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Durgun KX, Sikka N, Davey K, Hood C, Khokhar O, Sadur A, Labine M, Zaslavsky J. Emergency department documentation of legal intervention injuries at a Washington, DC, hospital. Acad Emerg Med 2024. [PMID: 38661226 DOI: 10.1111/acem.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The U.S. Centers for Disease Control and Prevention (CDC) defines legal intervention injuries as injuries caused by law enforcement agents in the course of official duties. Public health databases utilize International Classification of Diseases, 10th Revision (ICD-10), coding to collect these data through the "Y35" family ICD-10 code. Prior studies report deficiencies in public health recording of fatal legal intervention injuries. Few studies have characterized nonfatal injuries. This study investigates emergency department (ED) capture of legal intervention injury diagnostic coding. METHODS A retrospective chart review was performed on ED encounter data from January 1, 2017, to June 30, 2019, at an academic hospital in Washington, DC. Charts were identified using a keyword search program for "police." Chart abstracters reviewed the flagged charts and abstracted those that met injury definition. Primary outcomes included injury severity, patient demographics, and documented ICD-10 codes. One sample proportion testing was performed comparing sample census ED data. RESULTS A total of 340 encounters had sufficient descriptions of legal intervention injuries. A total of 259 had descriptions consistent with the patient specifier of "suspect." Hospital coders recorded 74 charts (28.6%) with the Y35 family legal intervention injury code. A total of 212 involved a Black patient. A total of 122 patients had Medicaid and 94 were uninsured. Black patients made up a higher proportion of individuals in the "suspect identified legal intervention injury" group than the total population (0.819 vs. 0.609, p < 0.01, 95% CI 0.772-0.866). Patients with Medicaid or who were uninsured made up substantial proportions as well (0.471 vs. 0.175, p < 0.01, 95% CI 0.410-0.532 for Medicaid patients and 0.363 vs. 0.155, p < 0.01, 95% CI 0.304-0.424 for the uninsured patients). CONCLUSION A large proportion of nonfatal legal intervention injuries remain unreported. Black and low-income patients are disproportionately affected. More research is needed but benefits from interprofessional data sharing, injury pattern awareness, and diagnostic coding guidance may improve reporting.
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Affiliation(s)
- Kevin Xerxes Durgun
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Kevin Davey
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Colton Hood
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Omair Khokhar
- George Washington University School of Medicine, Washington, DC, USA
| | - Alana Sadur
- George Washington University School of Medicine, Washington, DC, USA
| | - Monica Labine
- George Washington University School of Medicine, Washington, DC, USA
| | - Justin Zaslavsky
- George Washington University School of Medicine, Washington, DC, USA
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Gupta S, Sikka N, Kamboj M, Hooda A, Devi A, Narwal A. Dental professional's perspective regarding knowledge, awareness, and attitude towards the importance of charting dental anomalies: a cross-sectional study. J Forensic Odontostomatol 2023; 41:52-61. [PMID: 38183972 PMCID: PMC10859071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
OBJECTIVES The presence of dental anomalies could play a significant role in the identification of individuals by comparing antemortem and postmortem data. This cross-sectional study aimed to assess the level of knowledge, attitude, and awareness among dental professionals regarding the importance of charting dental anomalies and maintaining dental records. METHODOLOGY A self-structured questionnaire was e-mailed to dental professionals practicing in India. The responses were recorded, data tabulated, and one-way ANOVA and post hoc tests were applied for analysis. The criterion for significance was p < .05. RESULTS A total of 406 dental professionals responded to the survey. A significant difference was observed in the mean attitude score of participants towards the importance of charting dental anomalies and maintaining dental records with regard to place of work (p=.001), gender (p=.044) and educational qualification (p=.039). In addition, a statistically significant difference was observed in the mean awareness score of participants with respect to place of work (p=.033) and gender (p=.001). The major barriers in maintaining dental records were lack of time, adequate knowledge, infrastructure, and financial constraints. CONCLUSION 81.3% and 69.26% study participants had very good awareness and attitude, whereas 71.2% had good knowledge regarding the importance of charting dental anomalies and maintenance of dental records; however, their inaccurate responses in anomaly identification hinted towards the need for proper dental charting and their maintenance to be taught en masse and made part of the BDS curriculum.
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Affiliation(s)
- S Gupta
- Department of Or Anstomy Fas Graduato institute of Cantal Sciencos Rehtak, Haryana, India
| | - N Sikka
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - M Kamboj
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Hooda
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Devi
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Narwal
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Lew SQ, Kaur G, Sikka N, Erickson KF. In-center hemodialysis unit patient experience with telehealth. Hemodial Int 2023; 27:193-196. [PMID: 36744583 PMCID: PMC10957072 DOI: 10.1111/hdi.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/29/2022] [Accepted: 01/10/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Susie Q. Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
| | - Gurleen Kaur
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Kevin F. Erickson
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA
- Baker Institute for Public Policy and Department of Economics, Rice University, Houston, Texas, USA
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Wardlow L, Leff B, Biese K, Roberts C, Archbald-Pannone L, Ritchie C, DeCherrie LV, Sikka N, Gillespie SM. Development of telehealth principles and guidelines for older adults: A modified Delphi approach. J Am Geriatr Soc 2023; 71:371-382. [PMID: 36534900 DOI: 10.1111/jgs.18123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic elevated telehealth as a prevalent care delivery modality for older adults. However, guidelines and best practices for the provision of healthcare via telehealth are lacking. Principles and guidelines are needed to ensure that telehealth is safe, effective, and equitable for older adults. The Collaborative for Telehealth and Aging (C4TA) composed of providers, experts in geriatrics, telehealth, and advocacy, developed principles and guidelines for delivering telehealth to older adults. Using a modified Delphi process, C4TA members identified three principles and 18 guidelines. First, care should be person-centered; telehealth programs should be designed to meet the needs and preferences of older adults by considering their goals, family and caregivers, linguistic characteristics, and readiness and ability to use technology. Second, care should be equitable and accessible; telehealth programs should address individual and systemic barriers to care for older adults by considering issues of equity and access. Third, care should be integrated and coordinated across systems and people; telehealth should limit fragmentation, improve data sharing, increase communication across stakeholders, and address both workforce and financial sustainability. C4TA members have diverse perspectives and expertise but a shared commitment to improving older adults' lives. C4TA's recommendations highlight older adults' needs and create a roadmap for providers and health systems to take actionable steps to reach them. The next steps include developing implementation strategies, documenting current telehealth practices with older adults, and creating a community to support the dissemination, implementation, and evaluation of the recommendations.
