Improving Access to Cardiovascular Care Through Telehealth: A Single-Center Experience.

Background: Historically, access to healthcare has been a serious shortcoming of our healthcare system. Approximately 14.5% of US adults lack readily available access to health care and this has been worsened by the coronavirus disease 2019 (COVID-19) pandemic. There are limited data on the use of telehealth in cardiology. We share our single-center experience in improving access to care via telehealth at the University of Florida, Jacksonville cardiology fellows' clinic. Methods: Demographic and social variables were collected 6 months before and 6 months after the initiation of telehealth services. The effect of telehealth was determined via Chi-square and multiple logistic regression while controlling for demographic covariates. Results: We analyzed 3,316 cardiac clinic appointments over 1 year. Of these, 1,569 and 1,747 were before and after the start of telehealth, respectively. Fifteen percent (272 clinical encounters) out of the 1,747 clinic visits during the post-telehealth era were through telehealth, completed via audio or video consultation. Overall, there was a 7.2 % increase in attendance after the implementation of telehealth (P value < 0.001). Patients who attended their scheduled follow-up had significantly greater odds of being in the post-telehealth group while controlling for marital status and insurance type (odds ratio (OR): 1.31, 95% confidence interval (CI): 1.07 - 1.62). Patients who attended had higher odds of having City-Contract insurance - an institution-specific indigenous care plan (OR: 3.51, 95% CI: 1.79 - 6.87) compared to private insurance. Patients who attended also had higher odds of being previously married (OR: 1.34, 95% CI: 1.05 - 1.70) or married/dating (OR: 1.39, 95% CI: 1.05 - 1.82) compared to patients who were single. Surprisingly, telehealth did not lead to an increase in the use of Mychart, our electronic patient portal (P value = 0.55). Conclusions: Telehealth enhanced patients' access to care by improving appointment show-rate in a cardiology fellows' clinic during the COVID-19 pandemic. Telehealth as a resource adjunct to traditional care in cardiology fellows' clinic should be further explored.

Cardiac papillary fibroelastoma.

Papillary fibroelastoma (PFE) is a primary, histologically benign endocardial neoplasm. Though PFE has long been reported as the second most common primary cardiac neoplasm, it has since pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. While PFEs are benign histologically, they have the potential for devastating clinical consequences, transient ischemic attack, stroke, myocardial infarction, syncope, pulmonary, and peripheral embolism. Despite increased detection rate, there remains uncertainty regarding etiology, exact prevalence, and clinical management of PFEs. This paucity of information is reflected by the lack of official guidelines on this matter. In this article, we aim to summarize the current state of understanding regarding PFE and discuss areas of ongoing controversy.

Intraoperative Endoscopic Suction-Assisted Evaluation of the Nasal Valve.

IMPORTANCE: The study sought to identify a new method for measuring internal nasal valve patency. OBJECTIVE: To determine whether intraoperative endoscopic suction-assisted evaluation of the internal nasal valve is a useful technique to assess internal nasal valve area and function. DESIGN, SETTING, AND PARTICIPANTS: A study of 20 patients undergoing cosmetic and functional septorhinoplasty from May 1 through October 31, 2012, at a private surgical practice was performed. A follow-up study was performed 3 years postoperatively on 7 patients. A photograph of the internal nasal valve was taken endoscopically with and without suction preoperatively, postoperatively, and at 3-year follow-up. Measurement of the internal nasal valve surface areas was then performed by an evaluator masked to patient groupings. MAIN OUTCOMES AND MEASURES: Outcome measures were surface area of the internal nasal valve as measured by standardized, endoscopic photography preoperatively, postoperatively, and at 3 years with and without suction and Nasal Obstruction Symptom Evaluation (NOSE) scale scores at 3 years comparing preoperative and postoperative symptoms. RESULTS: Among the 20 patients studied, 13 were female and the mean age was 26 years. No difference was found in the observed static surface area of the internal nasal valve comparing preoperative and postoperative values (72 418 vs 76 973 square pixels, P = .58). No difference was found in the observed static surface area of the internal nasal valve comparing preoperative (56 426 square pixels) and postoperative (60 011 square pixels) values (P = .58). No difference was found in the observed surface area of the internal nasal valve under negative pressure comparing preoperative (54 194 square pixels) and immediate postoperative (58 325 square pixels) values (P = .97). At 3 years, the resting surface area of the internal nasal valve was not increased with an internal nasal valve surface area mean of 56 426 square pixels preoperatively and 84 352 postoperatively (P = .09). The surface area of the internal nasal valve was increased when exposed to negative sniff pressures in the 3-year follow-up by 45% (P = .03). The surface area measured a mean of 47 683 square pixels preoperatively and 85 612 square pixels at the 3-year mark under negative pressure. CONCLUSIONS AND RELEVANCE: The study outlines a novel technique for measuring internal nasal valve surface area and compliance preoperatively and postoperatively. Surgery on the internal nasal valve has a greater effect on the dynamic function of the internal nasal valve (ie, stiffness that can be accounted for by a mere increase in nasal valve size when measured endoscopically). The study lays the groundwork for future studies using this technique. LEVEL OF EVIDENCE: 4.

Long-term behavioral consequences of stress exposure in adolescent versus young adult rats.

Adolescence is a developmental time period marked by rapid changes in behavior and brain structure. Stress during adolescence has been shown to cause long-lasting behavioral changes, including increased anxiety- and depression-like behavior, in both rats and humans. These findings have led to the hypothesis that adolescence may be a particularly vulnerable or sensitive period for stress exposure. To investigate this hypothesis, we directly compared the effects of a 3-day stress exposure during either an adolescent (post natal day (PND) 27-29) or adult (PND 72-74) time window on exploratory behavior in male rats, measured 6 weeks post-stress (PND 72 or PND 117). Exploratory behavior was tested in both 'anxiogenic' and 'anxiolytic' environments, using the open field and novel object tests, respectively. We hypothesized that rats stressed as adolescents would show greater behavioral changes than rats stressed as adults. Contrary to our hypothesis, we found a decrease in exploratory behavior in the open-field test in both age groups. Furthermore, the magnitude of difference between stress and age-matched control animals was similar between age groups. In contrast, stress had no effect at either age in the novel object test, a more anxiolytic environment. Older adults showed decreased exploration in the novel object test compared to the younger adults, regardless of stress experience. These results suggest that adolescence is not a sensitive period for the effects of repeated variable stress on exploratory behavior in an anxiogenic environment.

Active behavioral coping alters the behavioral but not the endocrine response to stress.

Exposure to traumatic stressors typically causes lasting changes in emotionality and behavior. However, coping strategies have been shown to prevent and alleviate many stress consequences and the biological mechanisms that underlie coping are of great interest. Whereas the laboratory stressor inescapable tail-shock induces anxiety-like behaviors, here we demonstrate that permitting a rat to chew on a wooden dowel during administration of tail-shock prevented the development of anxiety like behaviors in the open field and juvenile social exploration tests. Uncontrollable stressors increase corticosterone and decrease thyroid hormone, and we hypothesized that coping would blunt these changes. While tail-shock did produce these effects, active coping did not alter hormone levels. The dissociation between behavioral resilience and circulating hormones is discussed with regard to the utility of these molecules as biomarkers for psychiatric disease.