A unique and sudden need for virtual medical visits created by the coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented expansion of telemedicine across nearly all medical specialties in the United States. In addition to providing essential medical services during the pandemic, telemedicine has the potential to expand health care access to underserved populations by eliminating traditional barriers to care such as transportation needs, distance from specialty providers, and approved time off from work. However, the literature regarding telehealth accessibility for low-income, non-English-speaking, and minority patients remains limited. Through a cross-sectional analysis comparing 2019 clinic visits with 2020 telehealth visits at the UMass Memorial Medical Center, we demonstrate specialty-specific changes in patient demographics, including a younger population, fewer non-English-speaking patients, and a relative preservation of minority, Medicaid, and Medicare patients among telehealth visits in comparison to clinic visits. We also demonstrate that nonsurgical specialties had significantly lower no-show rates and the greatest number of telehealth visits. Overall, our findings highlight the potential shortcomings of telemedicine in servicing non-English-speaking patients, while maintaining that it is an important tool with the potential to improve access to health care, particularly in nonprocedural specialties.
Progressive Macular Hypomelanosis (PMH) is a common but often misdiagnosed disorder of acquired hypopigmentation. An adolescent female presented with irregular, hypopigmented patches ultimately diagnosed as PMH. Complete repigmentation was achieved with narrowband UVB phototherapy, benzoyl peroxide wash, and clindamycin lotion.
Patch testing is the standard of care for diagnosing cutaneous allergic contact dermatitis (ACD) of unknown etiology. 1 While the list of testable allergens is extensive and growing by the year, it is a small group of materials that cause the majority of ACD cases. 1 Nickel is by far the most frequently positive of the patch-tested allergens, with rates around 17.5% in ACD patients. 2 Interestingly, individuals in the general population without previously diagnosed ACD can also test positive to patch-tested allergens, indicating previously unknown sensitivities. 3 In fact, one population study out of Norway found positive patch tests in about 35% of women and 15% of men in the general population, with nickel again representing the majority of reactions. 3 The possibility of undiagnosed or subclinical allergies is the basis for patch testing prior to certain surgical procedures, especially cardiovascular, gynecologic, orthopedic, and others in which foreign body implants are placed. Patch testing has been utilized for years as a screening tool prior to orthopedic joint replacement procedures to avoid allergic complications such as cutaneous reactions, edema, and implant failure. 4 Rather than routine patch testing for all patients, however, generally only those individuals with a history of metal allergy are recommended to be patch tested before orthopedic implant surgery. 5 Interestingly, this recommendation was made
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