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Affiliation(s)
- Liane Wardlow
- Clinical Research, West Health Institute, La Jolla, CA, USA
| | - Bruce Leff
- The Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Biese
- Emergency and Geriatric Medicine, University of North Carolina Health, Chapel Hill, NC, USA
| | - Carly Roberts
- Clinical Research, West Health Institute, La Jolla, CA, USA
| | | | - Christine Ritchie
- Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard University, Boston, MA, USA
| | - Linda V DeCherrie
- Clinical Strategy and Implementation, Medically Home, New York, New York, USA
| | - Neal Sikka
- Emergency Medicine, The George Washington University, Washington, DC, USA
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Abstract
Introduction: Telehealth is a potential solution to persistent disparities in health and health care access by eliminating structural barriers to care. However, its adoption in urban underserved settings has been limited and remains poorly characterized. Methods: This is a prospective cohort study of patients receiving telemedicine (TM) consultation for specialty care of diabetes, hypertension, and/or kidney disease with a Federally Qualified Health Center (FQHC) as the originating site and an academic medical center (AMC) multispecialty group practice as the distant site in an urban setting. Primary data were collected onsite at a local FQHC and an urban AMC between March 2017 and March 2020, before the COVID-19 pandemic. Clinical outcomes of study participants were compared with matched controls (CON) from a sister FQHC site who were referred for traditional in-person specialty visits at the AMC. No-show rates for study participants were calculated and compared to their no-show rates for standard (STD) in-person specialty visits at the AMC during the study period. A patient satisfaction questionnaire was administered at the end of each TM visit. Results: Visit attendance data were analyzed for 104 patients (834 visits). The no-show rate was 15%. The adjusted odds ratio for no-show for TM versus STD visits was 1.03 [0.66-1.63], p = 0.87. There were no significant differences between TM and CON groups in the change from pre- to intervention periods for mean arterial pressure (p = 0.26), serum creatinine (p = 0.90), or estimated glomerular filtration rate (p = 0.56). The reduction in hemoglobin A1c was significant at a trend level (p = 0.053). Patients indicated high overall satisfaction with TM. Discussion: The study demonstrated improved glycemic control and equivalent outcomes in TM management of hypertension and kidney disease with excellent patient satisfaction. This supports ongoing efforts to increase the availability of TM to improve access to care for urban underserved populations.
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Affiliation(s)
- Guenevere V Burke
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Kareem A Osman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Susie Q Lew
- Division of Kidney Disease & Hypertension, Department of Medicine, George Washington University, DC, USA
| | - Nicole Ehrhardt
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Lisa W Martin
- Division of Cardiology, Department of Medicine, George Washington University, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
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Pascual K, Fredman A, Naum A, Patil C, Sikka N. Should Mindfulness for Health Care Workers Go Virtual? A Mindfulness-Based Intervention Using Virtual Reality and Heart Rate Variability in the Emergency Department. Workplace Health Saf 2022; 71:188-194. [PMID: 36377263 DOI: 10.1177/21650799221123258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Research on burnout in the medical community has extensively studied the impact of mindfulness-based interventions (MBIs), which can include meditation, outdoor retreats, in-person didactics, and/or online wellness modules. However, in addition to these MBIs lacking objective, physiological measures for wellness, there has been little to no research involving virtual reality (VR) as an MBI modality for healthcare professionals in the United States. Methods: A randomized controlled intervention trial was used to study the impact of VR-based guided-meditations in the form of brief paced-breathing exercises. Heart-rate variability (HRV), a biomarker for relaxation, was measured during each session. Thirty-two participants, consisting of primarily medical students, resident physicians, and registered nurses, were recruited to complete brief guided-meditations via a VR headset or a standalone mobile app in the emergency department (ED) on-call room of a large urban academic medical center. Results: A total of 213 guided-meditation sessions were completed over the course of 4 weeks. Self-reported ratings of anxiety improved in both VR and mobile groups post-study. However, the VR group demonstrated higher intrasession HRV progress, indicating increased state of relaxation that also correlated with the number of sessions completed. Analysis by gender revealed disparity in HRV metrics between male and female VR participants. Conclusion/Application to Practice: VR-based guided meditations prove to be a feasible and accessible MBI that does not require extensive time commitment for healthcare workers. VR may be a more effective meditation platform compared with standalone mobile meditation apps, especially when used on a routine basis.
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Affiliation(s)
- King Pascual
- The George Washington University School of Medicine and Health Sciences
| | - Amiad Fredman
- The George Washington University School of Medicine and Health Sciences
| | | | | | - Neal Sikka
- The George Washington University School of Medicine and Health Sciences
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Lafleur J, Sikka N, Hood C. Wilderness-Telemedicine, a New Training Paradigm. Wilderness Environ Med 2022; 33:488-489. [PMID: 36123274 DOI: 10.1016/j.wem.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 10/14/2022]
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Chu F, Skrabal JR, Rutenberg A, Sikka N. Scalp laceration repair with hair apposition technique in the maritime environment under telemedicine guidance using free open-access medical resources. Int Marit Health 2022; 73:43-45. [DOI: 10.5603/imh.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
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Jeffries PR, Bushardt RL, DuBose-Morris R, Hood C, Kardong-Edgren S, Pintz C, Posey L, Sikka N. The Role of Technology in Health Professions Education During the COVID-19 Pandemic. Acad Med 2022; 97:S104-S109. [PMID: 34789662 PMCID: PMC8855755 DOI: 10.1097/acm.0000000000004523] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.
