Establishing a Virtual Home Assessment Program: from Concept to Implementation as a Result of the COVID-19 Pandemic.

PURPOSE OF REVIEW: Environmental home assessments have traditionally been performed in-person at the homes of Children's Mercy Kansas City patients. The COVID-19 pandemic brought many challenges to the way patients interact with their healthcare providers, including home visiting programs. Reaching out to patients with high-risk asthma and immunocompromised health was still needed, despite the pandemic. This project's purpose was to develop a virtual (telemedicine) healthy home assessment protocol that would continue to meet patients' needs during the isolation resulting from the pandemic. RECENT FINDINGS: This is a newly developing approach to performing home environmental assessments with limited published research. Research on the effective use of telemedicine as an alternative to in-person clinic visits has shown that for some health conditions telemedicine represents a useful technique to engage with patients and caregivers. For some conditions, like pediatric asthma, it provides a similar level of efficacy in disease management while providing a more efficient form of interaction. This article describes the development and delivery process, timelines of caregiver interaction, and guidelines for performing virtual home assessments. It summarizes the challenges and benefits of using a virtual process for delivering home assessment services for asthma and allergy patients. Overall, caregivers indicated they found the use of virtual technology had significant benefits for them including their personal comfort and the time efficiency gained by using virtual visits to interact with Healthy Homes Program staff.

The Role of Home Environments in Allergic Disease.

Allergic diseases are surprisingly common, chronic health conditions. The primary location where the vast majority of people are exposed to allergens and other substances is in their home. This means it is important to understand home environments and how a home's systems function and interact-and that how we occupy these spaces plays a crucial role in both environmental exposure and management of allergic disease. This review provides an overview of what is understood about home environmental exposure and its impact on our health, and proposes a systematic process for using a patient's environmental history to develop individualized, manageable and cost-effective recommendations. Once occupant-related information has been gathered, a home environmental exposure assessment should be performed focused on identifying the relationships between any identified sources of contaminants and the housing systems, and conditions that may be contributing to exposure. The results and recommendations from this assessment can then be used to guide exposure-reduction efforts by patients and/or their caregivers in an effort to improve disease management. In this review, we'll discuss three different types of home interventions-active, which must be routinely performed by the patient and/or caregiver, passive, which are interventions that work without routine, direct interaction from the homeowner, and behavioral changes in how the home environment is cleaned and maintained for long-term reduction of allergens. In this review, and others evaluated for this discussion, a significant number of home environmental assessment and intervention programs were shown to be cost effective, with the majority of programs showing a net positive return on investment. It is important to recognize that to be cost effective, the level and intensity of services offered through home visit programs need be stratified, based on the estimated health risks of the patient, in order to tailor the assessment and target the interventions to a patient's needs while maximizing cost effectiveness.

Measurement of aeroallergens from furnace filters.

BACKGROUND: Exposure assessment is an important component of allergic disease diagnosis and management. Analysis for allergen content in vacuumed dust has been used traditionally. OBJECTIVE: To study allergen levels of dust taken from high-efficiency furnace filters in Midwestern homes. METHODS: Furnace filters used were FQT12 1-inch disposable filters with high-efficiency media placed in homes enrolled in the Kansas City Safe and Healthy Homes Project. Dust was removed from the filters by vacuuming. Fungal culture was used to obtain counts of viable spores. Aeroallergens Fel d1, Can f1, Mus m1, Der f1, Der p1, and Bla g2 and antigenic material from Alternaria, Aspergillus, Cladosporium, and Penicillium species were measured using commercially available immunoassay materials. RESULTS: Sixty filters were recovered from 56 homes after an average 135 days in situ. Mean weight of dust recovered was 2.43 g and correlated well with the time the filter was in place. Viable spore counts ranged to 4.8 × 10(7) per gram of dust. Mean fungal antigenic material ranged to 42 µg per gram for Cladosporium species. Mean aeroallergen material ranged to 7 µg per gram for Fel d1. Aeroallergen measurements were above the level of detection in 100% of houses for Fel d1 and 89% of houses for Bla g2. Levels of Fel d1 and Can f1 were strongly positively correlated. CONCLUSION: Allergens from 5 common aeroallergen species and antigenic material from 4 common fungal taxa can be measured in dust taken from high-efficiency furnace filters.

Quantitation of homovanillic acid (HVA) and vanillylmandelic acid (VMA) in urine using gas chromatography-mass spectrometry (GC/MS).

Neuroblastoma, in most cases, is characterized by increased production of catecholamines and their metabolites. Laboratory diagnosis and clinical follow-up include the measurement of urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA). In the following procedure, urine samples are diluted to give a creatinine concentration of 2 mg/dL. Deuterated internal standards are added to the diluted urine samples followed by acidification using HCl. Ethyl acetate is used to extract HVA and VMA from the acidified samples, and the extract is dried. The residue is treated with bis-(trimethylsilyl)trifluoroacetamide (BSTFA), 1% trimethylchlorosilane (TMCS), and pyridine to prepare trimethylsilyl derivatives of HVA and VMA. The derivatized samples are injected to into gas-chromatograph mass spectrometer. The concentration of HVA and VMA is determined by comparing responses of unknown sample to the responses of calibrators using selected ion monitoring.