We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the study's conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinson's Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson's Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinson's disease living remotely is feasible.
A series of substituted 2-benzyl-3-aryl-7-trifluoromethylindazoles were prepared as LXR modulators. These compounds were partial agonists in transactivation assays when compared to 1 (T0901317) and were slightly weaker with respect to potency and efficacy on LXRalpha than on LXRbeta. Lead compounds in this series 12 (WAY-252623) and 13 (WAY-214950) showed less lipid accumulation in HepG2 cells than potent full agonists 1 and 3 (WAY-254011) but were comparable in efficacy to 1 and 3 with respect to cholesterol efflux in THP-1 foam cells, albeit weaker in potency. Compound 13 reduced aortic lesion area in LDLR knockout mice equivalently to 3 or positive control 2 (GW3965). In a 7-day hamster model, compound 13 showed a lesser propensity for plasma TG elevation than 3, when the compounds were compared at doses in which they elevated ABCA1 and ABCG1 gene expression in duodenum and liver at equal levels. In contrast to results previously published for 2, the lack of TG effect of 13 correlated with its inability to increase liver fatty acid synthase (FAS) gene expression, which was up-regulated 4-fold by 3. These results suggest indazoles such as 13 may have an improved profile for potential use as a therapeutic agent.
Objective: To determine the current practice and plans for telemedicine at leading US neurology departments. Design and Setting: An electronic survey was sent to department chairs, administrators, or faculty involved in telemedicine at 47 neurology departments representing the top 50 hospitals as ranked by U.S. News and World Report. Main Outcome Measures: Current use, size, scope, reimbursement, and perceived quality of telemedicine services. Results: A total of 32 individuals from 30 departments responded (64% response rate). The primary respondents were neurology faculty (66%) and department chairs (22%). Of the responding departments, 60% (18 of 30) currently provide telemedicine and most (n ¼ 12) had initiated services within the last 2 years. Two thirds of those not providing telemedicine plan to do so within a year. Departments provide services to patients in state, out of state, and internationally, but only 6 departments had more than 50 consultations in the last year. The principal applications were stroke (n ¼ 14), movement disorders (n ¼ 4), and neurocritical care (n ¼ 3). Most departments (n ¼ 12) received external funding for telemedicine services, but few departments (n ¼ 3) received payment from insurers (eg, Medicare, Medicaid). Reimbursement (n ¼ 21) was the most frequently identified barrier to implementing telemedicine services. The majority of respondents (n ¼ 20) find telemedicine to be equivalent to in-person care. Conclusions: Over 85% of leading US neurology departments currently use or plan to implement telemedicine within the next year. Addressing reimbursement may allow for its broader application.
Background: The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match. METHODS: We examined data from interview scheduling software used by 32 programs located in 31 US states and 1300 applicants for the US anesthesiology recruitment cycles from 2015 to 2018. Interviewee data (distance from program, region, numbers of interviews, and program at which interview occurred) were analyzed to quantify the effect of the interviewee being from the same state as the residency program on the odds of matching to that program. Other variables of interest (medical school, current address, US Medical Licensing Exam [USMLE] Step 1 and 2 clinical knowledge [CK] scores, Alpha Omega Alpha [AOA] status, medical school ranking) were also examined as controls. Confidence intervals (CI) were calculated for the ratios of odds ratios. RESULTS: An interviewee living in the same state as the interviewing program could have 5.42 fewer total interviews (97.5% CI, 3.02–7.81) while having the same odds of matching. The same state effect had an equivalent value as an approximately 4.14 USMLE points-difference from the program’s mean (97.5% CI was 2.34–5.94 USMLE points). Addition of whether the interviewee belonged to an affiliated medical school did not significantly improve the model; same-state remained significant (P < .0001) while affiliated medical school was not (P = .40). CONCLUSIONS: Our analysis of anesthesiology residency recruitment using previously unstudied interview data shows that same-state locality is a viable predictor of residency matching and should be strongly considered when evaluating whether to interview an applicant.
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