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Affiliation(s)
- Pamela R. Jeffries
- P.R. Jeffries is professor and dean, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Reamer L. Bushardt
- R.L. Bushardt is professor and senior associate dean, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Ragan DuBose-Morris
- R. DuBose-Morris is associate professor, Academic Affairs Faculty, Medical University of South Carolina, Charleston, South Carolina
| | - Colton Hood
- C. Hood is assistant professor, Department of Emergency Medicine, The George Washington University, Washington, DC
| | - Suzan Kardong-Edgren
- S. Kardong-Edgren is associate professor, Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts
| | - Christine Pintz
- C. Pintz is professor, School of Nursing, The George Washington University, Washington, DC
| | - Laurie Posey
- L. Posey is associate professor, School of Nursing, The George Washington University, Washington, DC
| | - Neal Sikka
- N. Sikka is professor, Department of Emergency Medicine, The GW Medical Faculty Associates, Washington, DC
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Pourmand A, Boniface KS, Douglass K, Hood C, Frasure SE, Barnett J, Bhatt K, Sikka N. Utilization of Automated Keyword Search to Identify E-Scooter Injuries in the Emergency Department. Cureus 2021; 13:e19539. [PMID: 34934557 PMCID: PMC8667961 DOI: 10.7759/cureus.19539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Accurate identification and categorization of injuries from medical records can be challenging, yet it is important for injury epidemiology and prevention efforts. Coding systems such as the International Classification of Diseases (ICD) have well-known limitations. Utilizing computer-based techniques such as natural language processing (NLP) can help augment the identification and categorization of diseases in electronic health records. We used a Python program to search the text to identify cases of scooter injuries that presented to our emergency department (ED). Materials and methods This retrospective chart review was conducted between March 2017 and June 2019 in a single, urban academic ED with approximately 80,000 annual visits. The physician documentation was stored as combined PDF files by date. A Python program was developed to search the text from 186,987 encounters to find the string "scoot" and to extract the 100 characters before and after the phrase to facilitate a manual review of this subset of charts. Results A total of 890 charts were identified using the Python program, of which 235 (26.4%) were confirmed as e-scooter cases. Patients had an average age of 36 years and 53% were male. In 81.7% of cases, the patients reported a fall from the scooter and only 1.7% reported wearing a helmet during the event. The most commonly injured body areas were the upper extremity (57.9%), head (42.1%), and lower extremity (36.2%). The most frequently consulted specialists were orthopedic and trauma surgeons with 28% of cases requiring a consult. In our population, 9.4% of patients required admission to the hospital. Conclusions The number of results and data returned by the Python program was easy to manage and made it easier to identify charts for abstraction. The charts obtained allowed us to understand the nature and demographics of e-scooter injuries in our ED. E-scooters continue to be a popular mode of transportation, and understanding injury patterns related to them may inform and guide opportunities for policy and prevention.
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Affiliation(s)
- Ali Pourmand
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith S Boniface
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Katherine Douglass
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Colton Hood
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarah E Frasure
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jeremy Barnett
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kunj Bhatt
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Neal Sikka
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Affiliation(s)
- Susie Q. Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC
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Hood C, Sikka N, Rutenberg A, Allabban A. 351 Can the Centor Score Be Used Effectively via Telehealth? Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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GW Maritime Medical Access Adam Rutenberg, Byrnes T, Sikka N, Haile-Mariam T, Boniface K, O'Connell F, Hood C, Pourmand A. 346 Mariner Self-Classification of Contact-Type With COVID-19 Index Case and Subsequent Infection on Ships. Ann Emerg Med 2021. [PMCID: PMC8536274 DOI: 10.1016/j.annemergmed.2021.09.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Gallerani C, Allabban A, Jacobs B, Sikka N, Manfredi R. 375 Telemedicine and Goals of Care Discussions: A Successful Combination in the Emergency Department. Ann Emerg Med 2021. [PMCID: PMC8536268 DOI: 10.1016/j.annemergmed.2021.09.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alshiakh S, Patil R, Rutenberg A, Hood C, Ajabnoor Y, Rebol M, Galavo C, Horan E, Pietroszek K, Sikka N, Ranniger C. 183 Preliminary Results of Assessing Cognitive Load During Procedure Training. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baker MC, King SL, Sikka N, Krupinski EA, Shipman SA, Haberman M. Trends in Adoption and Maturation of Telehealth Programs at Teaching Hospitals and Health Systems. Telemed J E Health 2021; 28:517-525. [PMID: 34265223 DOI: 10.1089/tmj.2020.0571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although early adopters of telehealth have built and sustained telehealth programs over long periods, little research has been conducted differentiating the characteristics of health systems at different stages of maturation. Methods: This study surveyed 165 major teaching hospitals and health systems from fiscal year 2015 through 2018 about the stage and characteristics of their telehealth services. Respondents reported (i) the progression level of their telehealth program, (ii) which of six services they provide, and (iii) greatest barriers and motivators to implementing telehealth, as well as their overall operational and financial characteristics. Results: Telehealth programs at teaching hospitals progressed steadily and adoption of a wide range of telehealth delivery modes expanded. Hospital operational and financial characteristics corresponding to both higher maturation and the adoption of more delivery modes were identified. Reported barriers and motivations were similar across maturation levels. Discussion: With telehealth's broader use and the heterogeneity of delivery modes being utilized, a binary metric of whether or not to implement telehealth does not sufficiently capture key differences in telehealth programs or differentiate implementation scope and scale across health systems. Conclusions: The findings suggest that programs at different levels of maturation are characteristically different from one another. Identifying factors related to mature telehealth programs may help guide policymakers, future telehealth program leaders, and other stakeholders in identifying barriers to continued investment in telehealth.
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Affiliation(s)
- Matthew C Baker
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Sarah L King
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Scott A Shipman
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Merle Haberman
- Association of American Medical Colleges, Washington, District of Columbia, USA
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Siddiqui S, Marin J, Kupsky G, Quan T, Frasure SE, Sikka N, Pourmand A. A Novel Approach to Establish and Enhance Event Reporting Systems Among Resident Physicians. AEM Educ Train 2021; 5:e10554. [PMID: 34124502 PMCID: PMC8171445 DOI: 10.1002/aet2.10554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Event reporting systems are an integral part of patient safety programs that continue to remain a challenge primarily due to systems-based barriers. Smartphone use in patient care continues to be an ever-growing facet of medicine and patient care. Combining the problem of event reporting challenges with the modern resource of mobile phones may be used to promote a culture of safety and increase event reporting in the emergency department (ED) and the hospital among residents. METHODS We introduced a new method of event reporting for emergency medicine (EM) residents in the ED using a mobile messaging application widely used throughout the hospital to facilitate physician communication to report events. Implementation of the intervention occurred in three phases. During the preintervention phase, we retrospectively reviewed EM resident rates of event reporting and administered a survey regarding their attitudes toward the traditional system of event reporting. We then introduced the mobile messaging application-based event reporting system and tracked the number of events recorded during the first 8 months of implementation. Following the intervention, we administered a postintervention survey to the EM residents inquiring about the same metrics that were used in the preintervention survey. RESULTS Forty EM residents reported a total of 147 events during the 8 months of the intervention phase compared to 12 reports during the prior year as whole, resulting in a 12-fold increase. The postintervention scores ranged from 55 to 73 with a mean (±SD) of 65 (±9). EM resident satisfaction rates and comfort level with the new reporting system increased by 232 and 104%, respectively, and the likelihood of reporting an event increased by 127% (p < 0.02). The time required by EM residents to submit a report also decreased significantly. CONCLUSION The implementation of a mobile application to target systems barriers associated with event reporting significantly increased event reporting by EM residents, improved EM resident attitudes about event reporting, and reduced the time required to submit an event, ultimately promoting a culture of safety.
