Healthcare in the Age of COVID-19: A Midwestern Catholic Health System's Innovative and Technology-Forward Approach to Life-Saving Care.

After the novel coronavirus SARS-CoV-2 was declared a pandemic in mid-March, it challenged healthcare systems to provide care while mitigating the risk to both patients and staff. The high transmissibility of the virus combined with PPE shortages made this an even more difficult task. A Catholic health system in Sioux Falls, South Dakota, embraced healthcare technology in order to bridge the gap between providing patient care, exposure to the virus, and lack of PPE. To treat COVID-19 patients, they developed a COVID clinic that provides triage, testing, and a hospital-at-home service. The service uses Health Recovery Solution devices to monitor more symptomatic or high-risk patients and provide real-time health data to physicians at a remote site, keeping stable COVID patients out of the hospital while still providing quality care. They also embraced telemedicine across all primary care and subspecialties, increasing the use of the AveraNow platform from less than 50 virtual visits per day to more than 1,000 per day. In long term care, the organization implemented multiple forms of healthcare technology, including TYTO Care devices, the Polycom RealPresence device, and doxy.me services to continue to provide care to these extremely high-risk patients. In the arguably most at-risk environment, the emergency department, the health system was able to use their eCARE emergency video call system to reduce the amount of staff exposed to COVID patients and allow physicians to minimize their exposure while still being able to communicate with patients and perform necessary procedures. Hopefully health systems that have yet to embrace telemedicine or other forms of healthcare technology can use this organization's model to implement changes, especially in the face of uncertainty regarding whether coronavirus will peak again, and whether that peak will be even higher than the surge already seen throughout the U.S.

Doxycycline-induced pancreatitis: a rare finding.

BACKGROUND: Drug-induced pancreatitis (DIP) is a rare problem in medicine. A retrospective study from 45 German centers of gastroenterology concluded that only 22 of 1613 (1.4 percent) cases of acute pancreatitis in 1993 were DIP. Though DIP is a rare etiology of acute pancreatitis compared to other common etiologies like alcohol, gallstones, hypercalcemia, hypertriglyceridemia, infection, trauma or medical procedures like endoscopic retrograde cholangiopancreatography (ERCP), its incidence continues to rise. We report a case of a 21-year-old female with DIP following doxycycline treatment for an upper respiratory infection. CASE: A 21-year-old, otherwise healthy female presented with severe abdominal discomfort associated with nausea and vomiting. She was hemodynamically stable with normal vital signs. Physical exam revealed a soft but tender to palpation epigastric area. Peritoneal signs were negative. Urinalysis was negative for acute infection. Urine human chorionic gonadotrophin was negative for pregnancy. Laboratory findings revealed a mildly elevated lipase level at 128 U/L (normal 13-60) but was otherwise normal. A computed tomography of abdomen and pelvis revealed evidence of fat stranding consistent with acute pancreatitis. A right upper quadrant ultrasound ruled out gallstones. A serum triglyceride was within normal limit at 80mg/dl. She denied any alcohol use. On further questioning, the patient admitted to previously being diagnosed with an upper respiratory infection two weeks earlier. She had consequently finished a 10-day course of doxycycline therapy, with her last dose five days before presentation. After a literature review of drugs implicated in DIP and ruling out other causes of acute pancreatitis, we concluded that our patient had doxycycline-induced pancreatitis. Follow-up visit three weeks post discharge revealed complete resolution of previous symptoms. CONCLUSION: In our vastly evolving pharmacotherapy world, DIP should be entertained as a possible etiology of idiopathic pancreatitis, especially after other common causes have been ruled out.

Developing Telemedicine Curriculum Competencies for Graduate Medical Education: Outcomes of a Modified Delphi Process.

PURPOSE: Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. METHOD: A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. RESULTS: Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. CONCLUSIONS: Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.