Kaiser Permanente Modesto Medical Center and Medical Offices

To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS). Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen. A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273). Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

To investigate differences in health care utilization between immediate (within 10 minutes of placental delivery) and delayed (after 24 hours) intrauterine device (IUD) placement. This retrospective cohort study was conducted with data from Kaiser Permanente Northern California from 2017 to 2019 and included patients with an IUD placed between 0 and 63 days postpartum. The primary outcome for health care utilization was the number of obstetrician-gynecologist (ob-gyn) or women's health office visits within 1 year. Secondary outcomes included formal imaging studies, surgical intervention, and hospitalizations related to IUD complications within 1 year. An additional secondary outcome was live births at 120 days and 1 year. Among 1,543 immediate and 10,332 delayed postpartum IUD placements, the number of visits to an ob-gyn or women's health office within 1 year was slightly increased with delayed placement (mean 2.30 vs 2.47, P <.001). Imaging was increased in the immediate compared with the delayed group (10.5% vs 4.1%, P <.001). Laparoscopy was decreased in the immediate compared with the delayed group (0.0% vs 0.4%, P =.005), with no significant difference in hysteroscopy (0.2% vs 0.1%, P =.413). Hospitalizations were rare and increased in the immediate group (0.4% vs 0.02%, P <.001). Lastly, there was no difference in repeat pregnancies between groups at 120 days (both 0.2%) or at 1 year (2.9% vs 2.5%, P =.342). Compared with delayed placement, immediate postpartum IUD placement is not associated with increased office visits. Immediate placement is associated with an increase in imaging but a decrease in laparoscopic surgery to manage IUD-related complications. There was no difference in live birth rates at 6 months or 1 year between groups.

Artificial intelligence (AI) has impacted many areas of healthcare. AI in healthcare uses machine learning, deep learning, and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes. In the sleep medicine field, a large amount of physiological data is gathered compared to other branches of medicine. This field is primed for innovations with the help of AI. A good quality of sleep is crucial for optimal health. About one billion people are estimated to have obstructive sleep apnea worldwide, but it is difficult to diagnose and treat all the people with limited resources. Sleep apnea is one of the major contributors to poor health. Most of the sleep apnea patients remain undiagnosed. Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors, and AI can help in this situation. AI can also help in the diagnosis and management of other sleep disorders such as insomnia, hypersomnia, parasomnia, narcolepsy, shift work sleep disorders, periodic leg movement disorders, etc. In this manuscript, we aim to address three critical issues about the use of AI in sleep medicine: (1) How can AI help in diagnosing and treating sleep disorders? (2) How can AI fill the gap in the care of sleep disorders? and (3) What are the ethical and legal considerations of using AI in sleep medicine?

Telehealth use including secure messages has rapidly expanded since the COVID-19 pandemic, including for multidisciplinary aspects of cancer care. Recent reports described rapid uptake and various benefits for patients and clinicians, suggesting that telehealth may be in standard use after the pandemic. To examine attitudes and perceptions of multidisciplinary cancer care clinicians toward telehealth and secure messages. Cross-sectional specialty-specific survey (ie, some questions appear only for relevant specialties) among multidisciplinary cancer care clinicians, collected from April 29, 2020, to June 5, 2020. Participants were all 285 clinicians in the fields of medical oncology, radiation oncology, surgical oncology, survivorship, and oncology navigation from all 21 community cancer centers of Kaiser Permanente Northern California. Clinician satisfaction, perceived benefits and challenges of telehealth, perceived quality of telehealth and secure messaging, preferred visit and communication types for different clinical activities, and preferences regarding postpandemic telehealth use. A total of 202 clinicians (71%) responded (104 of 128 medical oncologists, 34 of 37 radiation oncologists, 16 of 62 breast surgeons, 18 of 28 navigators, and 30 of 30 survivorship experts; 57% (116 of 202) were women; 73% [147 of 202] between ages 36-55 years). Seventy-six percent (n = 154) were satisfied with telehealth without statistically significant variations based on clinician characteristics. In-person visits were thought to promote a strong patient-clinician connection by 99% (n = 137) of respondents compared with 77% (n = 106) for video visits, 43% (n = 59) for telephone, and 14% (n = 19) for secure messages. The most commonly cited benefits of telehealth to clinicians included reduced commute (79%; n = 160), working from home (74%; n = 149), and staying on time (65%; n = 132); the most commonly cited negative factors included internet connection (84%; n = 170) or equipment problems (72%; n = 146), or physical examination needed (64%; n = 131). Most respondents (59%; n = 120) thought that video is adequate to manage the greater part of patient care in general; and most deemed various telehealth modalities suitable for any of the queried types of patient-clinician activities. For some specific activities, less than half of respondents thought that only an in-person visit is acceptable (eg, 49%; n = 66 for end-of-life discussion, 35%; n = 58 for new diagnosis). Most clinicians (82%; n = 166) preferred to maintain or increase use of telehealth after the pandemic. In this survey of multidisciplinary cancer care clinicians in the COVID-19 era, telehealth was well received and often preferred by most cancer care clinicians, who deemed it appropriate to manage most aspects of cancer care. As telehealth use becomes routine in some cancer care settings, video and telephone visits and use of asynchronous secure messaging with patients in cancer care has clear potential to extend beyond the pandemic period.

