During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors' primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences-complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.
Background Studies of the virtual interview format are needed to inform medical residency program leaders as they plan for future virtual interview seasons. Objective In the current study, completed in 2021, we sought to assess applicant perspectives of virtual interview effectiveness, advantages, and barriers, including factors that might impact equity and inclusion. Methods Interviewees applying to 7 residency programs and 2 clinical psychology programs at an academic medical center in the Pacific Northwest completed a post-interview survey. Results A total of 565 of 1429 interviewees (40%) completed the survey. A vast majority (83%–96%) agreed virtual interviews were effective in each measured domain, except for learning institutional culture (352 of 565, 62%). Many also found information regarding social/living environments inadequate. Participants selected advantages to virtual interviews more frequently than disadvantages. Commonly selected advantages included cost savings, time efficiency, reduced burden of travel, and reduced carbon footprint. Disadvantages included time zone differences, access to an appropriate interview setting, and reliable access to internet. The majority of interviewees (84%, 456 of 542) desired to keep a component of virtual interviews in the future. There were no significant disparities in results based on gender, rural/suburban/urban location, race, or underrepresented minority status. Conclusions Virtual interviews were perceived as effective, more advantageous than burdensome, and widely acceptable, with no disparities in these findings by included demographic characteristics.
Since 1963, eight patients with extraosseous osteogenic sarcoma were treated at Roswell Park Memorial Institute; these constituted 4.6% of all the osteogenic sarcoma patients during the period. The mean age of the patients was 58.7 years and a ratio of male to female was equal. Local swelling of insidious onset was the commonest symptom. All the tumors originated in extremities; the lower extremity was the more frequent site. At the time of diagnosis, seven patients had localized tumor and one had pulmonary metastases. Radiologically, a soft tissue mass with spotty calcification without any adjacent bone involvement, was the classical sign. Elevated alkaline phosphatase without liver metastases was observed in five of six patients when disease progressed. Ultrastructurally, the prominent cell type was a fibroblast-like cell intermingled with varying numbers of osteoblasts and undifferentiated mesenchymal cells. Extreme morphologic variability probably accounts for the difference in composition of this tumor. Radical soft part excision or amputation should be the treatment of choice. Local recurrence was not seen in four patients after radical surgery, but it was observed in three of the four patients who had simple excision. The lung was the commonest site of metastases. No objective responses were observed after chemo-or immunotherapy. The overall median survival was 20 months and 5-year survival rate was 25%.
The coronavirus disease 2019 (COVID-19) crisis has put extraordinary demands on hospitals and emergency departments (EDs), but outpatient clinicians on the front lines should not be ignored. 1 Primary care practices are the tip of the spear in confronting this pandemic. Public officials from the
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