 and 2018. Three studies were conducted in the United States, 2 in Spain, 1 in Sweden, and 1 in the United Kingdom. The telemedicine interventions investigated were multifaceted. All included synchronous visits with a primary care provider through videoconferencing and/or telephone, combined with other components such as asynchronous patient data transmission. Five studies reported on HbA1c changes, 5 on blood pressure changes, and 3 on changes in lipid levels. Compared to usual care with in-person visits, telemedicine was associated with greater reductions in HbA1c at 6 months and similar HbA1c outcomes at 12 months. Telemedicine conferred no significant differences in blood pressure and lipid levels compared to in-person clinic visits. CONCLUSIONS: A systematic review of the literature found few studies comparing clinical outcomes resulting from synchronous telemedicine versus in-person office visits, but the existing literature showed that in the primary care setting, telemedicine was not inferior to in-person visits for the management of diabetes, hypertension, or hypercholesterolemia. These results hold promise for continued use of telemedicine for chronic disease management.

Age of Both Parents Influences Reproduction and Egg Dumping Behavior in Drosophila melanogaster.

Trans-generational maternal effects have been shown to influence a broad range of offspring phenotypes. However, very little is known about paternal trans-generational effects. Here, we tested the trans-generational effects of maternal and paternal age, and their interaction, on daughter and son reproductive fitness in Drosophila melanogaster. We found significant effects of parent ages on offspring reproductive fitness during a 10 day postfertilization period. In daughters, older (45 days old) mothers conferred lower reproductive fitness compared with younger mothers (3 days old). In sons, father's age significantly affected reproductive fitness. The effects of 2 old parents were additive in both sexes and reproductive fitness was lowest when the focal individual had 2 old parents. Interestingly, daughter fertility was sensitive to father's age but son fertility was insensitive to mother's age, suggesting a sexual asymmetry in trans-generational effects. We found the egg-laying dynamics in daughters dramatically shaped this relationship. Daughters with 2 old parents demonstrated an extreme egg dumping behavior on day 1 and laid >2.35× the number of eggs than the other 3 age class treatments. Our study reveals significant trans-generational maternal and paternal age effects on fertility and an association with a novel egg laying behavioral phenotype in Drosophila.