Methods: A population-based study was constructed on TriNetX. The SUD cohort consisted of patients who tested positive for specific substances (phencyclidine, opioids, cocaine/benzoylecgonine, ...cannabinoids/tetrahydrocannabinol, benzodiazepines, amphetamine, methamphetamine, methylenedioxymethamphetamine, or methylenedioxyamphetamine) and were diagnosed with a SUD. A sub-analysis demonstrated similar patterns for patients with Opioid Use, Cannabis Use, and Sedative, Hypnotic, or Anxiolytic Use Disorders, indicating an increased risk of GERD and NERD (all P < 0.05) (Figure 1, Table 1).
Objective
We aimed to explore the impact of telehealth in the setting of COVID‐19 on patient access to ambulatory rheumatologic care at our academic public health system and to determine whether ...telemedicine visits had a beneficial impact on access to our rheumatology ambulatory clinics.
Methods
We compared completed, no‐show, and cancellation rates between in‐person clinic visits and telemedicine appointments over a 10‐week time period before Ohio's initial executive order responding to COVID‐19 (premandate period) and a 10‐week time period afterward (postmandate period). Scheduling and appointment data were retrospectively extracted from the medical center's electronic health record.
Results
During the premandate period, when all visits were in‐person, the total number of completed visits was 930. The percentages of cancellations, no‐shows, and completed appointments of all appointment activities were 31.43%, 13.12%, and 55.46%, respectively. During the postmandate period, when telemedicine visits were added, the overall total number of completed visits was 1038. The percentages of cancellations, no‐shows, and completed appointments of all appointment activities were 53.45%, 13.91%, and 32.64%, respectively, for in‐person appointments and 0.12%, 8.48%, and 91.39%, respectively, for telemedicine appointments.
Conclusion
Telemedicine during the COVID‐19 pandemic resulted in higher rates of completed appointments and lower rates of missed appointments in the rheumatology outpatient clinic compared with in‐person visits during and prior to the pandemic.
Background Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. ...Objective To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. Design Observational cohort study. Setting Outpatient and emergency care. Patients 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. Interventions Nasopharyngeal PCR test for SARS-CoV-2 infection. Measurements Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. Results We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 95% confidence interval: 0.91-3.59 times (at age 20) to 2.37 1.54-3.65 times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 3.9, 7.5) and cardiovascular disease (OR: 2.5 1.7, 3.8) were related to increased risk of hospitalization among the 1247 patients who tested positive. Limitations Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. Conclusion Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.
Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome (SSS) and may need permanent pacemaker (PPM) ...implantation. Association between catheter ablation of AF (CA) timing and need for PPM in SSS has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross-sectional analysis of 66,595 patients with AF and SSS to assess the need of PPM implantation temporally with atrial fibrillation performed earlier within 5 years (group 1), 5-10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest amongst those who had CA within 5 years of SSS diagnosis; group 1 versus group 2 (18.15 % vs 27.21 %) and group 1 versus group 3 (18.15 % vs 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21 % vs 27.22 %, OR 1.00 0.85- 1.20). Conclusion Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted odds (aOR) of PPM was lower if patient had CA within 5 years of diagnosis as compared to later than 5 years (aOR 0.64 0.59- 0.70).
Spirometry is necessary to diagnose chronic obstructive pulmonary disease (COPD), yet a large proportion of patients are diagnosed and treated without having received testing. This study explored ...whether the effects of interventions using the electronic health record (EHR) to target patients diagnosed with COPD without confirmatory spirometry impacted the incidence rates of spirometry referrals and completions. This retrospective before and after study assessed the impact of provider-facing clinical decision support that identified patients who had a diagnosis of COPD but had not received spirometry. Spirometry referrals, completions, and results were ascertained 1.5 years prior to and 1.5 years after the interventions were initiated. Inhaler prescriptions by class were also tallied. There were 10,949 unique patients with a diagnosis of COPD who were eligible for inclusion. 4,895 patients (44.7%) were excluded because they had completed spirometry prior to the cohort start dates. The pre-intervention cohort consisted of 2,622 patients, while the post-intervention cohort had 3,392. Spirometry referral rates pre-intervention were 20.2% compared to 31.6% post-intervention (p < 0.001). Spirometry completion rates rose from 13.2% pre-intervention to 19.3% afterwards (p < 0.001). 61.7% (585 of 948) had no evidence of airflow obstruction. After excluding patients with a diagnosis of asthma, 25.8% (126 of 488) patients who had no evidence of airflow obstruction had prescriptions for long-acting bronchodilators or inhaled steroids. A concerted EHR intervention modestly increased spirometry referral and completion rates in patients with a diagnosis of COPD without prior spirometry and decreased misclassification of disease.
Abstract We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two ...modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4° of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis.
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