Background The effect of the COVID19 pandemic on community‐based rheumatology care and use of telehealth is unclear. Methods Using a community practice‐based rheumatologist network, we examined trends in in‐person vs. telehealth visits vs. canceled visits in three time periods: pre‐COVID19, COVID19‐Transition (6‐weeks beginning 3/23/20), and post‐COVID19‐Transition (May‐August). In the Transition period, we compared patients who received in‐person care vs. telehealth visits vs. cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits. Results Pre‐COVID19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by approximately 300 providers practicing in 92 offices. This decreased substantially (24.6% reduction) during COVID19‐Transition period for in‐person but rebounded to pre‐COVID19 levels during post‐COVID19 transition. There were almost no telehealth visits pre‐COVID19, but telehealth increased substantially during the COVID19‐Transition (41.4% of all follow‐up visits) and slightly decreased during post‐COVID19‐Transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with greater likelihood of cancelling visits. Most factors were also associated with a lower likelihood of having telehealth vs. in‐office visits. Patients living further from the rheumatologists’ office were more likely to use telehealth. Conclusion COVID19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID‐19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.
The efficacy, safety, and metabolic consequences of rapid weight loss in privately owned obese cats by means of a canned weight-reduction diet and the influence of orally administered L-carnitine on rate of weight loss, routine clinical evaluations, hepatic ultrasonography, plasma amino acid profiles, and carnitine analytes were evaluated. A double-blinded placebo-controlled design was used with cats randomly divided into 2 groups: Group 1 (n = 14) received L-carnitine (250 mg PO q24h) in aqueous solution and group 2 (n = 10) received an identical-appearing water placebo. Median obesity (body condition scores and percentage ideal body weight) in each group was 25%. Caloric intake was restricted to 60% of maintenance energy requirements (60 kcal/kg) for targeted ideal weight. The reducing formula was readily accepted by all cats. Significant weight loss was achieved by week 18 in each group without adverse effects (group 1 = 23.7%, group 2 = 19.6%). Cats receiving carnitine lost weight at a significantly faster rate (P < .05). Significant increases in carnitine values developed in each group (P < .02). However, significantly higher concentrations of all carnitine moieties and a greater percentage of acetylcarnitine developed in cats of group 1 (P < .01). The dietary formula and described reducing strategy can safely achieve a 20% weight reduction within 18 weeks in obese cats. An aqueous solution of L-carnitine (250 mg PO q12h) was at least partially absorbed, was nontoxic, and significantly increased plasma carnitine analyte concentrations as well as rate of weight loss.
The efficacy, safety, and metabolic consequences of rapid weight loss in privately owned obese cats by means of a canned weight-reduction diet and the influence of orally administered L-carnitine on rate of weight loss, routine clinical evaluations, hepatic ultrasonography, plasma amino acid profiles, and carnitine analytes were evaluated. A double-blinded placebo-controlled design was used with cats randomly divided into 2 groups: Group 1 (n = 14) received L-carnitine (250 mg PO q24h) in aqueous solution and group 2 (n = 10) received an identical-appearing water placebo. Median obesity (body condition scores and percentage ideal body weight) in each group was 25%. Caloric intake was restricted to 60% of maintenance energy requirements (60 kcal/kg) for targeted ideal weight. The reducing formula was readily accepted by all cats. Significant weight loss was achieved by week 18 in each group without adverse effects (group 1 = 23.7%, group 2 = 19.6%). Cats receiving carnitine lost weight at a significantly faster rate (P < .05). Significant increases in carnitine values developed in each group (P < .02). However, significantly higher concentrations of all carnitine moieties and a greater percentage of acetylcarnitine developed in cats of group 1 (P < .01). The dietary formula and described reducing strategy can safely achieve a 20% weight reduction within 18 weeks in obese cats. An aqueous solution of L-carnitine (250 mg PO q12h) was at least partially absorbed, was nontoxic, and significantly increased plasma carnitine analyte concentrations as well as rate of weight loss.
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