Background The COVID-19 pandemic has rapidly transformed how healthcare is delivered to limit the transmission of the virus. This descriptive cross-sectional study explored the current use of virtual visits in providing care among primary care providers in southwestern Ontario during the first wave of the COVID-19 pandemic and the anticipated level of utilization post-pandemic. It also explored clinicians’ perceptions of the available support tools and resources and challenges to incorporating virtual visits within primary care practices. Methods Primary care physicians and nurse practitioners currently practicing in the southwestern part of Ontario were invited to participate in an online survey. The survey invite was distributed via email, different social media platforms, and newsletters. The survey questions gathered clinicians’ demographic information and assessed their experience with virtual visits, including the proportion of visits conducted virtually (before, during the pandemic, and expected volume post-pandemic), overall satisfaction and comfort level with offering virtual visits using modalities, challenges experienced, as well as useful resources and tools to support them in using virtual visits in their practice. Results We received 207 responses, with 96.6% of respondents offering virtual visits in their practice. Participants used different modalities to conduct virtual visits, with the vast majority offering visits via phone calls (99.5%). Since the COVID-19 pandemic, clinicians who offered virtual visits have conducted an average of 66.4% of their visits virtually, compared to an average of 6.5% pre-pandemic. Participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients’ limited access to technology, 55% about patients’ knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection. There were significant differences in perception of some challenges between clinicians in urban vs, rural areas. Clinicians in rural areas were more likely to consider the inconsistent Wi-Fi and limited connectivity as barriers to incorporating virtual visits within the practice setting (58.8% vs. 40.2%, P = 0.030). In comparison, clinicians in urban areas were significantly more concerned about patients overusing virtual care services (39.4% vs. 21.6%, P = 0.024). As for support tools, 47% of clinicians advocated for virtual care standards outlined by their profession’s college. About 32% identified change management support and technical training as supportive tools. Moreover, 39% and 28% thought local colleagues and in-house organizational support are helpful resources, respectively. Conclusion Our study shows that the adoption of virtual visits has exponentially increased during the pandemic, with a significant interest in continuing to use virtual care options in the delivery of primary care post-pandemic. The study sheds light on tools and resources that could enhance operational efficiencies in adopting virtual visits in primary care settings and highlights challenges that, when addressed, can expand the health system capacity and sustained use of virtual care.

Background: Clinicians use the Activities-specific Balance Confidence Scale to understand balance confidence. A short-form Activities-specific Balance Confidence scale, was developed using the six most difficult tasks from the original Activities-specific Balance Confidence scale; however, short-form the short-form scale psychometrics and agreement with the original scale have yet to be explored in people with lower extremity amputations. Objective: To determine the relative and absolute reliability, construct validity, and agreement of the short-form Activities-specific Balance Confidence scale. Study design: Test–retest with a 2-week interval. Methods: Analysis for relative reliability and internal consistency was intraclass correlation coefficient and Cronbach’s α, respectively. Absolute reliability was measured using standard error of measurement and minimal detectable change. Bland–Altman plots measured agreement between scales. Construct validity was evaluated against the L Test using a Pearson-product moment correlation. Results: The short-form Activities-specific Balance Confidence (intraclass correlation coefficient = 0.92) and Activities-specific Balance Confidence (intraclass correlation coefficient = 0.91) scales had excellent relative reliability. Both scales demonstrated good internal consistency. Worse absolute reliability was observed in the short-form Activities-specific Balance Confidence scale. Construct validity against the L Test was confirmed. Bland–Altman plots indicated poor agreement between scales. Conclusion: Both scales exhibit excellent relative reliability and good internal consistency and construct validity. Poor agreement between short-form Activities-specific Balance Confidence and Activities-specific Balance Confidence indicates the scales should not be used interchangeably. Inadequate absolute reliability of the short-form Activities-specific Balance Confidence scale suggests the Activities-specific Balance Confidence should be the balance confidence scale of choice. Clinical relevance: Balance confidence is an important metric for our understanding of rehabilitation and community re-integration in people with lower extremity amputations. Due to inferior absolute reliability and a lack of appropriate items composing the short-form Activities-specific Balance Confidence scale, the full-scale Activities-specific Balance Confidence is recommended for the assessment of balance confidence in this population.

Background Effective treatments for hematologic malignancies include therapies that target tyrosine kinase (TK) signaling pathways. Tumor lysis syndrome (TLS) is an oncologic emergency that can occur due to rapid turnover following the initiation of treatments for hematologic malignancy. The incidence of TLS is under‐reported and it is unclear as to whether TK inhibitors (TKIs) are associated with TLS. Objective To conduct a systematic review to determine the incidence of TLS with TKIs. Methods A search was performed using EMBASE, MEDLINE, and Web of Science electronic databases, as well as a manual search of the American Society of Hematology and American Society of Clinical Oncology abstract databases. Keywords included: “tumor lysis syndrome,” “tyrosine kinase inhibitors,” “lymphoma,” and “leukemia.” Results We identified a total of 57 publications that commented on the incidence of TLS with TKIs for hematologic malignancy. Thirty‐nine of those publications reported TLS as an adverse event. TLS was described as an adverse event among essentially all the subclasses of TKIs that are used to manage hematologic malignancies. Conclusion The overall number of articles commenting on TLS as an adverse event is sparse and there needs to be more transparency regarding the incidence of TLS when employing newer targeted therapies. Physicians should consider the risk of TLS on an individual basis and the added risk of TLS when using TKIs to treat hematologic malignancy.

Background: Because the population grows older and the burden of chronic disease increases, many individuals will undergo major lower limb amputation (LLA) at advanced ages. There is a scarcity of literature focusing on the outcomes of rehabilitation for people who acquire LLA at 80 years of age and older. Objectives: To determine the scope of empirical evidence regarding prosthetic rehabilitation for newly acquired LLA in the oldest old ($80 years of age). Study design: Systematic Review. Methods: The databases CINAHL, EMBASE, MEDLINE, and Scopus were searched from inception through June 6, 2020 (PROSPERO: #CRD 42020188623). Two authors independently reviewed all titles and abstracts for inclusion. Inclusion criteria, LLA of any etiology at the transtibial level or above, those who were $80 years of age at the time of amputation, and had rehabilitation outcomes reported. Results: Of 11,738 articles identified from databases, 117 underwent full-text review and 10 met inclusion criteria. Multiple rehabilitation outcomes were assessed by the selected studies, including general outcomes, prosthetic-related outcomes, and functional abilities. Individuals $80 years of age were able to successfully use a prosthesis, discharged home, and performed activities independently or with support. However, increased age was negatively associated with prosthesis fitting and rehabilitation success was not uniform in some participants. Conclusions: The oldest old with major LLA can be successful in prosthetic rehabilitation. Age alone should not disqualify individuals from assessment or participation in an amputee rehabilitation program. More research is needed to better understand the rehabilitation outcomes in this population of people with LLA.

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