Telehealth Policy, Practice, and Education: a Position Statement of the Society of General Internal Medicine.

Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.

Travel from the United Kingdom to the United States by a Symptomatic Patient Infected with the SARS-CoV-2 B.1.1.7 Variant - Texas, January 2021.

In December 2020, the B.1.1.7 genetic variant of SARS-CoV-2, the virus that causes COVID-19, was first reported after emergence and rapid circulation in the United Kingdom (1). Evidence suggests that the B.1.1.7 variant is more efficiently transmitted than are other SARS-CoV-2 variants, and widespread circulation could thereby increase SARS-CoV-2 infection and hospitalization rates (1,2). The first reported SARS-CoV-2 B.1.1.7 variant case in the United States was confirmed by sequencing in Colorado on December 29, 2020.* This report describes a person who traveled from the United Kingdom to the United States after experiencing COVID-19-compatible symptoms† and was eventually confirmed to be infected with the B.1.1.7 variant.

Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care.

OBJECTIVE: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residency-based primary care offices. PATIENTS AND METHODS: A retrospective study was conducted to measure antibiotic prescribing rates, and multivariable analysis was utilized to identify predictors of inappropriate prescribing among patients presenting to IM residency-based primary care office practices. Patients with an office visit at either of 2 IM residency-based primary care office practices from January 1, 2016, through December 31, 2016, with a primary encounter diagnosis of ARI were included. RESULTS: During the study period, 911 unique patient encounters were included with 518 for conditions for which antibiotics were considered always inappropriate. Antibiotics were not indicated in 85.8% (782 of 911) of encounters. However, antibiotics were prescribed in 28.4% (222 of 782) of these encounters. Inappropriate antibiotic prescribing occurred in 111 of 518 (21.4%) encounters for conditions for which antibiotics are always inappropriate. Using multivariable logistic regression analysis to assess for independent risk factors when adjusted for other potential risk factors for office visits at which antibiotics were not indicated, IM resident-associated visits (odds ratio, 0.25; 95% CI, 0.18-0.36) was the only variable independently associated with lower risk of inappropriate antibiotic prescribing. CONCLUSION: For ARI visits at which antibiotics were not indicated, IM resident comanagement was associated with lower rates of inappropriate prescribing.

[Effect of environmental factors and fishing effort allocation on catch of the Spotted Eagle Ray Aetobatus narinari (Rajiformes: Myliobatidae) in Southern Gulf of Mexico]. / Efecto de factores ambientales y la asignación del esfuerzo pesquero sobre las capturas de la raya Aetobatus narinari (Rajiformes: Myliobatidae) en el sur del Golfo de México.

Aetobatus narinari represents a fisheries target in Southern Gulf of Mexico, and it is currently considered a Near Threatened species by the IUCN red list. The information available of this batoid fish includes some biological and fishery aspects; nevertheless, little is known about the factors influencing on fishing operations and catches. In order to evaluate the effect of environmental factors and the fishing effort allocation by vessels on the target fishery of A. narinari in this area, a daily basis sampling was carried out on four small-scale vessels, from January to July 2009 (the entire fishing season), in two fishing localities (Campeche and Seybaplaya). A total of 896 rays were recorded from 280 fishing trips. A General Linear Model was used to predict the factors effect on the probability that fishing operations occurred, and on the probability for captures of at least one or three or five rays per vessel-trip. The probability that fishing operations occurred off Campeche was predicted by the lunar cycle, with the highest probability in the new moon period (66%) and a probability smaller than 35% for the other periods. The probability that fishing operations occurred off Seybaplaya was predicted by wind velocity, with higher probabilities at low wind velocity than at high wind velocity, and a 50% probability of fishing operations at 12-15 km/h. Catch rates off Seybaplaya were predicted by the vessel's factor (the effect of fishing effort allocation), the North wind season and sea surface temperature. The probability for captures of at least one and three rays per vessel-trip was predicted by the vessel's factor and the North wind season. One vessel had higher catch probability (83% for at least one ray and 43% for at least three rays) than the others (69 and 70% for at least one ray and 26% for at least three rays), and during the North wind season the catch probability was higher (96% for at least one ray and 72% for at least three rays) than out of that season (68% for at least one ray and 21% for at least three rays). The probability for capture at least five rays per vessel-trip was predicted by the sea surface temperature and the North wind season. At 23 degrees C the catch probability was of 49% and the probability gradually diminished to 4% at 28 degrees C, and during the North wind season the catch probability was higher (40%) than out of that season (7%). This study shows that some environmental factors and fishermen perceptions and experience (fishing effort allocation) influence on the catch rate of A. narinari, and that these factors must be considered in future studies on elasmobranch fisheries, mainly when comparisons between catch rates among seasons or regions are analyzed.

