Telemedicine as a component of forward triage in a pandemic.

OBJECTIVE(S): Coronavirus disease 2019 (COVID-19) presents an enormous challenge to healthcare systems globally. Optimizing access to healthcare while minimizing face-to-face patient encounters is critical to limiting exposures, conserving resources, and preserving health. We aimed to evaluate the utility of a COVID-focused telehealth program in avoiding potential in-person visits while maintaining high patient satisfaction. METHODS: All patients with COVID-related virtual visits at our center between March and May 2020 were included. Demographic, satisfaction, and clinical information were gathered using a modified, validated telehealth satisfaction questionnaire disseminated via email or telephone. Data were analyzed using Stata. RESULTS: Of 581 eligible patients, 180 (31%) responded to the survey. Symptoms (73%) and possible exposure (22%) were the main reasons cited for pursuing a virtual visit; cough (44%) and fever (36%) were the most common presenting symptoms. Regarding patient satisfaction, most patients rated the experience as "very good" or "excellent", and 94% of respondents said they would recommend COVID-focused triage through telehealth to others. Over 81% of patients indicated that, if telehealth was not an option, they would have sought an in-person encounter. Ultimately, only 27% of patients reported pursuing a face-to-face encounter after participating in the virtual visit. CONCLUSION: Based on patient self-reporting, telemedicine potentially prevented face-to-face COVID-related encounters. Patients expressed satisfaction with the virtual process and were less likely to pursue in-person consultation. Leveraging a telehealth strategy for forward triage has the potential to reduce exposures while conserving healthcare resources.

Predictors of post-mastectomy reconstruction in an underserved population.

OBJECTIVE: Past studies found insurance status, race, comorbidities and hospital setting influence the likelihood and timing of post-mastectomy breast reconstruction (BR). We evaluated these factors at a public hospital serving a predominantly minority and uninsured population. METHODS: Women who underwent mastectomy and/or BR from 2005 to 2011 were reviewed. The association between patients' characteristics and receipt of BR and timing (immediate BR vs. delayed BR) were analyzed. The 5-year overall BR rate was estimated with the Kaplan-Meier method. RESULTS: The analysis included 387 patients. 130 received BR. 85 (65%) received immediate BR and 25 (19%) underwent microsurgical repair. The total complication rate was 25%. The 5 yr overall BR rate was 43% (95% CI: 36%-51%). Univariate factors positively associated with overall BR included younger age, non-smoker, lower BMI, no comorbidities, no neoadjuvant chemotherapy requirement, lower AJCC stage and negative lymph nodes. Younger age, no comorbidities, neoadjuvant chemotherapy, higher AJCC stage, and positive lymph nodes were positively associated with delayed breast reconstruction compared to immediate BR. Multivariate regression models show patient of younger age (p<0.001), BMI less than 30 (p<0.01), negative lymph nodes (p<0.03) and no neoadjuvant chemotherapy requirement (p<0.01) are more likely to have BR overall: young patients (p<0.02) are more likely to have delayed BR. Race and insurance type were not significantly associated with BR or timing of BR given the patient population. CONCLUSION: At a public hospital, serving a largely uninsured population, post-mastectomy rates of immediate BR and overall BR within 5 yrs are 22% and 43%, respectively. Overall complication rates were low and a substantial fraction of post-mastectomy patients received microsurgical BR. Contrary to previous studies, race and insurance status were not found to be the primary drivers of post-mastectomy reconstruction.

Treatment of mandibular angle fractures with a matrix strut miniplate.

New innovative techniques and more efficacious hardware allowing rapid and reliable fixation have resulted in better mandibular angle fracture management. This article presents follow-up data to our previous report, "Treatment of mandibular angle fracture with a matrix miniplate: a preliminary report," regarding the safety and efficacy of the 2.0 matrix strut miniplate in clinical practice. Mandibular angle fractures repaired with a single 2.0 matrix strut miniplate, using an intraoral approach, were selected for chart review over a 10-year period. Demographics including patient information, fracture etiology, site of fracture, treatment, surgical duration, and follow-up were collected. Complications were recorded along with the method of treatment. The significance (P = 0.05) of association between demographic and clinical factors with surgical complications was examined using Fisher exact tests. Thirty-four patients with mandibular angle fractures underwent matrix miniplate fixation via an intraoral approach. These patients were followed up for a mean follow-up period of 12 months. Four patients developed complications: 2 with infection requiring hardware removal and external fixation (5.9%), 1 infection treated with incision and drainage (2.9%), and 1 nonunion (2.9%). The matrix strut miniplate offers surgeons another tool to successfully accomplish mandibular fixation expediently while minimizing additional risk to patients. This system adds superior stability without negatively impacting other aspects of care and should be strongly considered for angle fixation.