Background:Little is known about the prevalence and nature of mobile application adoption in clinical practice.Aims: To explore current and potential mobile application use in primary care physicians (PCPs) for stroke prevention. Do PCPs recommend, use, or discuss mobile health applications for stroke preventative measures?Methods: Current PCPs in the New York City area specializing in Internal Medicine, Ob/Gyn, and Family Medicine were surveyed in person. The survey consisted of demographic questions and 11 questions on mobile application use. Results:Of the 86 physicians surveyed (53% female; mean age 37 years, SD 12), 74% (95% CI 65%, 84%) reported using mobile applications in patient care, whether for their own use or in recommending to patients. Experience was the most important determining factor, with 82% of physicians with less than 3 years practice experience using mobile apps, 78% of physicians with 3 to 10 years, 60% of physicians with 11 to 20 years, and 58% of physicians with greater than 20 years experience (p=0.045). Physicians reported using mobile applications to manage stroke risk factors 25% (95% CI 16%, 35%) of the time, while 77% (95% CI 68%, 86%) expressed interest in new apps to help their patients manage these risks. Lastly, 41% (95% CI 30%, 51%) of physicians surveyed strongly agreed that mobile applications are useful in providing patient care, while 49% (95% CI 38%, 59%) simply agreed and 0% disagreed. Conclusions:Most urban PCPs we surveyed believe that mobile applications belong in healthcare, with one in four using them to manage stroke risk factors.

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Background Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. Methods A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. Results Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic’s support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic’s integral role in allowing health services to resume in other areas of the health system following an initial lockdown. Conclusions Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic’s role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.

Introduction: Point-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes. Methods: We conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received cardiac or lung POCUS with a 12-zone protocol. Images were interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was ICU admission incidence. Secondary outcomes included intubation and supplemental oxygen usage. Results: N=160 patients (N=201 scans) were included. Scans were collected a median 23 hours (IQR:7-80) from emergency department triage. Triage POCUS findings associated with ICU admission included B-lines (OR 4.41 [95% CI:1.71-14.30]; p<0.01) or consolidation (OR 2.49 [95% CI:1.35-4.86]; p<0.01). B-lines were associated with intubation (OR 3.10 [95% CI:1.15-10.27]; p=0.02) and supplemental oxygen usage (OR 3.74 [95% CI:1.63-8.63; p<0.01). Consolidations present on triage were associated with the need for oxygen at discharge (OR 2.16 [95% CI: 1.01-4.70]; p=0.047). A normal lung triage scan was protective for ICU admission (OR 0.28 [95% CI:0.09-0.75; p<0.01) or need for supplemental oxygen during the hospitalization (OR 0.26 [95% CI:0.11-0.61]; p<0.01). Triage cardiac POCUS scans were not associated with any outcomes. Discussion: Lung POCUS findings detected early in the hospitalization may provide expedient risk stratification for important COVID-19 clinical outcomes, including ICU admission, intubation, or need for oxygen on discharge. A normal admission scan appears protective against adverse outcomes, which may aid in triage decisions of patients.

Background and Purpose: Post stroke fatigue (PSF) is a common and debilitating condition that can last months or even years. Although the relationship between PSF and Health Related Quality of Life (HRQoL) has been studied, the results have been largely inconclusive and not previously reported in a minority cohort. Hypothesis: Higher levels of PSF and Post Stroke Depression (PSD), will predict lower levels of HRQoL in African/Caribbean Blacks. Methods: Prospective, cross-sectional, observational study approved by the IRB. Patients ≥ 18 years old with a stroke in the past 3 years were enrolled. Standardized questionnaires were administered to assess the patients’ levels of PSF [Fatigue Assessment Scale (FAS)], HRQoL [Short Form-36 (SF-36)], and PSD [Beck’s Depression Inventory (BDI)]. Stroke related disability was assessed by modified Rankin Scale (mRS). Responses to the SF-36 were weighted and then averaged in accordance to standard practices. FAS, BDI, and mRS scores were dichotomized and adjusted for gender. A multiple linear regression model was constructed for the HRQoL overall score. The dichotomized FAS, BDI, and mRS scores, age and gender were considered as predictors. Results: Of 100 patients enrolled (55% female), mean age = 66.7 years ± 12.8; 93% African or Caribbean American, 86% with hypertension, 53% with diabetes, and 37% with a family history of stroke/TIA. The prevalence of stroke related disability (mRS ≥ 2) was 63%, PSF (FAS≥22) was 51%, PSD (BDI ≥11) was 24%. Both PSF and PSD was seen in 20%. The cohort’s mean SF-36 score was 51.6 ± 21.1. BDI <11 was associated with a score 9.5 units higher on the SF-36 (95% CI: 2.3-16.8, p =0.01) than BDI ≥ 11; mRS <2 was associated with 19.8 units higher score on the SF-36 (95%CI: 13.7-25.8, p<0.0001) than mRS≥2. FAS score<22 was associated with 15.0 higher HRQoL score (95%CI: 8.9-21.1, p <0.0001) than FAS≥ 22. The analysis was adjusted for gender ( p =0.10), while age ( p =0.29) was not included. BDI, mRS, FAS, and gender accounted for 56% of the variability in the HRQoL score. Conclusion: Our results suggest that both PSF and PSD are significantly correlated with a lower HRQoL. In this minority cohort, over half of post-stroke HRQoL is attributed to depression, disability, fatigue, and female gender.