Provider Perceptions of Telemedicine Video Visits to Home in a Veteran Population.

Background: Clinical Video Telemedicine to Home (CVTH) allows primary care clinicians to conduct clinical encounters with patients in remote locations through a secure synchronous video connection, offering improved access to care and increased patient satisfaction. Introduction: Although implementation of CVTH continues to grow, little is known about clinician perceptions of clinical applicability or utilization barriers. We assessed provider attitudes and perceived barriers toward implementation of CVTH visits at the Seattle Veterans Affairs Primary Care Clinic. Materials and Methods: Data are presented from a cross-sectional survey. A total of 49 clinicians, including faculty, MD residents, nurse practitioner residents, and pharmacists, were surveyed with 13 questions gauging opinions of CVTH and prior experience with video telemedicine. Results: Forty-seven providers (96%) were interested in incorporating CVTH into their practice. Forty-one clinicians (83.7%) were concerned about patient technological competency, and 39 (79.6%) were worried about insufficient internet connectivity. A large majority of providers saw opportunities to provide medication reconciliation and improve access to care for geographically distant or homebound patients. Discussion: Although limited by its descriptive data and analysis, this study provides evidence that primary care providers are most likely to offer CVTH visits to patients who find it physically challenging to attend a clinic appointment or have chief complaints perceived as not requiring a physical examination. Conclusions: Although most providers are interested in using video visits to care for patients who live remotely, they are concerned about using CVTH visits for patients who might require a physical examination or technological assistance.

Trillions and Trillions: Herpes Simplex Virus-1 Hepatitis in an Immunocompetent Adult.

We describe a case of acute liver failure and myopericarditis due to herpes simplex virus-1 (HSV-1) in an immunocompetent adult. We estimate that, at the height of viremia, the patient contained a quantity of HSV-1 virions approaching that of human cells. The patient recovered with acyclovir that was dose-adjusted for neurotoxicity and developed a vigorous anti-HSV-1 T-cell response.

Feeding and contact call stimulation both induce zenk and cfos expression in a higher order telencephalic area necessary for vocal learning in budgerigars.

Stimulation with natural contact calls and feeding were used to assess zenk and fos protein expression in budgerigars (Melopsittacus undulatus), a vocal learning parrot species in which feeding and physical contact often occur in conjunction with vocalization. Although only calls induced gene expression in Field L, the primary telencephalic auditory area, both calls and feeding induced gene expression in the frontal lateral nidopallium (NFl), a brain area in receipt of input from Field L which projects to areas afferent to vocal control nuclei and which is necessary for new call learning. NFl thus appears poised to provide both non-auditory as well as auditory feedback to the vocal system.