Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits.

BACKGROUND: The number of pre-anesthetic medical evaluations (PAMEs) being conducted in primary care is increasing. Due to the COVID-19 pandemic, the use of telemedicine has surged, providing a feasible way to conduct some of these visits. This study aimed to identify patient-related factors where a face to face (FTF) evaluation is indicated, measured by the need for pre-operative testing. METHODS: A retrospective chart review was conducted on patients age ≥ 18 years who had a PAME between January 2019-June 2020 at a rural primary care clinic in Southeast Minnesota. Data collected included age, gender, Charlson Comorbidity Index Score, medications, revised cardiac risk index (RCRI), smoking status, exercise capacity, body mass index, and pre-operative testing. Logistical regression modeling for odds ratios of outcomes was performed. RESULTS: 254 patients were included, with an average age of 64.1 years; 43.7% were female. Most were obese (mean BMI 31.6), non-smoking (93.7%) with excellent functional capacity (87.8% ≥ 5 METs). 76.8% of the planned surgeries were intermediate or high risk. 35.0% (n = 89) of visits resulted in medication adjustments and 76.7% (n = 195) in pre-operative testing. Age ≥ 65 years, ≥7 current medications, and diabetes all significantly increased the odds of requiring pre-operative testing (P < .05). CONCLUSIONS: This study was able to identify patient-related factors that increased the likelihood of requiring pre-operative testing. Patients who are age ≥ 65 years, ≥7 current medications, and those with diabetes could be scheduled for a FTF evaluation. Others could be scheduled for a telemedicine visit to minimize health-care exposures.

Athletic disruptions caused by the COVID-19 pandemic negatively affect high school student-athletes social-emotional well-being.

To examine whether high school student-athletes who experienced more COVID-19 disruptions had increased anxiety, increased dejection, increased anger, decreased excitement, and decreased happiness as measured by the validated Sports Emotion Questionnaire (SEQ). During the COVID-19 pandemic high school student-athletes faced disruptions which resulted in cancelation of competitions, reduced in-person training sessions, and quarantine of athletes. The impact of these disruptions on the mental health and well-being of student-athletes is unknown. An anonymous cross-sectional online survey was electronically distributed to high school student-athletes in one school district during the spring of the 2020 to 21 academic year. Basic demographic questions, sport information, and personal and team disruptions were collected. Multivariate linear regression was used to assess correlation between each emotional domain on the SEQ with independent variables such as personal or teammate quarantines, cancelations, season, sport gender, indoor or outdoor location, and level of competition. 125 surveys were returned representing 28 different sports. Student-athletes who were personally quarantined (22.4%) during their athletic season experienced greater dejection (ß = 0.78, P = .003) and greater anger (ß = 0.78, P = .005). Those with teammates quarantined (61.6%) experienced more anxiety (ß = 0.30, P = .048). Spring sports, which faced fewer restrictions, were associated with less anger (ß = -0.48, P = .048). Student-athletes who were directly affected by COVID-19 disruptions experienced increased anxiety, more dejection, and more anger. Public health authorities and school districts should minimize disruptions to athletic participation using established COVID-19 safety protocols to avoid causing harm to athletes' social-emotional well-being. If athletics must be disrupted, student-athletes should receive wellness support and virtual or remote training options.