The clinical management of patients with inherited metabolic disorders (IMDs) includes medical nutrition therapy (MNT) by a registered dietitian (RD). We utilized an online quantitative and qualitative survey to characterize the practices of RDs treating patients with IMDs during the COVID-19 pandemic and to identify challenges and unmet needs. We received responses from 117 RDs. Results indicate that RDs are using alternate methods to engage this vulnerable population and provide MNT during the pandemic, including offering telemedicine appointments. Barriers to implementation of telemedicine include the limitations of virtual visits (inability to conduct physical exams and collect blood samples), time, patient knowledge of technology, audio problems, and patient access to internet, computers, or smartphones. RDs have addressed these barriers by extending prescriptions without a medical exam, relying on local facilities for blood draws, increasing the number of patients that use at-home filter papers for blood monitoring, and expanding the use of phone calls and emails. RDs identified patient education materials to facilitate telemedicine visits as a primary unmet need. Despite the reported barriers and limitations of telemedicine for MNT of IMDs, there was widespread satisfaction with the approach among RDs, with 96.9% reporting that they were somewhat or very satisfied with telemedicine. Although this survey focused on barriers, benefits of telemedicine for both RDs and patients were also reported. Identification of barriers and unmet needs can help clinics plan strategies to maximize telemedicine delivery models, to improve efficiency and patient outcomes, and to support sustained use of telemedicine post-pandemic.

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revealed suboptimal adherence. Investigators developed a multitiered intervention program that included pamphlets, lecturers, and posters of the Checklist for the OR; the impact of these interventions on adherence has not been described. We hypothesized: 1) Interventions will improve Checklist adherence; and 2) Adherence is associated with positive perceptions about the Checklist and use of the Educational Interventions.Methods: Between 06/2014 and 08/2014, a serial cross sectional study design was implemented at two hospitals. Surgical observations measured verbal confirmation of the WHO Checklist's 19 steps by the appropriate surgical staff in their prescribed order ("pre-anesthesia", "pre-incision", "pre-exit from the OR"). Questionnaires were administered to surgeons, anesthesiologists, and nurses. Questionnaires assessed perceptions of the Checklist, interventions, and surgical safety. Responses were compared among surgical staff position and hospital site using ANOVA, T-test, and Chi-squared analyses.Findings: 45 surgeries were observed. Adherence to "pre-incision" Checklist items decreased significantly from 2014 to 2015 (P ¼ 0.026). The questionnaire response rate was 93%, with a total of 91 questionnaires administered. On a 1-10 scale, the mean rating of Checklist effectiveness was high, at 9.01 (SD ¼ 1.54). There was no association between adherence and Checklist perceptions or educational intervention use. Perceived unavailability of hard copies of the Checklist, lack of time and motivation to complete the Checklist were frequently identified barriers to adherence.