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Affiliation(s)
- Saud Siddiqui
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Johnnatan Marin
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Genevieve Kupsky
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Theodore Quan
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Sarah E. Frasure
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Neal Sikka
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Ali Pourmand
- Department of Emergency MedicineGeorge Washington University School of Medicine and Health SciencesWashingtonDCUSA
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Aalam AA, Hood C, Donelan C, Rutenberg A, Kane EM, Sikka N. Remote patient monitoring for ED discharges in the COVID-19 pandemic. Emerg Med J 2021; 38:229-231. [PMID: 33472870 PMCID: PMC7818800 DOI: 10.1136/emermed-2020-210022] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 01/06/2023]
Abstract
COVID-19 has had a significant effect on healthcare resources worldwide, with our knowledge of the natural progression of the disease evolving for the individual patient. To allow for early detection of worsening clinical status, protect hospital capacity and provide extended access for vulnerable patients, our emergency department developed a remote patient monitoring programme for discharged patients with COVID-19. The programme uses a daily emailed secure link to a survey in which patients submit biometric and symptoms data for monitoring. Patients' meeting criteria are escalated to a physician for a phone or video visit. Here, we describe the development, implementation and preliminary analysis of utilisation of the programme.
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Affiliation(s)
- Ahmad A Aalam
- Emergency Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Colton Hood
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Crystal Donelan
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adam Rutenberg
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Erin M Kane
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Neal Sikka
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Abstract
Background: The COVID-19 pandemic has driven most clinicians, from those practicing in small independent practices to those in large system, to adopt virtual care. However, individuals and organizations may lack the experience and skills that would be considered fundamental prerequisites to adopting telehealth in less urgent times. What are those skills? Before the pandemic, the Association of American Medical Colleges (AAMC) convened national experts to identify and articulate a consensus set of critical telehealth skills for clinicians. Methods: Through a structured review of the literature, followed by several rounds of review and refinement by committee and community members via a modified Delphi process, the committee came to consensus on a set of skills required by clinicians to provide quality care via telehealth. Conclusion: The consensus set of telehealth skills presented in this paper, developed by the AAMC and national experts, can serve providers and health systems seeking to ensure that clinicians are prepared to meet the demand for care delivered via telehealth now and in the future.
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Affiliation(s)
- Kevin Galpin
- Telehealth Services, Veterans Health Administration, Washington, District of Columbia, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA
| | - Sarah L King
- Health Care Affairs, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Keith A Horvath
- Health Care Affairs, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Scott A Shipman
- Health Care Affairs, Association of American Medical Colleges, Washington, District of Columbia, USA
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20
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Rutenberg A, Pourmand A, Jones E, Ajabnoor Y, Sikka N. 178 Pattern of Skin Infection Presentations in the Maritime Environment. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Abstract
Purpose: With numerous advancements in telemedicine over the past few years, there has been a huge shift toward home-based digital care. However, the absence of telepresenters in the home to facilitate these teleconsultations can result in incomplete and insufficient patient assessments, both of which can affect overall health outcomes. We describe the feasibility of training laypersons to serve as telepresenters in a community-based telemedicine setting. Methods: Community members were recruited to become trained telepresenters. The training protocol consisted of four modules: (1) didactics, (2) vital signs, (3) physical examinations, and (4) proficiency. Trainees complete surveys regarding the training and were observed on skills competency and interactions with patients and providers. Results: A total of 32 volunteers completed the training. Layperson telepresenters (LTPs) gained knowledge and confidence to perform their role successfully, as well as received positive ratings from patients, distant providers, and onsite program personnel on all aspects of their performance as telepresenters. Conclusions: Although further research is needed to determine the impact and generalizability of these results, this pilot study demonstrated the initial feasibility of training LTPs.
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Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Davin Combs
- Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
| | - Nicole Lum
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Kendrick E Curry
- The Pennsylvania Ave Baptist Church, Washington, District of Columbia, USA
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23
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Pourmand A, Ghassemi M, Sumon K, Amini SB, Hood C, Sikka N. Lack of Telemedicine Training in Academic Medicine: Are We Preparing the Next Generation? Telemed J E Health 2020; 27:62-67. [PMID: 32294025 DOI: 10.1089/tmj.2019.0287] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Telemedicine focuses on providing medical care to patients in remote locations using telecommunication technologies. It has been shown to be cost-effective, improve health outcomes, and enhance patient satisfaction. This study examines the extent to which medical students and resident physicians are exposed to telemedicine during training. Materials and Methods: The authors accessed the American College of Graduate Medical Education (ACGME) Residency Milestones from specialties and subspecialties mentioned in the 2018 Milestones National Report and searched for key terms, including "Technology," "Telemedicine," "Telehealth," "EMR," "Electronic Medical Record," "EHR," "Electronic Health Record," "Electronics," and "Social Media." The authors also accessed the 2018 American Association of Medical Colleges (AAMC) "Curriculum Inventory and Reports" to retrieve data from surveys of medical schools that included telemedicine in required courses and electives for medical students from 2013 to 2018. Results: From the 104 ACGME specialty milestones, only one specialty (Child and Adolescent Psychiatry) mentioned telehealth in its ACGME Milestone document. According to the AAMC data the number of medical schools surveyed increased every academic year from 140 in 2013/2014 to 147 in 2017/2018, telemedicine education in medical school increased significantly from 41% in 2013/2014 to 60% in 2017/2018 (p = 0.0006). However, the growth in telemedicine education plateaued from 56% in 2015/2016 to 60% in 2017/2018 (p = 0.47). Conclusion: Familiarizing medical students with telemedicine is essential; the next generation of health care providers should be equipped with knowledge of telemedicine as a valuable skill to serve populations that do not have direct access to quality medical care. Methods of implementing telemedicine education into more medical schools and residency programs merits further study.
