Clinical course and treatment interventions for adolescents who vaped during the COVID-19 pandemic.

Vaping nicotine and marijuana have been increasing among adolescents in the past 5 years. Tetrahydrocannabinol is the psychoactive cannabinoid in marijuana. The COVID-19 pandemic created gaps in healthcare access and visits, making it difficult to collect accurate data on adolescent vaping, willingness to quit and methods used to quit. In addition, the literature lacks information regarding effective evidence-based treatment measures for adolescents who vape. In this report, we seek to address this using two patient cases and detailing the interventions a managed care organisation enacted during this timeframe. Our investigation revealed a relationship between social stressors and vaping among teens. Addressing these underlying stressors and eliciting and treating mental health symptoms and polysubstance use appears to be critical to curbing vaping.

Mitigating the Youth Vaping Epidemic through Increasing Screening Rates for Youth Vaping/E-Cigarette Use in Pediatrics.

INTRODUCTION: E-cigarette/vaping use in adolescents has increased 77.8% among high schoolers and 48.5% among middle schoolers in 2017-2018. As such, there is need for an effective workflow for screening for vaping. We aimed to increase screening rates of e-cigarette/vaping users from less than 1% to at least 50% in 6 months. METHODS: Screening for vaping in youth was implemented in a pediatric clinic in Northern California beginning in the summer of 2019 for 6 months. Depending on comorbidity, severity, and readiness to quit, patients were referred to treatment. Outcomes included screening rates, process measure included positive screening rates, and balancing measure was provider time. RESULTS: The clinic completed 1414 physicals with an average screening rate of 76% and a positive rate of 7.9%. The average age of patients was 15 (standard deviation = 1.3), 48% were female and 29% were Asian/Pacific Islander, 23% Hispanic, and 23% White. After 6 months, we met our goal in all but 1 plan-do-study-act (PDSA) cycle. DISCUSSION: We created a standardized workflow that identified teens who vaped. When compared to other studies, the positive rate for this study was low which is likely due to misinterpretation by staff of screening questions as well as the fact that data were collected during a clinic visit. CONCLUSIONS: It is important to find ways in which providers can mitigate this epidemic given the alarming increase in e-cigarette/vaping use among adolescents. This study furthers the effort to develop a screening method that is simple and brief, allowing physicians to intervene if necessary.

Ensuring Mentorship of New Physicians in Their First Year: Constructs for New Mentoring Processes.

INTRODUCTION: The importance of mentoring new physicians is well established. OBJECTIVES: To evaluate and improve use of a competencies-based mentoring checklist to help new physicians understand the basic work environment and resources in their daily jobs as well as achieve needed competencies. METHODS: Literature searches, process improvements, and a review of curricula and mentoring from both inside and outside our large Medical Group were conducted to understand the workflow for new physician orientation, onboarding, and mentoring processes. We aimed to achieve a structured framework for mentor training, evaluation of the mentor-mentee relationship, and development of a bridge for the knowledge gaps and needs of the individual physicians in their departments. Finally, we surveyed new physician hires/mentees in 2017 about their competencies using the new checklist. RESULTS: The new mentoring process was improved compared with the current mentoring process. Polling of physician mentees after implementation of the checklist showed a 75% completion rate of checklist competencies from January 2017 to April 2018, compared with a baseline of 0%. CONCLUSION: Review of performance data and addressing deficiencies in a mentoring relationship can lead to active participation and meaningful change in competencies among new physicians.