RESUMO
Background: Beginning in March 2020, the COVID-19 pandemic forced many outpatient chest pain evaluations to be performed via telemedicine. The purpose of this study was to examine the impact of telemedicine on management and outcomes of patients who presented with chest pain. Methods: This retrospective chart review study included 771 unique patients, age >18 years, who were seen face-to-face in cardiology clinic visits from March 2019 through September 2019 with an encounter diagnosis of chest pain or angina, compared with 172 unique patients of age >18 who were seen via telehealth visit from March 2020 through September 2020. Data were extracted on patients' clinical outcomes up to 1 year after the initial visit, including emergency department visit or hospital admission for chest pain, any hospital admission, additional diagnostic testing, revascularization, and death (cardiovascular or any). Results: The telehealth group had higher rates of emergency department visits (19.2% vs 11.7%, P = 0.008), hospital admissions for chest pain (16.9% vs 10.5%, P = 0.019), as well as all hospital admissions (36.1% vs 28.2%, P = 0.04) compared with the face-to-face group. More patients in the face-to-face group received a stress test (41.1% vs 21.5% for the telehealth group; P < 0.001). There were no other statistically significant differences for diagnostic evaluations, revascularization, or death. Conclusion: Our findings suggest that in-person evaluation for chest pain may aid in reducing the number of emergency department visits and hospital admissions when compared to telehealth evaluation.
RESUMO
Bacteriophages, which are the natural predators of bacteria, have re-emerged as an attractive alternative to combat antibiotic resistant bacteria. Phages are highly specific at the species and strain level and measurement of the phage host range plays an important role in utilizing the phage as antimicrobials. The most common method for phage host range determination has been to spot phage lysates on soft agar overlays and observe plaque formation. In this study, a liquid culture-based assay was developed in a 96-well microtiter plate format to measure the phage host range and virulence for a collection of 15 Salmonella phages against a panel of 20 Salmonella strains representing 11 serovars. This method was compared to a traditional spot method. The majority of the host range results from two methods were in agreement including in cases where a bacterial strain was insensitive to the phage. Each method produced a false-negative result in 19/300 (6%) of the measured phage-host combinations when compared to the other method. The spot method tended to indicate greater phage sensitivity than the microtiter assay even though direct comparisons of the response magnitude between the two methods is difficult since they operate on different mechanisms. The microtiter plate assay was able to provide data on both the phage host range and virulence in greater resolution in a high-throughput format.
