Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review.

In this systematic review, we compared the effectiveness of telehealth with in-person care during the pandemic using PubMed, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from March 2020 to April 2023. We included English-language, U.S.-healthcare relevant studies comparing telehealth with in-person care conducted after the onset of the pandemic. Two reviewers independently screened search results, serially extracted data, and independently assessed the risk of bias and strength of evidence. We identified 77 studies, the majority of which (47, 61%) were judged to have a serious or high risk of bias. Differences, if any, in healthcare utilization and clinical outcomes between in-person and telehealth care were generally small and/or not clinically meaningful and varied across the type of outcome and clinical area. For process outcomes, there was a mostly lower rate of missed visits and changes in therapy/medication and higher rates of therapy/medication adherence among patients receiving an initial telehealth visit compared with those receiving in-person care. However, the rates of up-to-date labs/paraclinical assessment were also lower among patients receiving an initial telehealth visit compared with those receiving in-person care. Most studies lacked a standardized approach to assessing outcomes. While we refrain from making an overall conclusion about the performance of telehealth versus in-person visits the use of telehealth is comparable to in-person care across a variety of outcomes and clinical areas. As we transition through the COVID-19 era, models for integrating telehealth with traditional care become increasingly important, and ongoing evaluations of telehealth will be particularly valuable.

Telemedicine in Primary Care: Qualitative Work Towards a Framework for Appropriate Use.

INTRODUCTION: Telemedicine has been implemented in many health systems by necessity, yet evidence is sparse about its appropriate use for the delivery of primary care. We sought to understand what clinicians and patients consider to be appropriate use of telemedicine in primary care to inform future development of a framework that should be valuable to diverse stakeholders. METHODS: We conducted in-depth, structured interviews of patients, clinicians who deliver primary care, and other select informants. They were asked to discuss optimal, acceptable, and suboptimal uses of telemedicine for delivering care relative to in-person care delivery. Audio was transcribed and paired reviewers analyzed the content to identify the key concepts that motivated the informants. The reviewers did thematic analysis to organize the concepts into unifying themes. RESULTS: Our 18 key informants generated 103 unique concepts. The unique concepts aggregated into themes suggesting the clinical situations in which telemedicine is appropriately used in primary care and clinical situations in which it should be avoided. We also learned of motivators toward expanded, or at least continued, use of telemedicine and motivators away from telemedicine's continued use. The informants expressed their expectations regarding decision making about telemedicine use and who should make these decisions. DISCUSSION: These key concepts and themes are expected to be a valuable starting point for the development of a framework to inform appropriate use of telemedicine in primary care.

Working Framework for Appropriate Use of Virtual Care in Primary Care.

BACKGROUND: Given the absence of guidelines for use of virtual visits for primary care delivery, a framework is needed to inform the most appropriate use of virtual visits. METHODS: We conducted in-depth, structured interviews of 18 patients, primary care clinicians, and other select informants. They were asked to discuss optimal, acceptable, and suboptimal uses of telemedicine for delivering care relative to in-person care delivery. The concepts expressed informed our development of a framework about appropriate use of virtual visits. RESULTS: The 103 concepts supported 5 main themes that emerged as a framework: clinical situations which are optimal for in-person care; situations optimal for virtual visits; situations that might be exchangeable between sites; contextual factors favoring in-person care; and contextual factors favoring virtual visits. CONCLUSIONS: After further validation, we expect that this framework may guide future research and practice: it may be valuable for clinical practice redesign, for designing evaluations of the outcomes of virtual visits, for outcomes research, for patient education, for triage, and possibly for reimbursement considerations.

Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center.

INTRODUCTION: Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. METHODS: This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. RESULTS: Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. DISCUSSION: The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.

Formative Research to Create a Farm-to-School Program for High School Students in a Lower Income, Diverse, Urban Community.

BACKGROUND: Using Social Cognitive Theory as a framework, we examined opportunities for promoting local produce consumption among high school students in a lower-income, ethnically diverse, urban community. METHODS: Six focus groups (N = 53) were conducted with students. Using Atlas.ti qualitative software, data were coded and reviewed to identify code categories which could be taken to represent themes. RESULTS: Students (56.8% girls, 86.5% nonwhite) described local produce as being grown "nearby" or "in Connecticut." Overwhelmingly, students perceived local produce to be of higher quality (eg, "tastes better," "fresher") than nonlocal produce. Students reported that the foods served at school are "unnatural" and "made in a factory." Salient perceived outcomes associated with consuming local produce included "benefits the environment," "builds community and trust," and "keeps taxes down." Students recommended hanging large colorful posters highlighting the positive outcomes associated with consuming local produce in school locations with captive audiences such as lunch lines and classrooms. Labels identifying the food origins of cafeteria foods provided as well as taste tests of local produce might support students' self-efficacy for consuming local fruits and vegetables. CONCLUSIONS: These findings provide theory-based strategies for how to promote local produce consumption among a diverse group of urban high schools students.

