Virtual Hospitalization at Home After the Covid-19 Pandemic: Time to Consider Our Future Community Healthcare Options.

The concept of acute hospitalization at home has been described for over 3 decades. Its scope, however, was largely limited to small experimental trials and pilot studies. The Covid-19 pandemic changed these circumstances. The convergence of the critical need for acute hospital beds along with the growing sophistication and comfort in virtual monitoring facilitated the rapid deployment of hospitalization at home throughout many communities in the United States. Now in the waning times of the pandemic, community health leaders and health systems are questioning what the future role of home virtual hospitalization might be. Might this concept be relegated to only future times of critical bed shortage, or might it be part of a true change in community healthcare delivery.

Ending Cervical Cancer Screening in Low-Risk Women After Age 65: Understanding Barriers to Adherence With Evidence-Based Guidelines Among Primary Care Providers.

BACKGROUND: Current evidence-based cervical cancer testing guidelines recommend that screening of low-risk women ceases after age 65. Despite this, research suggests that continued testing by primary care providers remains common and represents unnecessary patient discomfort, cost, and consumption of valuable primary care resources. OBJECTIVE: To understand why primary care providers might knowingly ignore consensus evidence-based screening guidelines for cervical cancer in low-risk women of this age-group and to identify barriers to adherence with best practice recommendations. METHODS: A survey tool to identify barriers to adherence with current guidelines for cervical cancer screening in low-risk women older than age 65 was mailed to 4929 randomly selected primary care providers throughout California. Providers were asked to indicate the predominant reason(s) they might knowingly continue cervical cancer screening in women older than 65 years, despite evidence-based recommendations to the contrary. RESULTS: Qualified surveys were received from 1259 (25.5%) of those surveyed, representing primary care providers of all types, practicing in areas of vastly different demographics. Despite published reassurance to the contrary, many providers retain fear that discontinuation of testing in low-risk women after age 65 may result in missed invasive cervical cancer. Even among health-care providers who agree that cessation of screening is safe, other circumstances prompt their recommendation to continue cervical screening. CONCLUSION: Although the data from this study suggest areas of policy intervention to lessen unnecessary cervical cancer screening, the broader implication is that advancement of evidence-based medicine will be of little value in improving the quality and cost of health care if barriers to guideline adherence are poorly understood and addressed.

Discontent and Confusion: Primary Care Providers' Opinions and Understanding of Current Cervical Cancer Screening Recommendations.

BACKGROUND: In 2012, new cervical cancer screening guidelines were published by three widely recognized entities which advocate delayed onset of testing, fewer screenings, selective use of human papilloma virus co-testing, and no further screening in women over age 65 years. Early observations report that these recommendations are not being followed and overscreening is common. This study seeks to understand why primary care providers might not adhere to these new 'best practice' health policy protocols. METHODS: A total of 4,909 randomly selected primary care providers (physicians, nurse practitioners, and physician assistants) practicing in California were mailed a study questionnaire. Participants were asked if they consider current published screening guidelines to be authoritative, reliable, and/or clinically appropriate. Clinical vignettes captured individual provider beliefs on timing and method of cervical cancer screening in women within the four key age groups embedded in current screening guidelines. RESULTS: Of the 4,909 surveys mailed, 1,268 (25.8%) qualified responses were received. Fundamentally, 35.0% of all primary care providers do not believe current guidelines are clinically appropriate, with 58.6% of obstetrician/gynecologist physicians having this same skepticism. Even among those who affirmatively believe current guidelines are authoritative, reliable, and clinically appropriate, only 15.3% recommend screening intervals and methodology of testing in women of four differing ages consistent with that of current policy guidelines. CONCLUSION: Among the primary care providers surveyed, distrust and confusion likely limit adherence to current evidence-based cervical cancer screening health policy recommendations, and contribute to the current high rates of overscreening that have been observed.

Going against the grain: an atypical presentation of celiac disease.

With the current prevalence of celiac disease, it is important to know the common signs and symptoms of this disease process and to also be aware of atypical presentations. This article describes a toddler who initially presented with recurrent diarrhea and weight loss with a significant secondary hypokalemia. His initial examination included screening for celiac disease, but the serology was negative. After persistent and worsening symptoms, further tests were pursued and a diagnosis of celiac disease was confirmed based on an upper endoscopy and histology.

Liquid culture and growth quantification of the seagrass pathogen, Labyrinthula spp.

Symptoms characteristic of wasting disease, thought to result from infection by protozoan pathogens (i.e. Labyrinthula spp.), are a common phenomenon affecting seagrass species worldwide. However relatively little is known about factors that control the survival and success of Labyrinthula in part due to the difficulty associated with quantifying the growth of this organism. Here we describe a simple and inexpensive method for measuring growth of Labyrinthula in liquid culture that takes into consideration both cell density and areal spread. The technique allows for examination of the effects of both abiotic and biotic factors on the growth of Labyrinthula apart from its seagrass host, separating the effects of environmental condition on the host from their effects on the pathogen.