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Affiliation(s)
- Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Mateen Ghassemi
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kazi Sumon
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Saeid B Amini
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Colton Hood
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Neal Sikka
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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24
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Boniface KS, Sikka N, Page N, Peretz A, Shokoohi H. A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound. Int Marit Health 2020; 71:42-45. [PMID: 32212147 DOI: 10.5603/imh.2020.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/25/2022] Open
Abstract
Cruise ships travel far from shoreside medical care and present a unique austere medical environment. For the cruise ship physician, decisions regarding emergency medical evacuation can be challenging. In the event that a passenger or crew member becomes seriously ill or is injured, the use of point-of-care ultrasound may assist in clarifying the diagnosis and stratifying the risk of a delayed care, and at times expedite an emergent medical evacuation. In this report we present the first case reported in the literaturę of an emergency medical evacuation from a cruise ship triggered by handheld ultrasound. A point-of-care ultrasound performed by a trained cruise ship physician, reviewed by a remote telemedical consultant with experience in point-of-care ultrasound, identified an ectopic pregnancy with intraabdominal free fluid in a young female patient with abdominal pain and expedited emergent helicopter evacuation from a cruise ship to a shoreside facility, where she immediately underwent successful surgery. The case highlights a medical evacuation that was accurately triggered by utilising a handheld ultrasound and successfully directed via a tele-ultrasound consultation. American College of Emergency Physicians (ACEP) health care guidelines for cruise ship medical facilities should be updated to include guidelines for point-of-care ultrasound, including training and telemedical support.
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Affiliation(s)
- Keith S Boniface
- The George Washington University, 2120 L Street NW, Suite 450, 20037 Washington, DC, United States.
| | - Neal Sikka
- The George Washington University, 2120 L Street NW, Suite 450, 20037 Washington, DC, United States
| | | | | | - Hamid Shokoohi
- The George Washington University, 2120 L Street NW, Suite 450, 20037 Washington, DC, United States.,Massachusetts General Hospital, Boston, MA, United States
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25
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Abstract
The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare beneficiaries who receive home dialysis in which two of three monthly visits in a quarter may be performed by telehealth after three initial face-to-face monthly visits. The originating site (where the patient is located) can be a dialysis unit or the patient's home and without geographic restriction. Patient awareness and interest in this new telehealth benefit in urban patients has not been well characterized. Patients receiving peritoneal dialysis (PD) treatment located in an urban facility completed a survey to ascertain knowledge of telehealth and readiness and willingness to participate in telehealth for their monthly visit. A total of 30 patients participated: 37% who completed the survey had heard of telehealth and 40% were able to define telehealth in words and correctly identify an example of telehealth. None of the patients were aware of the 2018 US Bipartisan Budget Act which extended telehealth assess to Medicare beneficiaries. Almost everyone had a mobile phone (83%), owned a computer (50%), and had access to Internet services (90%). The majority of patients (73%) were willing to use telehealth services for their monthly visit with the physician. PD patients living in an urban setting appear to be ready and interested in using telehealth to perform their monthly visit with the physician.
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Affiliation(s)
- Susie Q Lew
- Department of Medicine, George Washington University, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, DC, USA
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26
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Magnus M, Edwards E, Dright A, Gilliam L, Brown A, Levy M, Sikka N, Siegel M, Criss V, Watson CC, Machtinger E, Kuo I. Development of a telehealth intervention to promote care-seeking among transgender women of color in Washington, DC. Public Health Nurs 2020; 37:262-271. [PMID: 32017202 DOI: 10.1111/phn.12709] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/21/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. METHODS Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC ≥ 18 years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18 years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. RESULTS Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. CONCLUSIONS Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Elizabeth Edwards
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aurnell Dright
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leandrea Gilliam
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Angela Brown
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Matthew Levy
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Neal Sikka
- Section of Innovative Practice, Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Marc Siegel
- Medical Faculty Associates, Inc, George Washington University, Washington, DC, USA
| | - Vittoria Criss
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christopher Chauncey Watson
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Edwards Machtinger
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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27
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Sikka N, Gross H, Joshi AU, Shaheen E, Baker MJ, Ash A, Hollander JE, Cheung DS, Chiu AR, Wessel CB, Robinson M, Lowry G, Guyette FX. Defining emergency telehealth. J Telemed Telecare 2019; 27:527-530. [PMID: 31825766 DOI: 10.1177/1357633x19891653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The American College of Emergency Physicians Emergency Telehealth Section was charged with development of a working definition of emergency telehealth that aligns with the College's definition of emergency medicine. A modified Delphi method was used by the section membership who represented telehealth providers in both private and public health-care delivery systems, academia and industry, rural and urban settings. Presented in this manuscript is the final definition of emergency telehealth developed with an additional six clarifying statements to address the context of the definition. Emergency telehealth is a core domain of emergency medicine and is inclusive of remotely providing all types of care for acute conditions of any kind requiring expeditious care irrespective of any prior relationship. The development of this definition is important to the global community of emergency physicians and all patients seeking acute care to ensure that appropriately trained clinicians are providing the highest quality of emergency services via the telehealth modality. We recommend implementing emergency telehealth in a manner that ensures appropriate qualifications of providers, appropriate/parity reimbursement for telehealth services and, most importantly, the delivery of quality care to patients in a safe, efficient, timely and cost-effective manner.
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Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, The George Washington University, USA
| | - Hartmut Gross
- Medical College of Georgia at Augusta University, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University Hospital, USA
| | - Edward Shaheen
- Shaheen Consulting, a division of On Call Specialists, Inc., USA
| | | | - Adam Ash
- Progressive Emergency Physicians, USA
| | | | | | - Alexander R Chiu
- Faculty, Health + Hospitals/Coney Island Hospital, USA.,State University of New York Downstate College of Medicine, USA.,mHealth Technology and Distance Learning SIG, American Telemedicine Association, USA
| | | | | | - Gregory Lowry
- Department of Emergency Medicine, University of Pittsburgh
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28
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Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A. Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department. Telemed J E Health 2019; 25:1207-1215. [DOI: 10.1089/tmj.2018.0273] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Liqi Shu
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Brandon Ritchie
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Richard L. Amdur
- Department of Surgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Ali Pourmand
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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29
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Pourmand A, Quan T, Amini SB, Sikka N. Can Emoji's assess patients' mood and emotion in the emergency department? An emoji based study. Am J Emerg Med 2019; 38:842-843. [PMID: 31761435 DOI: 10.1016/j.ajem.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington DC, United States.
| | - Theodore Quan
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington DC, United States
| | - Saeid B Amini
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington DC, United States
| | - Neal Sikka
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington DC, United States
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30
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Siddiqui S, Marin J, Sikka N, Quan T, Pourmand A. 55 A Novel Approach to Establish and Enhance Event Reporting Systems Among Emergency Medicine Residents. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Sikka N, Vila C, Stratton M, Ghassemi M, Pourmand A. Sharing the sidewalk: A case of E-scooter related pedestrian injury. Am J Emerg Med 2019; 37:1807.e5-1807.e7. [DOI: 10.1016/j.ajem.2019.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022] Open
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Sikka N, Siev A, Boyer R, Pourmand A. Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers. Am J Emerg Med 2019; 37:1215.e5-1215.e7. [PMID: 30922527 DOI: 10.1016/j.ajem.2019.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022] Open
Abstract
Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.