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption.

OBJECTIVE: To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption. DESIGN: Cross-sectional survey research. SETTING: Public high schools in a lower-income, diverse, urban, northeastern community. PARTICIPANTS: A total of 327 students from 3 public high schools. MAIN OUTCOME MEASURE(S): Exposures were prior experience helping on a farm or community garden (yes/no) and having a home garden (yes/no). Outcomes were perceptions about local produce consumption (α = .73), willingness to try new fruits (α = .86) and vegetables (α = .86), and adequate fruit and vegetable consumption (yes/no) as measured by a valid 2-item cup screener. ANALYSIS: Independent t tests, 1-way ANOVA, and chi-square tests were used. RESULTS: Half of students (52.9%) reported prior farm experience; 29.7% reported having a garden at home. Few students reported consuming at least 3 cups/d of vegetables (9.8%) or 2 cups/d of fruit (37.0%). Students with prior farm experience had more favorable scores for local produce perceptions (P = .002) and willingness to try new fruits (P = .001) and vegetables (P < .001) than were students without prior experience. Students with a home garden had more favorable scores for local produce perceptions (P = .02) and willingness to try new fruits (P = .001) and vegetables (P = .001) and more often consumed adequate vegetables (P = .007) than did students without a garden. CONCLUSIONS AND IMPLICATIONS: Those working with high school students might consider offering agriculture experiences that could promote positive fruit and vegetable attitudes and behaviors.

Deaf college students' comprehension of relational language in arithmetic compare problems.

In this study of deaf college students' performance solving compare word problems, relational statements were either consistent or inconsistent with the arithmetic operation required for the solutions. The results support the consistency hypothesis Lewis and Mayer (1987) proposed based on research with hearing students. That is, deaf students were more likely to miscomprehend a relational statement and commit a reversal error when the required arithmetic operation was inconsistent with the statement's relational term (e.g., having to add when the relational term was less than). Also, the reversal error effect with inconsistent word problems was magnified when the relational statement was a marked term (e.g., a negative adjective such as less than) rather than an unmarked term (e.g., a positive adjective such as more than). Reading ability levels of deaf students influenced their performance in a number of ways. As predicted, there was a decrease in goal-monitoring errors, multiple errors, and the number of problems left blank as the reading levels of students increased. Contrary to expectations, higher reading skills did not affect the frequency of reversal errors.

Unmet needs for home and community-based services among frail older Americans and their caregivers.

OBJECTIVE: This study examined unmet needs for home- and community-based services (HCBS) among frail older Americans. METHOD: Using population-based sample from the National Long-Term Care Survey, a hierarchical logistic regression analysis was conducted to examine the predictors of unmet needs for seven types of HCBS. RESULTS: Lack of awareness, reluctance, unavailability, and affordability of services were the main reasons for unmet needs for HCBS. Factors that were associated with unmet needs included Black race/ethnicity, greater care needs (functional limitations and behavioral problems), and less informal support (substitute help and family agreement). DISCUSSION: It is important to identify risk factors that may lead to older adults' unmet needs for HCBS. The findings of this study charge researchers to look beyond service utilization and give more attention to service needs among those who did or could not access the services.

Pre-clinical evaluation of new adjuvant formulations to improve the immunogenicity of the malaria vaccine RTS,S/AS02A.

