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Phimphasone-Brady P, Chiao J, Karamsetti L, Sieja A, Johnson R, Macke L, Lum H, Lee R, Farro S, Loeb D, Schifeling C, Huebschmann AG. Clinician and staff perspectives on potential disparities introduced by the rapid implementation of telehealth services during COVID-19: a mixed-methods analysis. Transl Behav Med 2021; 11:1339-1347. [PMID: 34132810 PMCID: PMC8344776 DOI: 10.1093/tbm/ibab060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has rapidly altered ambulatory health care delivery and may have worsened disparities in health care access. To assess the telehealth implementation experiences of ambulatory personnel in different disciplines and their perspectives on potential telehealth disparities, and to make recommendations for more equitable telehealth delivery. We used a convergent parallel mixed-methods design. Clinic managers from geriatric medicine, internal medicine, and psychiatry e-mailed a survey to clinicians and staff regarding experiences with telehealth care delivery. Quantitative survey responses were analyzed with Fisher's Exact tests. Qualitative responses were coded thematically. Recommendations were categorized by type of implementation strategy. Quantitative and qualitative findings on telehealth disparities were merged in a joint data display. Respondents (n = 147, 57% response rate) were distributed across three specialties: 66% internal medicine, 19% psychiatry, and 14% geriatric medicine. Prior to 2020, 77% of clinicians had never delivered telehealth services. By Spring 2020, 78% reported conducting more than half of clinic visits by telehealth. Among clinicians, 52% agreed/strongly agreed that rapid telehealth implementation exacerbated access to care disparities to: older adult patients, those with limited internet access, and those needing interpretation services. Staff expressed similar difficulties with telehealth set-up especially for these patients. To improve telehealth equity, clinicians recommended to: (i) change infrastructure; (ii) train and educate stakeholders; and (iii) support clinicians. Clinicians and staff reported specific subpopulations had challenges in accessing telehealth visits. To avoid perpetuating telehealth access disparities, further co-discovery of equitable implementation strategies with patients and clinics are urgently needed.
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Affiliation(s)
| | - J Chiao
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - L Karamsetti
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - A Sieja
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - R Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - L Macke
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - H Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - R Lee
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - S Farro
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - D Loeb
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - C Schifeling
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - A G Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
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Nikiforow S, Baiocchi R, Nasta S, Weng W, Loeb D, Mahadeo K, Whangbo J, Phuong P, Navarro W, Gamelin L, Sun Y, Guzman-Becerra N, Prockop S. 1051P Clinical experience of tabelecleucel in patients with EBV+ primary (PID) or acquired immunodeficiency (AID) associated lymphoproliferative disease. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1171] [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] Open
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Shah N, Loeb D, Khuu H, Stroncek D, Raffeld M, Delbrook C, Richards K, Baird K, Levine J, Leitman S, Mackall C, Fry T, Wayne A. A Pilot Trial of WT1 Peptide-Loaded Allogeneic Dendritic Cell (DC) Vaccination and Donor Lymphocyte Infusion (DLI) for WT1-Expressing Hematologic Malignancies and Post-Transplant Relapse. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.163] [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: 10/14/2022]
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Ben Othmane K, Speer MC, Stauffer J, Blel S, Middleton L, Ben Hamida C, Etribi A, Loeb D, Hentati F, Roses AD. Evidence for linkage disequilibrium in chromosome 13-linked Duchenne-like muscular dystrophy (LGMD2C). Am J Hum Genet 1995; 57:732-4. [PMID: 7668303 PMCID: PMC1801260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Othmane KB, Loeb D, Hayworth-Hodgte R, Hentati F, Rao N, Roses AD, Ben Hamida M, Pericak-Vance MA, Vance JM. Physical and genetic mapping of the CMT4A locus and exclusion of PMP-2 as the defect in CMT4A. Genomics 1995; 28:286-90. [PMID: 8530038 DOI: 10.1006/geno.1995.1143] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have previously localized one form of the autosomal recessive Charcot-Marie-Tooth disease type 4 (CMT4A) to a 5-cM region of chromosome 8q13-q21. We now report the formation of a 7-Mb YAC contig spanning the region. This contig was used to map nine additional microsatellites and six STSs to this region, and subsequent haplotype analysis has narrowed the CMT4A flanking interval to less than 1 cM. In addition, using SSCP and our physical map, we have demonstrated that the myelin protein PMP-2, mapped by FISH to this region, is not the defect in CMT4A.
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Affiliation(s)
- K B Othmane
- Division of Neurology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
A case of Pasteurella multocida infection in a puerperal healthy young women is reported. The agent was isolated from vaginal discharge and blood cultures of the patient, and also from pets and poultry with which the patient was in contact. Although Pasteurella multocida septicemia is rare, awareness of this infection and adequate intensive antibiotic therapy may improve its prognosis.
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Abstract
Renal ornithine decarboxylase (ODC) activity was evaluated in normal female, male, testosterone-treated female and androgen-insensitive Tfm/Y mice for its heat sensitivity and in vivo half-life. ODC activity in normal female kidney consisted of 2 forms which differed in their heat sensitivity at 46 degrees C. Androgens, either endogenous in normal males or administered exogenously to females, induced primarily the heat-sensitive form. Results from mixing experiments indicated that the heat-sensitive form represented a change in the property of the ODC activity rather than a change in cytoplasmic factors. The in vivo half-life of ODC activity was increased slightly in males and short-term androgen-treated females over normal females and was markedly increased by prolonged androgen treatment. In vivo, the androgen-induced, heat-sensitive form decayed faster than did the heat-resistant form. We conclude that androgens have specific effects on both the amount as well as the biochemical properties of ODC activity in mouse kidney.
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