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Affiliation(s)
- N Sikka
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - A Siev
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - R Boyer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - A Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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Abstract
Until January 2019, Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth services only if the originating site was located in a rural area and the patient was situated in an authorized facility. Free-standing dialysis facilities and the patient's home were clearly restricted sites. Beginning in 2019, new opportunities are available for home dialysis patients in the United States to engage in telehealth; these include existing waivers within End-Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care demonstration project and, more broadly, for most prevalent home dialysis patients based on legislation within the 2018 Bipartisan Budget Act. Under this act, Medicare will pay for a monthly comprehensive telehealth encounter with the patient that originates from his or her home or a dialysis unit without geographic restrictions. The home dialysis patient has the sole power to choose the telehealth option, which may occur twice over a 3-month cycle and cannot occur during the first 3 months of home dialysis therapy. With studies suggesting that effective use of remote monitoring and telehealth encounters may improve patient satisfaction and outcomes while reducing the cost of care, increased use of telehealth has the potential to improve patient-centered care for home dialysis patients. In this perspective, we review the legislative changes, regulatory requirements, and technical and operational challenges for conducting telehealth encounters for home dialysis patients.
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Affiliation(s)
- Susie Q Lew
- Department of Medicine, George Washington University, Washington, DC.
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC
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34
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Affiliation(s)
- Kunj Bhatt
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Neal Sikka
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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35
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Sikka N, Shu L, Ritchie B, Pourmand A. 297 Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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36
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Lew SQ, Sikka N, Thompson C, Magnus M. Impact of remote biometric monitoring on cost and hospitalization outcomes in peritoneal dialysis. J Telemed Telecare 2018; 25:581-586. [DOI: 10.1177/1357633x18784417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IntroductionPeritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, and in particular – remote monitoring, is making inroads in managing this cohort.MethodsWe examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care.ResultsOutpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non- or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p = 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p = 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$–734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33–0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26–0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization.ConclusionsRBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific sub-groups receiving peritoneal dialysis.
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Affiliation(s)
- Susie Q Lew
- Department of Medicine, George Washington University, Washington, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, USA
| | - Clinton Thompson
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, USA
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37
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Magnus M, Edwards E, Dright A, Gilliam L, Brown A, Levy M, Sikka N, Siegel M, Criss V, Watson C, Machtinger E, Kuo I. A Feasibility Study of a Telehealth Intervention on Health Care Service Utilization among Transgender Women of Color in Washington, DC. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1639603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Transgender women of color (TWC) are a medically underserved population who often experience substantial barriers to care. TWC experience high rates of stigma, violence, and entrenched barriers to receiving routine or specialty health services. Novel ways to improve access for TWC are urgently needed. Telehealth is one way to support TWC in overcoming barriers, yet this approach has been largely unexamined. The purpose of this study was to develop a TWC-specific telehealth intervention to increase access to primary and specialty care and then pilot test this intervention in a sample of TWC with at least one structural barrier to care.
Methods Eligible participants were 18 years or older, identified as male sex at birth with a current gender identity of either female or transgender, a member of a racial/ethnic minority, and had experienced at least one study-defined structural barrier to primary or specialty care in the past 6 months. Following a 3-month preintervention phase, participants began a 3-month telehealth intervention which provided secure, remote access to trained, culturally appropriate, peer health consultants (PHCs) via video chat, e-mail, text, or phone. Health care utilization was assessed monthly via computer-assisted self-interview. Outcomes of intention to seek care in the next month and receipt of care in the past month were modeled using generalized estimating equations (GEE).
Results Twenty-five eligible participants were enrolled in the study; a majority were black (96%), older than 25 years (69%), living with human immunodeficiency virus (HIV) (52%), and reported depressive symptomatology (67%). Of the 16 who had at least one pre- and one intervention data collection point, 13 downloaded the mobile video chat application and 7 participated in a qualitative exit interview. The intervention was associated with significantly (p < 0.05) increased odds of intention to seek transgender-specific care (adjusted odds ratio, aOR: 1.76 [95% confidence interval, CI: 1.001–3.08]); participants with depression defined by an elevated Center for Epidemiologic Studies 8-item depression scale (CES-D-8) score were significantly more likely to have intention to seek specialty care (aOR: 10.53 [95% CI: 1.42–77.97]), HIV-specific care (aOR: 2.56 [95% CI: 1.27–5.17]), and mental health care (aOR: 2.56 [95% CI: 1.27–5.17]) during the intervention period. Participants with elevated CES-D-8 scores had significantly greater odds of having sought HIV-specific care (aOR: 2.31 [95% CI: 1.31–4.06]) during the intervention period relative to those with lower scores.
Conclusion These pilot data suggest that telehealth with remote access to PHCs who can provide immediate, culturally competent, nonclinical, education, and referral guidance may be effective in overcoming multiple barriers and improving care utilization outcomes for TWC. Telehealth may be an innovative, low-cost solution to improve health outcomes for populations with multiple barriers to health care services.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Elizabeth Edwards
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Aurnell Dright
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Leandrea Gilliam
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Angela Brown
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Matthew Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Neal Sikka
- Section of Innovative Practice, Department of Emergency Medicine, The George Washington University, District of Columbia, United States
| | - Marc Siegel
- Medical Faculty Associates, The George Washington University, District of Columbia, United States
| | - Vittoria Criss
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Christopher Watson
- Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
| | - Edward Machtinger
- Department of Medicine, University of California, San Francisco, California, United States
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
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Shokoohi H, Kendrick Z, Sikka N, Boniface KS. Sonographic localization of a retained urethral foreign body in an elderly patient. J Clin Ultrasound 2018; 46:296-298. [PMID: 28656661 DOI: 10.1002/jcu.22515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
A retained urethral foreign body is an uncommon presentation in the Emergency Department. The diagnosis and treatment of retained urethral foreign bodies are determined by their size, location, shape, and mobility and often require specialty consultation and operative intervention. In this case of a 74-year-old man with a self-inserted, retained urethral foreign body, we present the utility of a bedside ultrasound to detect the depth, size, and distance from the meatus of the object to guide the approach to extraction of the object at the bedside in the Emergency Department. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:296-298, 2018.