BACKGROUND: RTS,S/AS02A, a pre-erythrocytic Plasmodium falciparum vaccine based upon the circumsporozoite protein, is the only vaccine demonstrated in field trials to confer partial protection against a range of malaria disease manifestations. Pre-clinical studies are on-going to identify new RTS,S formulations with improved magnitude and duration of specific immunity. METHODS: Rhesus macaques were immunized with saline or one of four "RTS,S/adjuvant" formulations at 0, 4, and 12 weeks: RTS,S/AS01B, RTS,S/AS02A-standard (current formulation), RTS,S/AS05 or RTS,S/AS06. An RTS,S/AS02A-accelerated group was immunized at 0, 1, and 4 weeks. Outcomes were safety, RTS,S-specific antibody, and IFN-gamma and IL-5 ELISpots (weeks 14 and 34). FINDINGS: All regimens were safe and, except for RTS,S/AS06, generated equivalent high titer antibody levels. For IFN-gamma ELISpots, RTS,S/AS01B had the highest geometric mean (GM) values at weeks 14 and 34, and was the only group with an overall GM mean (weeks 14+34) higher than RTS,S/AS02A-standard (p<0.015). For IFN-gamma to IL-5 ELISpot response ratios, RTS,S/AS01B had the highest values at weeks 14 and 34, and was the only group higher than RTS,S/AS02A-standard at each individual time point and overall (weeks 14+34) (p<0.015). INTERPRETATION: RTS,S/AS01B is a safe and immunogenically superior formulation for cellular responses, in comparison with the RTS,S/AS02A-standard. Phase 1, 2a, and 2b clinical trials are underway to determine if RTS,S/AS01B demonstrates improved immunogenicity and protective efficacy against experimental challenge and natural mosquito-borne malaria.

Comparing deaf and hearing college students' mental arithmetic calculations under two interference conditions.

Deaf and hearing college students' mean reaction times (RTs) were compared on a mental calculation task in which they had to verify the accuracy of solutions to addition and multiplication problems. The deaf students were divided into higher and lower readers. Higher deaf readers and hearing students had similar RTs and accuracy on addition problems; their RTs were greater in the voicing interference mode than in the manual tapping interference mode. The lower deaf readers showed no RT differences between the two interference modes and had consistently lower RT performance and score accuracy across the verification tasks. On the verification task for multiplication problems, all participants showed a greater RT effect for manual tapping. The lower deaf readers were significantly less accurate on multiplication problems.

A "dock, lock, and latch" structural model for a staphylococcal adhesin binding to fibrinogen.

Gram-positive pathogens such as staphylococci contain multiple cell wall-anchored proteins that serve as an interface between the microbe and its environment. Some of these proteins act as adhesins and mediate bacterial attachment to host tissues. SdrG is a cell wall-anchored adhesin from Staphylococcus epidermidis that binds to the Bbeta chain of human fibrinogen (Fg) and is necessary and sufficient for bacterial attachment to Fg-coated biomaterials. Here, we present the crystal structures of the ligand binding region of SdrG as an apoprotein and in complex with a synthetic peptide analogous to its binding site in Fg. Analysis of the crystal structures, along with mutational studies of both the protein and of the peptide, reveals that SdrG binds to its ligand with a dynamic "dock, lock, and latch" mechanism. We propose that this mechanism represents a general mode of ligand binding for structurally related cell wall-anchored proteins of gram-positive bacteria.

The serine-aspartate repeat (Sdr) protein family in Staphylococcus epidermidis.

Staphylococcus epidermidis can express three different cell-surface-associated proteins, designated SdrF, SdrG and SdrH, that contain serine-aspartate dipeptide repeats. Proteins SdrF and SdrG are similar in sequence and structural organization to the Sdr proteins of Staphylococcus aureus and comprise unique 625- and 548-residue A regions at their N termini, respectively, followed by 110-119-residue B-repeat regions and SD-repeat regions. The C termini contain LPXTG motifs and hydrophobic amino acid segments characteristic of surface proteins covalently anchored to peptidoglycan. In contrast, SdrH has a short 60-residue A region at its N terminus followed by a SD-repeat region, a unique 277-residue C region and a C-terminal hydrophobic segment. SdrH lacks a LPXTG motif. Recombinant proteins representing the A regions of SdrF, SdrG and SdrH were expressed and purified from Escherichia coli. Antisera specific to these proteins were raised in rabbits and used to identify Sdr proteins expressed by S. epidermidis. Only SdrF was released from lysostaphin-generated protoplasts of cells grown to late-exponential phase. SdrG and SdrH remained associated with the protoplast fraction and thus appear to be ineffectively sorted along the conventional pathway used for cell-wall-anchored proteins. In Southern hybridization analyses, the sdrG and sdrH genes were present in all 16 strains tested, whilst sdrF was present in 12 strains. Antisera from 16 patients who had recovered from S. epidermidis infections contained antibodies that reacted with recombinant A regions of SdrG and SdrH, suggesting that these proteins can be expressed during infection.