RESUMEN
OBJECTIVE: We aimed to develop a decision-making tool to predict telehealth appropriateness for future rheumatology visits and expand telehealth care access. METHODS: The model was developed using the Encounter Appropriateness Score for You (EASY) and electronic health record data at a single academic rheumatology practice from January 1, 2021, to December 31, 2021. The EASY model is a logistic regression model that includes encounter characteristics, patient sociodemographic and clinical characteristics, and provider characteristics. The goal of pilot implementation was to determine if model recommendations align with provider preferences and influence telehealth scheduling. Four providers were presented with future encounters that the model identified as candidates for a change in encounter modality (true changes), along with an equal number of artificial (false) recommendations. Providers and patients could accept or reject proposed changes. RESULTS: The model performs well, with an area under the curve from 0.831 to 0.855 in 21,679 encounters across multiple validation sets. Covariates that contributed most to model performance were provider preference for and frequency of telehealth encounters. Other significant contributors included encounter characteristics (current scheduled encounter modality) and patient factors (age, Routine Assessment of Patient Index Data 3 scores, diagnoses, and medications). The pilot included 201 encounters. Providers were more likely to agree with true versus artificial recommendations (Cohen's κ = 0.45, P < 0.001), and the model increased the number of appropriate telehealth visits. CONCLUSION: The EASY model accurately identifies future visits that are appropriate for telehealth. This tool can support shared decision-making between patients and providers in deciding the most appropriate follow-up encounter modality.
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Reumatología , Telemedicina , Humanos , PandemiasRESUMEN
10% of symptomatic parotid stones cannot be removed by minimally invasive radiological or endoscopic techniques alone. In these cases endoscopically assisted surgical parotid sialolithectomy can be performed via an extraoral approach, reconstituting the duct and preserving functioning glandular tissue. Between 2003 and 2010, 55 consecutive patients underwent endoscopically assisted surgical removal of parotid stones from 57 glands, two having bilateral procedures. Outcome was assessed using a structured questionnaire. 39/55 patients (71%) patients were successfully contacted (40 procedures; one bilateral case). At median follow-up of 3.1 years 28 glands (70%) were symptomless, whilst 11 (28%) were much improved but causing mild or occasional residual symptoms. One patient required postoperative lithotripsy and basket retrieval of a retained stone, but was subsequently symptom free. A further patient was initially symptom free then relapsed, did not respond to lithotripsy and is awaiting further assessment. In 10% of cases a short-lived sialocoele developed postoperatively. No individual reported facial weakness and one had a scar of concern. 37/39 (95%) patients were pleased to have had the operation and would have the procedure contralaterally in similar circumstances. Endoscopically assisted surgical removal of parotid stones is a successful technique with low morbidity that is well received by patients.
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Endoscopía/métodos , Enfermedades de las Parótidas/cirugía , Cálculos de las Glándulas Salivales/cirugía , Adolescente , Adulto , Anciano , Cicatriz/etiología , Femenino , Estudios de Seguimiento , Humanos , Litotricia , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Satisfacción del Paciente , Complicaciones Posoperatorias , Ránula/etiología , Recurrencia , Cálculos del Conducto Salival/cirugía , Conductos Salivales/cirugía , Sensación/fisiología , Colgajos Quirúrgicos , Transiluminación , Resultado del Tratamiento , Adulto JovenRESUMEN
Extracts of the red seaweed Porphyra umbilicalis are a valuable constituent of herbal medicines. The nucleotide complement of such an extract was purified and compounds identified by chromatographic behaviour, UV absorbance/pH profile, base-to-phosphate ratio, acid hydrolysis, and by fast-atom bombardment mass spectrometry with mass-analysed ion kinetic energy spectrum scanning. In addition to eighteen common nucleotides, and two cyclic nucleotides, fifteen novel nucleotides were identified, comprising eight deoxynucleotides and two cyclic deoxynucleotides, ten aminoacylnucleotides and two nucleoside trisphosphates together with 2'-phosphoadenosine-3',5'-cyclic pyrophosphate, 5'-phosphoadenosine-2',3'-cyclic monophosphate and N6,N6-dimethyladenosine-5'-monophosphate. The possible origin and potential actions of these novel compounds are discussed.