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Affiliation(s)
- Hamid Shokoohi
- Emergency Ultrasound Fellowship, Department of Emergency Medicine, George Washington University Medical Center, 2120 L Street NW, Suite 450, Washington, DC, 20037
| | - Zachary Kendrick
- George Washington University Medical School, 2300 I Street NW, Washington, DC, 20037
| | - Neal Sikka
- Section of Innovative Medicine, George Washington University Medical Center, 2120 L Street NW, Suite 530, Washington, DC, 20037
| | - Keith S Boniface
- Section of Emergency Sonography, Department of Emergency Medicine, George Washington University Medical Center, 2120 L Street NW, Suite 450, Washington, DC, 20037
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Rosner MH, Lew SQ, Conway P, Ehrlich J, Jarrin R, Patel UD, Rheuban K, Robey RB, Sikka N, Wallace E, Brophy P, Sloand J. Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT. Clin J Am Soc Nephrol 2017; 12:1900-1909. [PMID: 28710094 PMCID: PMC5672984 DOI: 10.2215/cjn.12781216] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Telehealth and remote monitoring of a patient's health status has become more commonplace in the last decade and has been applied to conditions such as heart failure, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Conversely, uptake of these technologies to help engender and support home RRTs has lagged. Although studies have looked at the role of telehealth in RRT, they are small and single-centered, and both outcome and cost-effectiveness data are needed to inform future decision making. Furthermore, alignment of payer and government (federal and state) regulations with telehealth procedures is needed along with a better understanding of the viewpoints of the various stakeholders in this process (patients, caregivers, clinicians, payers, dialysis organizations, and government regulators). Despite these barriers, telehealth has great potential to increase the acceptance of home dialysis, and improve outcomes and patient satisfaction while potentially decreasing costs. The Kidney Health Initiative convened a multidisciplinary workgroup to examine the current state of telehealth use in home RRTs as well as outline potential benefits and drawbacks, impediments to implementation, and key unanswered questions.
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Affiliation(s)
| | | | - Paul Conway
- American Association of Kidney Patients, St. Petersburg, Florida
| | | | | | | | | | - R. Brooks Robey
- Geisel School of Medicine at Dartmouth and US Department of Veterans Affairs, Hanover, New Hampshire
| | - Neal Sikka
- George Washington University, Washington, DC
| | - Eric Wallace
- University of Alabama at Birmingham, Birmingham, Alabama
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Lew SQ, Sikka N, Thompson C, Cherian T, Magnus M. Adoption of Telehealth: Remote Biometric Monitoring among Peritoneal Dialysis Patients in the United States. Perit Dial Int 2017; 37:576-578. [DOI: 10.3747/pdi.2016.00272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We examined participant uptake and utilization of remote monitoring devices, and the relationship between remote biometric monitoring (RBM) of weight (Wt) and blood pressure (BP) with self-monitoring requirements. Participants on peritoneal dialysis (PD) (n = 269) participated in a Telehealth pilot study of which 253 used remote monitoring of BP and 255 for Wt. Blood pressure and Wt readings were transmitted in real time to a Telehealth call center, which were then forwarded to the PD nurses for real-time review. Uptake of RBM was substantial, with 89.7% accepting RBM, generating 74,266 BP and 52,880 Wt measurements over the study period. We found no significant correlates of RBM uptake with regard to gender, marital, educational, socio-economic or employment status, or baseline experience with computers; frequency of use of BP RBM by Black participants was less than non-Black participants, as was Wt RBM, and participants over 55 years old were more likely to use the Wt RBM than their younger counterparts. Having any review of the breach by a nurse was associated with reduced odds of a subsequent BP breach after adjusting for sex, age, and race. Remote biometric monitoring was associated with adherence to self-monitoring BP and Wt requirements associated with PD. Remote biometric monitoring was feasible, allowing for increased communication between patient and PD clinical staff with real-time patient data for providers to act on to potentially improve adherence and outcomes.
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Affiliation(s)
- Susie Q. Lew
- Department of Medicine, Milken Institute School of Public Health George Washington University, Washington, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, Milken Institute School of Public Health George Washington University, Washington, DC, USA
| | - Clinton Thompson
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health George Washington University, Washington, DC, USA
| | - Teena Cherian
- Department of Medicine George Washington University, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health George Washington University, Washington, DC, USA
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Pourmand A, Davis S, Lee D, Barber S, Sikka N. Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine. Games Health J 2017; 6:263-270. [PMID: 28759254 DOI: 10.1089/g4h.2017.0046] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. MATERIALS AND METHODS To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. RESULTS The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). CONCLUSION Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Steven Davis
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Danny Lee
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Scott Barber
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
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Jacob MS, Kulie P, Benedict C, Ordoobadi AJ, Sikka N, Steinmetz E, McCarthy ML. Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED. Am J Emerg Med 2017; 36:61-65. [PMID: 28711277 DOI: 10.1016/j.ajem.2017.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not. METHODS We prospectively enrolled 257 subjects with a urinalysis and/or urine culture test ordered in the ED and asked them to watch our MSCC instructional app. After prospective enrollment was complete, we retrospectively matched each enrolled subject to an ED patient who did not watch the instructional app. Controls were matched to cases based on gender, type of urine specimen provided, ED visit date and shift. Urinalysis and urine culture contamination results were compared between the matched pairs using McNemar's test. RESULTS The overall urine culture contamination rate of the 514 subjects was 38%. The majority of the matched pairs had a urinalysis (63%) or urinalysis plus urine culture (35%) test done. There were no significant differences in our urine contamination rates between the matched pairs overall or when stratified by gender, by prior knowledge of the clean catch process or by type of urine specimen. CONCLUSION We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination.
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Affiliation(s)
- Mary S Jacob
- Washington Adventist Hospital, Emergency Department, United States
| | - Paige Kulie
- George Washington Medical Faculty Associates, Department of Emergency Medicine, United States
| | - Cameron Benedict
- George Washington Medical Faculty Associates, Department of Emergency Medicine, United States
| | - Alexander J Ordoobadi
- George Washington Medical Faculty Associates, Department of Emergency Medicine, United States
| | - Neal Sikka
- George Washington Medical Faculty Associates, Department of Emergency Medicine, United States
| | - Erika Steinmetz
- George Washington University Milken Institute School of Public Health, Department of Health Policy and Management, United States
| | - Melissa L McCarthy
- George Washington University Milken Institute School of Public Health, Department of Health Policy and Management, United States.
