BackgroundPediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians.ObjectiveOur aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed.MethodsIn September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later.ResultsThe age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection.ConclusionsParental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness.
Plasmablastic myeloma is a rare variant of multiple myeloma characterised by neoplastic proliferation of single clone of plasma cells producing monoclonal immunoglobulins. A 60-year-old man presented to hospital with a 6-week history of chest pain, back pain, leg weakness and numbness. Imaging revealed a 75 mm left lobular lung mass with chest wall invasion, metastatic bony and soft-tissue deposits and spinal cord compression at T5 level. Lung biopsy, for suspected metastatic lung cancer, surprisingly showed features of plasmablastic myeloma. Protein electrophoresis demonstrated 2 g/L of IgG lambda paraproteinaemia and an increase in lambda light chains with reduced kappa/lambda ratio of 0.01. Bone marrow biopsy did not show evidence of infiltration by disease. The patient received radiotherapy to the spine; responded to third-line chemotherapy and received autologous stem cell transplant. This case adds to the rare causes of lung mass and is the first reported case of plasmablastic myeloma diagnosed on lung biopsy.
Background: Pediatric online chat services offer a novel, low-threshold communication channel between caregivers and physicians. Objectives: Our aim was to evaluate profiles of chat conversations between caregivers and physicians in a Web-based chat service to determine which factors should be taken into account when planning a similar chat service. We also aimed to evaluate the feasibility of a Web-based chat service that helps caregivers with concerns about their child's health. Methods: In September 2015, a private health care clinic in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an Internet connection, and open from 9 a.m. to 9 p.m., local time. Four residents in pediatrics served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire, which 98 caregivers answered a median 11 days [interquartile range (IQR) 7-20] later. Results: The age of the children whose caregivers contacted the chat service was a median 2.1 years (IQR 0.83-4.69), and 102 (30%) children were less than 1 year old. The majority (119/343, 34.7%) of chat conversations took place from 9 a.m. to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended an in-person appointment with a physician for that same day in 13.7% (47/343) of cases. A physical exam was recommended for that same day more often if the chat concerned infection [36 cases (19%)] compared with other reasons [11 cases (7%), P=.001]. Physicians felt capable of answering caregivers' questions in nearly three-quarters of cases (249/343, 72.6%), whereas 93% (91/98) of caregivers considered physicians' answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers' main concern was infection did not associate with whether caregivers considered physicians' answers helpful or not. However, physicians felt more capable of answering caregivers' questions when the main concern was infection. Conclusions: Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be taken into account when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat service may be a useful way to help caregivers with concerns about their child's health or illness.
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