ABSTRACT
BACKGROUND: Telemedicine serves millions of patients and is transforming healthcare delivery worldwide. In October of 2015, Nemours Children's Health System began offering direct-to-consumer (DTC) pediatric telemedicine on the Nemours CareConnect (NCC) platform. INTRODUCTION: Currently, there are no descriptive data available on pediatric-specific DTC 24/7 programs. This is the first article to our knowledge that provides data on such a program. MATERIALS AND METHODS: A retrospective data analysis of the first 1,000 visits was conducted. All patient data were precollected and deidentified. RESULTS: NCC was accessed for skin-related concerns (18.7%), upper respiratory symptoms (17.5%), fever (15.2%), and gastrointestinal issues (9.7%) most often on Saturdays and Sundays. Patients' ages ranged from 2 weeks to 20 years with the median age of 4 years. The peak time of call was between 4:00 PM and 8:00 PM. Median visit wait time was 2 min 11 s and median treatment time was 12 min 10 s. Patients rated providers and the NCC platform using a 5-star rating system. Over 93% of patients rated providers 5 stars and 86.0% rated the NCC platform 5 stars. Sixty-seven percent of parents reported they would have accessed an urgent care center, emergency room, or retail clinic if NCC were not available. DISCUSSION: NCC provides accessible, efficient care and parents are satisfied with the service. The postvisit survey suggested parents would have sought more expensive care if NCC were not available. CONCLUSION: NCC provided descriptive data using an audiovisual model. NCC warrants further investigation in regard to redirection of services.
ABSTRACT
OBJECTIVES: The aim of this study was to increase education and awareness among pediatric practitioners of possibility of simultaneous hemophagocytic lymphohistiocytosis and Kikuchi-Fujimoto disease/Kikuchi disease occurring in the pediatric population and the diagnostic dilemma it can present. We describe a case presentation of acquired and self-limited simultaneous hemophagocytic lymphohistiocytosis and Kikuchi-Fujimoto disease in a 16-year-old in the United States who presented with fevers, night sweats, and joint pain, along with tiredness and decreased appetite along with pancytopenia and elevated lactate dehydrogenase. To the best of our knowledge, simultaneous hemophagocytic lymphohistiocytosis and Kikuchi-Fujimoto in the pediatric population has not been described in North America but remains fairly common in Asia. The literature on both diseases and their simultaneous occurrence is comprehensively reviewed. METHODS: This was a case report and review of the literature. RESULTS: The patient was diagnosed with both hemophagocytic lymphohistiocytosis and Kikuchi-Fujimoto disease based on bone marrow aspiration/biopsy and axillary node biopsy, respectively. Both illnesses resolved completely. CONCLUSIONS: Benign causes of pancytopenia and elevated lactate dehydrogenase exist, but they may not be always straightforward diagnostically. Bone marrow aspiration and lymph node biopsy may be helpful in ascertaining the diagnosis. Hemophagocytic lymphohistiocytosis and Kikuchi-Fujimoto disease may represent a continuum of illness.
