Evaluation of Telephone Visits in Primary Care: Satisfaction of Pediatricians and Family Physicians and Their Perceptions of Quality of Care and Safety.

Telehealth has accelerated since the outbreak of the COVID-19 virus. As telephone visits become more common, it is important to examine the challenges involved in using this modality of care. In this study, we examined family physicians' and pediatricians' perceptions regarding three aspects of the use of telephone visits: quality of care, safety of care, and physicians' satisfaction. A total of 342 family physicians and pediatricians responded to an online survey. Respondents were asked to rate their degree of agreement with 17 statements inquiring about quality, safety, and satisfaction with telephone visits on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This was followed by in-depth interviews between January and April 2023 with 26 physicians. Participants expressed satisfaction (3.66 ± 0.80) with the use of telephone visits and lower assessments of safety (3.03 ± 0.76) and quality (2.27 ± 0.76) of care using the telephone modality. Eighty percent of the respondents think combining a face-to-face visit with a telephone visit is recommended, and 51% noted that the inability to examine patients closely affects and impedes a physician's decision making. Most interviewees indicated that telephone visits are safe only with former patients they had already seen in the clinic. The findings shed light on the perceptions of family physicians and pediatricians regarding telephone visits. The lower assessments of quality and safety compared to the assessment of satisfaction underscore the need for careful use of telephone visits in healthcare. A proper and balanced selection of patients, implementing technological upgrades to the modality, and performing patient education practices are recommended.

A structured graduated protocol with heat denatured eggs in the treatment of egg allergy.

BACKGROUND: Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols. OBJECTIVE: To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age. METHODS: In a case-control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non-parametric Kaplan-Meier and Cox proportional hazard regression models. RESULTS: Thirty-nine egg-allergic children with a median age at intervention of 16 months (interquartile range: 13-19) were treated with SGEP and followed to a median age of 39 months (26.8-50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46-104). The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5-28.5 months), compared to 78 months (95% CI, 53-102) in the control group, P < .001. At last follow-up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P = .001. CONCLUSION: A structured protocol with EHBE appears to promote faster resolution of EA.

A Structured Gradual Exposure Protocol to Baked and Heated Milk in the Treatment of Milk Allergy.

OBJECTIVE: To evaluate the efficacy and safety of a structured gradual exposure protocol (SGEP) with extensively heated and baked milk in promoting allergy resolution in children with cow milk allergy (CMA). STUDY DESIGN: In a case control study, children with CMA aged 1-4 years who were treated with SGEP including extensively heated and baked milk, were compared with children treated with strict avoidance. Data were collected from medical records and from validated telephone questionnaires. Data analysis was performed using a nonparametric Kaplan-Meier and proportional hazard Cox regression model, after evaluation of the adequacy of the case control matching. RESULTS: There were 43 children with milk allergy-26 (62%) males with a mean age at intervention of 21 months (range, 12-47 months)-who were treated with SGEP and followed to a mean age of 40 months (range, 20-82 months). The median age at resolution of CMA was compared with a matched group of 67 children treated with strict avoidance at least until 4 years of age or followed until earlier resolution, with a mean age at follow-up of 71 months (range, 11-176 months). The median estimated age at CMA resolution in the SGEP group was 36 months (95% CI, 34.5-49.7) compared with 98 months (95% CI, 82.4-114.1) in controls (P < .001). At last follow-up, 86% of treated children were tolerant to unheated milk proteins vs 52% of controls (P = .003). CONCLUSION: A structured protocol with extensively heated and baked milk seems to promote faster resolution of CMA.

The effect of meconium staining of amniotic fluid on the growth of Escherichia coli and group B streptococcus.

OBJECTIVE: To compare the effect of meconium staining on the growth rate of Escherichia coli and group B streptococci (GBS) in amniotic fluid. STUDY DESIGN: Sterile meconium was added in different concentrations to pooled sterile amniotic fluid obtained from term mothers. Meconium concentration was equal to: 1, 1.5, 3, 6, and 12 mg meconium/ml amniotic fluid. Amniotic fluid was quantitatively inoculated with E. coli and GBS type II and type III organisms (10(3) organisms/ml). Clear amniotic fluid and Todd-Hewitt broth served as controls. Growth rates of organisms were measured at 2, 4, 6, 8, and 24 hours after inoculation. RESULTS: Clear amniotic fluid was completely inhibitory for growth of E. coli even after 24 hours of incubation. In contrast, after 6 hours of incubation, significantly increased growth of GBS occurred (10(5) organisms/ml) (p<0.0001). The inhibitory effect on E. coli was observed even with meconium concentration of up to 1.5 mg/ml. In contrast, even the smallest concentration of meconium (1 mg/ml) resulted in a 2-log fold increase of GBS within 4 hours. The more rapid growth rate of GBS compared to E. coli persisted even at moderate staining of amniotic fluid (6 mg/ml) in the first 8 hours of incubation (p<0.005). In the presence of thick meconium (12 mg/ml), during the first 6 hours of incubation, the growth rates of GBS and E. coli were nearly similar. CONCLUSIONS: GBS (type II and III) growth, in contrast to E. coli, was less inhibited by amniotic fluid, occurred at a more rapid rate, and was enhanced at lower concentrations of meconium. As such, the presence of even light meconium staining in cases of rupture of membranes of even less than 6 hours in a mother who is a GBS carrier should be considered as a risk factor for the development of perinatal GBS infection.