Efecto de factores ambientales y la asignación del esfuerzo pesquero sobre las capturas de la raya Aetobatus narinari (Rajiformes: Myliobatidae) en el sur del Golfo de México / Effect of environmental factors and fishing effort allocation on catch of the Spotted Eagle Ray Aetobatus narinari (Rajiformes: Myliobatidae) in Southern Gulf of Mexico

Aetobatus narinari represents a fisheries target in Southern Gulf of Mexico, and it is currently considered a Near Threatened species by the IUCN red list. The information available of this batoid fish includes some biological and fishery aspects; nevertheless, little is known about the factors influencing on fishing operations and catches. In order to evaluate the effect of environmental factors and the fishing effort allocation by vessels on the target fishery of A. narinari in this area, a daily basis sampling was carried out on four small-scale vessels, from January to July 2009 (the entire fishing season), in two fishing localities (Campeche and Seybaplaya). A total of 896 rays were recorded from 280 fishing trips. A General Linear Model was used to predict the factors effect on the probability that fishing operations occurred, and on the probability for captures of at least one or three or five rays per vessel-trip. The probability that fishing operations occurred off Campeche was predicted by the lunar cycle, with the highest probability in the new moon period (66%) and a probability smaller than 35% for the other periods. The probability that fishing operations occurred off Seybaplaya was predicted by wind velocity, with higher probabilities at low wind velocity than at high wind velocity, and a 50% probability of fishing operations at 12-15km/h. Catch rates off Seybaplaya were predicted by the vessel´s factor (the effect of fishing effort allocation), the North wind season and sea surface temperature. The probability for captures of at least one and three rays per vessel-trip was predicted by the vessel´s factor and the North wind season. One vessel had higher catch probability (83% for at least one ray and 43% for at least three rays) than the others (69 and 70% for at least one ray and 26% for at least three rays), and during the North wind season the catch probability was higher (96% for at least one ray and 72% for at least three rays) than out of that season (68% for at least one ray and 21% for at least three rays). The probability for capture at least five rays per vessel-trip was predicted by the sea surface temperature and the North wind season. At 23°C the catch probability was of 49% and the probability gradually diminished to 4% at 28°C, and during the North wind season the catch probability was higher (40%) than out of that season (7%). This study shows that some environmental factors and fishermen perceptions and experience (fishing effort allocation) influence on the catch rate of A. narinari, and that these factors must be considered in future studies on elasmobranch fisheries, mainly when comparisons between catch rates among seasons or regions are analyzed.

Aunque existen estudios sobre las pesquerías de batoideos en aguas Mexicanas, falta información sobre la influencia de factores sobre las operaciones pesqueras y las tasas de captura. Para evaluar el efecto de algunos factores en la pesquería dirigida sobre la raya pinta Aetobatus narinari en el Sur del Golfo de México, se realizaron registros diarios de las operaciones pesqueras de cuatro embarcaciones menores en dos localidades (Campeche y Seybaplaya), de enero a julio 2009 (temporada de pesca completa). Fueron registradas 896 rayas en 280 viajes de pesca. Se utilizó el Modelo General Lineal para evaluar la influencia de los factores en las operaciones de pesca y las tasas de captura. La operación pesquera fue predicha por el ciclo lunar (frente a Campeche) y la velocidad del viento (frente a Seybaplaya). Las tasas de captura frente a Seybaplaya fueron predichas por el factor embarcación, la temporada de frentes fríos y la temperatura superficial del mar. Este estudio demuestra que tanto los factores ambientales como las diferencias en la asignación del esfuerzo pesquero entre embarcaciones, influyen en las tasas de captura, por lo que deben ser considerados en estudios futuros que comparen tasas de captura entre estaciones del año y regiones.