Abstract Background: In response to the SARS-CoV-2 pandemic, the multidisciplinary care of cancer patients has rapidly evolved. This study aims to determine utilization trends of in-person, telephone, and video visits, before and after the California shelter-in-place (SIP) orders on 3/19/20, and assess perspectives of cancer care providers on telehealth. Methods: This study was conducted in 22 medical centers of a large integrated health care system. Utilization of different visit types in medical oncology (excluding infusion visits) was collected between 12/1/2019–5/24/2020, for a total of 104,588 visits. Chi-square with Yates correction was used for p-values. Voluntary, anonymous electronic surveys were sent to 276 cancer care providers measuring attitudes and experiences with telehealth. Overall, 68.8% responded: 101/128 medical oncologists (MedOnc), 34/37 radiation oncologists (RadOnc), 16/62 breast surgeons (Brst Surg), 18/28 breast oncology nurse navigators (OncNav), and 21/21 cancer survivorship advanced practitioners (SurvOnc). Results: Comparing visit types prior to and after SIP, in-person visits went from 55.3% to 3.3%, telephone visits went from 44.2% to 79%, and video visits went from 0.5% to 17.8% (p&amp;lt;.0001). Between 12/2019 and 05/2020, video visits increased from 0.42% to 31.3%. Telephone visits increased from 39.3 to a peak of 86.6% in 04/2020 and then decreased to 63.7%. In-person visits dropped from 60.3% to 2.3% in 04/2020 and then increased to 5.0% (p&amp;lt;.0001). Satisfaction with telehealth was high: 87.1% of MedOnc, 91.2% of RadOnc, 68.6% of BrstSurg, 72.2% of OncNav, and 90.4% SurvOnc providers were very or somewhat satisfied. Most providers preferred to increase or maintain telehealth utilization after the pandemic: 84% of MedOnc, 85% of RadOnc, 81% of BrstSurg, 51% of OncNav, and 90% of SurvOnc. Among most providers, highest cited benefits of telehealth included work from home, reduced commute, staying on time, flexible hours, and shorter visits. Commonly cited challenges included connection/equipment problems, need for physical exam, difficulty evaluating performance status, and in-person visit required anyway. Of MedOnc, 11.8% responded that a patient suffered an adverse effect that could have been prevented with in-person visit. In-person visits were thought to promote the strongest provider-patient connection, followed by video, telephone visits, and emails. MedOnc providers deemed in-person visits were needed for end-of-life discussion (49%), discussing a new diagnosis (47.1%), palliative care discussion (34.3%), and clinical trial enrollment (34.3%). Activities for which email or phone visits were most accepted included check-in pretreatment, survivorship planning/follow-up, and patient navigation. Conclusion: Overall, telehealth utilization has rapidly increased and is well accepted by various cancer care providers. Addressing technical issues and tailoring visit type to specific activities may further promote telehealth adoption and satisfaction. Citation Format: Elad Neeman, Tatjana Kolevska, Mary Reed, Tilak Sundaresan, Amit Arora, Yan Li, Samantha Seaward, Gillian Kuehner, Sharon Likely, Julia Trossman, Christine Weldon, Raymond Liu. Cancer care telehealth utilization rates and provider attitudes in the wake of the novel coronavirus pandemic: The Kaiser Permanente Northern California experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S06-03.

Destruction by neurolytic agent. The term neurolytic agent includes chemical, thermal, electrical, or RF methods. CPT assignments for paravertebral facet RF ablations are the following: