Socioeconomic patient benefits of a pediatric neurosurgery telemedicine clinic

2020 ◽  
Vol 25 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Kelsey Hayward ◽  
Sabrina H. Han ◽  
Alexander Simko ◽  
Hector E. James ◽  
Philipp R. Aldana
Keyword(s):  
Travel Time ◽  
Cost Savings ◽  
Transportation Cost ◽  
Pediatric Neurosurgery ◽  
University Of Florida ◽  
Remote Location ◽  
Socioeconomic Data ◽  
The University ◽  
Time Away

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was < 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

scholarly journals Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories

2016 ◽  
Vol 18 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Hector E. James
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Clinical History ◽  
The United States ◽  
Nursing Personnel ◽  
Cultural Barriers ◽  
University Of Florida ◽  
Clinic Patient ◽  
The University ◽  
Physical Findings

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

scholarly journals Implant Treatment in an Urban General Dentistry Residency Program: A 4-Year Retrospective Study

2004 ◽  
Vol 30 (6) ◽  
pp. 364-368 ◽  
Author(s):  
Mohamed A. Maksoud ◽  
Clifford B. Starr
Keyword(s):  
Dental Implants ◽  
Survival Rates ◽  
First Year ◽  
University Of Florida ◽  
Residency Programs ◽  
Implant Therapy ◽  
The University ◽  
Implant Treatment ◽  
Florida College

Abstract Little data have been published on the survival rates of implants placed in dental residency programs. This study reports on the outcome of dental implants placed by first-year general dentistry residents in the University of Florida College of Dentistry–Jacksonville Clinic. The patients for this study received both surgical and restorative implant therapy from 1998 to 2002. A total of 108 patients (62 women, 46 men) were treated with dental implants. On average, a patient was 52.9 years old and received 2.6 implants. A variety of simple and complex restorative procedures were performed. Advanced general dentistry residents in conjunction with supervisory faculty treated all cases. The cumulative implant survival was 98.2%. Follow-up varied from 6 months to 4 years after placement. Cases included implants not yet loaded as well as implants loaded for 3 years or more. The findings of this study compare favorably with published studies and were unexpected in light of the residents' limited clinical experience.

Repeat Radiosurgery for Intracranial Arteriovenous Malformations

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 150-154 ◽  
Author(s):  
John M. Stahl ◽  
Yueh-Yun Chi ◽  
William A. Friedman
Keyword(s):  
Initial Treatment ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
University Of Florida ◽  
The Status ◽  
Median Volume ◽  
Radiation Induced ◽  
Prescription Dose ◽  
The University

Abstract BACKGROUND Despite a high success rate in the stereotactic radiosurgical treatment of intracranial arteriovenous malformations (AVMs) that cannot be safely resected with microsurgery, some patients must be managed after treatment failure. OBJECTIVE To provide an update on the use of repeat linear accelerator radiosurgery as a treatment for failed AVM radiosurgery at the University of Florida. METHODS We reviewed 103 patients who underwent repeat radiosurgical treatment for residual AVM at the University of Florida between December 1991 and December 2007. Each of these patients had at least 2 radiosurgical treatments for the same AVM. Patient information, including AVM nidus volume, prescription dose, age, and sex, was collected at the time of initial treatment and again at the time of retreatment. Patients were followed up after treatment with magnetic resonance, computed tomography, and angiographic imaging at standard intervals to determine the status of their AVM. The median follow-up after retreatment was 31 months. RESULTS Between the first and second treatments, the median AVM nidus volume was decreased by 69% (from a median volume of 12.7 to 4.0 cm3), allowing the median prescribed dose to be increased from 1500 cGy on initial treatment to 1750 cGy on retreatment. The final obliteration rate on retreatment was 65.3%. After salvage retreatment, 5 patients (4.9%) experienced radiation-induced complications, and 6 patients (5.8%) experienced posttreatment hemorrhage. CONCLUSION Repeat radiosurgery is a safe and effective salvage treatment for AVMs.

Implant Treatment in an Urban General Dentistry Residency Program: A 7-year Retrospective Study

10.1563/807.1 ◽  
2006 ◽  
Vol 32 (3) ◽  
pp. 142-147 ◽  
Author(s):  
Clifford B. Starr ◽  
Mohamed A. Maksoud
Keyword(s):  
Dental Implants ◽  
Survival Rates ◽  
First Year ◽  
University Of Florida ◽  
Residency Programs ◽  
Implant Therapy ◽  
The University ◽  
Implant Treatment ◽  
Florida College

Abstract Survival rates of multiple implant designs placed in various clinical situations average more than 90%. However, little data have been published on the survival rates of implants placed in dental residency programs. This study reports on the outcome of dental implants placed by first-year general dentistry residents in the University of Florida College of Dentistry–Jacksonville Clinic. The patients for this study received both surgical and restorative implant therapy from 1998 to 2005. A total of 263 patients (147 women, 116 men) were treated with dental implants. On average, a patient was 55.5 years old and received 3 implants. A variety of simple and complex restorative procedures were performed. Advanced general dentistry residents in conjunction with supervisory faculty treated all cases. The cumulative implant survival was 96.6%. Follow-up varied from 6 months to 7 years after placement. Cases included implants not yet loaded as well as implants loaded for 6 years or more. The findings of this study compare favorably with published studies and were unexpected in light of the residents' limited clinical experience.

scholarly journals Silent science: a mixed-methods analysis of faculty engagement in science communication

2021 ◽  
Vol 20 (04) ◽  
pp. A09
Author(s):  
Taylor T. Ruth ◽  
Joy N. Rumble ◽  
Lisa K. Lundy ◽  
Sebastian Galindo ◽  
Hannah S. Carter ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Science Communication ◽  
Spiral Of Silence ◽  
Tenure Track ◽  
University Of Florida ◽  
The Public ◽  
Effective Science ◽  
The Spiral Of Silence ◽  
The University

To address science literacy issues, university faculty have to engage in effective science communication. However, social pressures from peers, administration, or the public may silence their efforts. The purpose of this study was to understand the effect of the spiral of silence on faculty's engagement with science communication. A survey was distributed to a census of tenure-track faculty at the University of Florida [UF], and the findings did not support the spiral of silence was occurring. However, follow-up interviews revealed faculty did not perceive their peers to value science communication and were more concerned about how the public felt about their research and communication.

scholarly journals Values and Ecosystem Services Provided by Gainesville's Urban Forest in 2016

EDIS ◽  
2019 ◽  
Vol 2019 (5) ◽  
pp. 3
Author(s):  
Michael G Andreu ◽  
Caroline A Hament ◽  
David A. Fox ◽  
Robert J. Northrop
Keyword(s):  
Ecosystem Services ◽  
Vegetation Structure ◽  
Urban Forest ◽  
Cost Savings ◽  
Well Being ◽  
Forest Resources ◽  
Ecological Analysis ◽  
University Of Florida ◽  
Fact Sheet ◽  
The University

The urban forest is a crucial factor in the well-being of a community because of the aesthetics, health benefits, and cost-savings that it provides. The urban forest is our habitat, and we must manage it in ways that will provide the benefits we need and desire. This 3-page fact sheet written by Michael G. Andreu, Caroline A. Hament, David A. Fox, and Robert J. Northrop and published by the UF/IFAS School of Forest Resources and Conservation describes an urban forest ecological analysis conducted in 2016 in Gainesville, Florida, by the University of Florida in partnership with the Parks, Recreation, and Cultural Affairs Department to quantify the vegetation structure, functions, and values of the urban forest. http://edis.ifas.ufl.edu/fr414

scholarly journals Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Vanessa M. Holanda ◽  
Robert Stephen Eisinger ◽  
Leonardo Almeida ◽  
Takashi Tsuboi ◽  
Huimin Wang ◽  
...  
Keyword(s):  
High Resolution ◽  
Ct Scan ◽  
Target Location ◽  
Neurological Diseases ◽  
University Of Florida ◽  
Single Center Study ◽  
Measurement Protocol ◽  
Change Position ◽  
The University

Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting.Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies.Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053).Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.

scholarly journals Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation

2014 ◽  
Vol 7 (1) ◽  
pp. 152-157
Author(s):  
Hashim Faris ◽  
A. Gregg Jon ◽  
R. Dharnidharka Vikas
Keyword(s):  
Late Onset ◽  
Cmv Infection ◽  
University Of Florida ◽  
Pediatric Kidney Transplantation ◽  
Final Study ◽  
Significant Difference ◽  
Infection Resistance ◽  
The University ◽  
Cmv Disease

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx) recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR (Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and 18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58 and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.

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