Objective: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. Materials and Methods: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. Results: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. Discussion: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. Conclusion: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.

OBJECTIVE Given the growing number of military service members with families and the multiple combat deployments characterizing current war time duties, the impact of deployments on military children requires clarification. Behavioral and emotional adjustment problems were examined in children (aged 6 –12) of an active duty Army or Marine Corps parent currently deployed (CD) or recently returned (RR) from Afghanistan or Iraq. METHOD Children (N=272) and their at-home civilian (AHC) (N=163) and/or recently returned active duty (AD) parent (N=65) were interviewed. Child adjustment outcomes were examined in relation to parental psychological distress and months of combat deployment (of the AD) using mixed effects linear models. RESULTS Parental distress (AHC and AD) and cumulative length of parental combat-related deployments during the child’s lifetime independently predicted increased child depression and externalizing symptoms. Although behavioral adjustment and depression levels were comparable to community norms, anxiety was significantly elevated in children in both deployment groups. In contrast, AHC parental distress was greater in those with a CD (vs. RR) spouse. CONCLUSIONS Findings indicate parental combat deployment has a cumulative effect on children which remains even after the deployed parent returns home, and is predicted by psychological distress of both the AD and AHC parent. Such data may be informative for screening, prevention and intervention strategies.

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.

The sniper shootings were associated with substantial changes in perceived safety and threat assessment as well as decreased activities outside the home among highly educated hospital employees. Levels of acute stress disorder were similar to levels of posttraumatic stress disorder in New York City after the terrorist attacks of September 11, 2001. Peritraumatic dissociation was associated not only with acute stress disorder but also with depression and increased alcohol use after the attacks.

Early posttraumatic psychiatric disorders have not been well studied in disaster workers. This study examined the rates of probable acute stress disorder (ASD), probable depression, increased tobacco use, and their associated risk factors in 9/11 World Trade Center disaster workers. Surveys were obtained from 90 disaster workers (e.g., medical personnel, police, firefighters, search and rescue) 2-3 weeks after 9/11. Nearly 15% of disaster workers had probable ASD and 26% had probable depression. Probable ASD and depression were highly related to functional impairment. The risk for ASD was increased for those with 9/11-specific disaster exposures, more pre-9/11 trauma exposures, and the peritraumatic dissociative symptom of altered sense of time. Disaster workers who were younger, non-White, or who had increasing numbers of peritraumatic dissociative symptoms were more likely to have probable depression. More than half of tobacco users increased their tobacco use after 9/11. Additionally, all tobacco users with probable ASD and almost all tobacco users with probable depression increased tobacco use. Rapid mobilization of resources for early screening and intervention and health promotion campaigns aimed at improving adverse health-related behaviors may be helpful for this high-risk group.

Canine cervical vertebral instability is a complex syndrome involving cervical spinal cord compressive lesions. Doberman pinschers and Great Danes are the most commonly affected breeds. Measurements of vertebral canal diameter (VCD), vertebral body height (H), and vertebral body length (L) were made from C3-C7 in 24 Doberman pinschers and 8 Great Danes by using digital and analog techniques. Significant differences between affected and unaffected sites were noted for Doberman pinschers at C6 (P = 0.039) and C7 (P = 0.027) using analog measurements of VCD/H, and Great Danes at C6 using analog (P = 0.041) and digital (P = 0.004) measurements of VCD/L. Cervical vertebral ratios have potential as a breed-specific screening tool for cervical vertebral instability and warrant longitudinal studies.

Findings indicate that parental combat deployment has a cumulative effect on children that remains even after the deployed parent returns home, and that is predicted by psychological distress of both the AD and AHC parent. Such data may be informative for screening, prevention, and intervention strategies.

BACKGROUND: Understanding the impact of key metrics on operating room (OR) efficiency is important to optimize utilization and reduce costs, particularly in freestanding ambulatory surgery centers. The aim of this study was to assess the association between commonly used efficiency metrics and scheduled end-time accuracy. METHODS: Data from patients who underwent surgery from May 2018 to June 2019 at an academic freestanding ambulatory surgery center was extracted from the medical record. Unique operating room days (ORDs) were analyzed to determine (1) duration of first case delays, (2) turnover times (TOT), and (3) scheduled case duration accuracies. Spearman’s correlation coefficients and mixed-effects multivariable linear regression were used to assess the association of each metric with scheduled end-time accuracy. RESULTS: There were 1378 cases performed over 300 unique ORDs. There were 86 (28.7%) ORDs with a first case delay, mean (standard deviation [SD]) 11.2 minutes (15.1 minutes), range of 2–101 minutes; the overall mean (SD) TOT was 28.1 minutes (19.9 minutes), range of 6–83 minutes; there were 640 (46.4%) TOT >20 minutes; the overall mean (SD) case duration accuracy was −6.6 minutes (30.3 minutes), range of −114 to 176; and there were 389 (28.2%) case duration accuracies ≥30 minutes. The mean (SD) scheduled end-time accuracy was 6.9 minutes (68.3 minutes), range of −173 to 229 minutes; 48 (15.9%) ORDs ended ≥1 hour before scheduled end-time and 56 (18.6%) ORDs ended ≥1 hour after scheduled end-time. The total case duration accuracy was strongly correlated with the scheduled end-time accuracy (r = 0.87, 95% confidence interval [CI], 0.84-0.89, P < .0001), while the total first case delay minutes (r = 0.12, 95% CI, 0.01-0.21, P = .04) and total turnover time (r = −0.16, 95% CI, 0.21-0.05, P = .005) were less relevant. Case duration accuracy had the highest association with the dependent variable (0.95 minutes changed in the difference between actual and schedule end time per minute increase in case duration accuracy, 95% CI, 0.90-0.99, P < .0001), compared to turnover time (estimate = 0.87, 95% CI, 0.75-0.99, P < .0001) and first case delay time (estimate = 0.83, 95% CI, 0.56-1.11, P < .0001). CONCLUSIONS: Standard efficiency metrics are similarly associated with scheduled end-time accuracy, and addressing problems in each is requisite to having an efficient ambulatory surgery center. Pursuing methods to narrow the gap between scheduled and actual case duration may result in a more productive enterprise.