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Magnus M, Sikka N, Cherian T, Lew SQ. Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth. Appl Clin Inform 2017; 8:214-225. [PMID: 28246673 DOI: 10.4338/aci-2016-09-ra-0154] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/19/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND SIGNIFICANCE End stage renal disease (ESRD) affects approximately 660,000 persons in the US each year, representing a significant financial burden to the health care system and affected individuals. Telehealth approaches to care offer an important means of reducing costs as well as increasing autonomy for patients. Understanding patient satisfaction with telehealth provides a key towards eventual scalability. MATERIALS AND METHODS Quarterly surveys were conducted to characterize satisfaction with remote biometric monitoring (RBM) for blood pressure, weight, glucose and peritoneal dialysis (PD)-specific educational online videos for ESRD patients using PD. RESULTS Of 300 participants, 67% participated in the surveys and provided baseline and at least one follow-up assessment. The majority were 45 to 64 years of age (50.5%), Black (64.5%), married or living with significant other (52.0%), and had more than a high school degree (73.0%). RBM was associated with perceived autonomy and confidence in health care activities and decreased negative perceptions of PD care and ESRD. The majority of participants (80.1%) indicated that they were satisfied or completely satisfied with the system. Participants found that the interface increased confidence, reduced frustration, and related perceptions were significantly and positively altered (p<0.05) for each of the separate telehealth components. Educational videos were well utilized with nearly half of the participants (42.5%) reporting that they watched at least one of the videos, and the majority reporting that the videos seen had an overall positive impact on health. DISCUSSION AND CONCLUSIONS Supplementing PD with telehealth has the potential to have a positive impact on patient perceptions of PD care and consequently improve clinical outcomes.
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Affiliation(s)
- Manya Magnus
- Manya Magnus, PhD, MPH, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, NW Suite 507, Washington, DC 20052, Phone 202 994 3024, Fax 202 994 0082,
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Sikka N, Robinson H, Little C, Pourmand A. ED approach to electrical toothbrush associated hand injury, a unique case of non-oropharyngeal injury. Am J Emerg Med 2016; 35:667.e3-667.e5. [PMID: 27839840 DOI: 10.1016/j.ajem.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 01/29/2023] Open
Abstract
Puncture wounds are common injuries treated in the emergency department (ED). Prior studies have shown that toothbrushes are common reservoirs for oral flora, especially in regions near the head of the toothbrush near the bristles. ED providers must be aware of the danger associated with bacterial contamination of the associated wound and should be familiar with different pathogens and options for treatment. We present a unique case of a 30-year-old male with non-intraoral injury who presented to the ED after puncturing his left palm with the metal post of an electric toothbrush.
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Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, United States.
| | - Hannah Robinson
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
| | - Chimere Little
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
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Lee A, Sikka N, O’Connell F, Dyer A, Boniface K, Betz J. Telepsychiatric assessment of a mariner expressing suicidal ideation. Int Marit Health 2015; 66:49-51. [DOI: 10.5603/imh.2015.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Neal Sikka
- Director for the Emergency Medicine Telemedicine and Digital Health Fellowship program, chief of the Innovative Practice and Telehealth Section, and an associate professor in the Department of Emergency Medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC
| | - Tina Choudhri
- Associate program director for the Emergency Medicine Residency Program and an assistant professor in the Department of Emergency Medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC
| | - Robert Jarrin
- Senior director of government affairs for Qualcomm Incorporated, responsible for Qualcomm's efforts directed toward federal and state health information technology policy, oversight of convergent medical devices, congressional legislative health affairs, Medicare and Medicaid telehealth reimbursement, and improvement of broadband access for health care, and an adjunct assistant professor in the Department of Emergency Medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC
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Affiliation(s)
- S Q Lew
- Department of Medicine1 Department of Emergency Medicine2 The George Washington University School of Medicine Washington, DC, USA
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Sikka N, Pirri M, Carlin KN, Strauss R, Rahimi F, Pines J. The Use of Mobile Phone Cameras in Guiding Treatment Decisions for Laceration Care. Telemed J E Health 2012; 18:554-7. [DOI: 10.1089/tmj.2011.0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Neal Sikka
- Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, D.C
| | - Michael Pirri
- Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, D.C
| | - Katrina Norbury Carlin
- Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, D.C
| | - Ryan Strauss
- Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, D.C
| | - Faisal Rahimi
- Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, D.C
| | - Jesse Pines
- Health Policy, The George Washington University, Washington, D.C
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Lu W, Bacino CA, Richards BS, Alvarez C, VanderMeer JE, Vella M, Ahituv N, Sikka N, Dietz FR, Blanton SH, Hecht JT. Studies of TBX4 and chromosome 17q23.1q23.2: an uncommon cause of nonsyndromic clubfoot. Am J Med Genet A 2012; 158A:1620-7. [PMID: 22678995 DOI: 10.1002/ajmg.a.35418] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/21/2012] [Indexed: 01/28/2023]
Abstract
Clubfoot is a common birth defect characterized by inward posturing and rigid downward displacement of one or both feet. The etiology of syndromic forms of clubfoot is varied and the causes of isolated clubfoot are not well understood. A microduplication of 2.2 Mb on chromosome 17q23.1q23.2 which includes T-box 4 (TBX4), a hindlimb-specific gene, and 16 other genes was recently identified in 3 of 66 families reported as nonsyndromic clubfoot, but additional non-foot malformations place them in the syndromic clubfoot category. Our study assesses whether variation in or around TBX4 contributes to nonsyndromic clubfoot. To determine whether this microduplication was a common cause of nonsyndromic clubfoot, 605 probands (from 148 multiplex and 457 simplex families) with nonsyndromic clubfoot were evaluated by copy number and oligonucleotide array CGH testing modalities. Only one multiplex family (0.68%) that had 16 with clubfoot and 9 with other foot anomalies, had a 350 kb microduplication, which included the complete duplication of TBX4 and NACA2 and partial duplication of BRIP1. The microduplication was transmitted in an autosomal dominant pattern and all with the microduplication had a range of phenotypes from short wide feet and toes to bilateral clubfoot. Minimal evidence was found for an association between TBX4 and clubfoot and no pathogenic sequence variants were identified in the two known TBX4 hindlimb enhancer elements. Altogether, these results demonstrate that variation in and around the TBX4 gene and the 17q23.1q23.2 microduplication are not a frequent cause of this common orthopedic birth defect and narrows the 17q23.1q23.2 nonsyndromic clubfoot-associated region.
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Affiliation(s)
- W Lu
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas 77030, USA
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