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PURPOSE The need to rapidly implement telemedicine in primary care during the coronavirus disease 2019 (COVID-19) pandemic was addressed differently by various practices. Using qualitative data from semistructured interviews with primary care practice leaders, we aimed to report commonly shared experiences and unique perspectives regarding telemedicine implementation and evolution/maturation since March 2020. METHODS We administered a semistructured, 25-minute, virtual interview with 25 primary care practice leaders from 2 health systems in 2 states (New York and Florida) included in PCORnet, the Patient-Centered Outcomes Research Institute clinical research network. Questions were guided by 3 frameworks (health information technology evaluation, access to care, and health information technology life cycle) and involved practice leaders' perspectives on the process of telemedicine implementation in their practice, with a specific focus on the process of maturation and facilitators/barriers. Two researchers conducted inductive coding of qualitative data open-ended questions to identify common themes. Transcripts were electronically generated by virtual platform software. RESULTS Twenty-five interviews were administered for practice leaders representing 87 primary care practices in 2 states. We identified the following 4 major themes: (1) the ease of telemedicine adoption depended on both patients' and clinicians' prior experience using virtual health platforms, (2) regulation of telemedicine varied across states and differentially affected the rollout processes, (3) visit triage rules were unclear, and (4) there were positive and negative effects of telemedicine on clinicians and patients. CONCLUSIONS Practice leaders identified several challenges to telemedicine implementation and highlighted 2 areas, including telemedicine visit triage guidelines and telemedicine-specific staffing and scheduling protocols, for improvement. Key words: telemedicine; primary care; COVID-19 pandemic; East Coast; primary health care; https://doi.org/10.1370/afm.2967, INTRODUCTION The abrupt onset of the coronavirus disease 2019 (COVID-19) pandemic required a rapid implementation of telemedicine--the synchronous delivery of health care in an audio-plus-video or audio-only modality--in primary care. [...]

Purpose Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes. Methods This retrospective cohort study utilized data from the nationwide database (2006-2016) on TAA (n = 5,290) and ankle arthrodesis (n = 14,709) procedures. PNB use was defined from billing; outcomes included opioid utilization, length and cost of stay, discharge to a skilled nurse facility, and opioid-related complications. Mixed-effects models estimated the association between PNB use and outcomes, separate by procedure type and inpatient/outpatient setting. We report odds ratios and 95% confidence intervals (CI). Results Overall, PNB was utilized in 8.7% of TAA and 9.9% of ankle arthrodesis procedures, with increased utilization from 2006 to 2016 of 2.6% to 11.3% and 5.2% to 12.0%, respectively. After adjustment for relevant covariates, PNB use was significantly associated with decreased total opioid utilization specifically in the inpatient setting in TAA ( - 16.9% CI - 23.9%; - 9.1%) and ankle arthrodesis procedures ( - 18.9% CI - 24.4; - 13.0%), this was particularly driven by a decrease in opioid utilization on the day of surgery. No clinically relevant effects were observed for other outcomes. Conclusion PNB utilization is associated with substantial reductions in opioid utilization, particularly in the inpatient setting. Our study is in support of a wider use of this analgesic technique, which may translate into more benefits in terms of clinical outcomes and resource utilization. Level of Evidence III., Author(s): Jimmy J. Chan [sup.1], Evan Garden [sup.1], Jesse C. Chan [sup.1], Jashvant Poeran [sup.2], Nicole Zubizarreta [sup.2], Madhu Mazumdar [sup.2], Leesa M. Galatz [sup.1], Ettore Vulcano [sup.1] Author Affiliations: [...]

Following the 'fetal origins of adult disease' hypothesis, environmental determinants of birth weight regained interest. The authors applied a detailed spatial-time exposure model for climatological factors thought to affect fetal growth: seasonality, temperature, and sunshine. Daily climatological data (29 stations) were linked to 1,460,401 term births with an individual exposure matrix for each pregnancy. Linear regression was utilized to determine effects of climatological factors on individual birth weight and existing spatial variations in birth weight. In the Netherlands substantial regional climatological differences exist. Summer was associated with significantly reduced birth weight (16-19 g). Minimum and maximum temperatures were significantly associated with increased and reduced birth weight, respectively. Spatial birth weight differences ranged from -11 to +25 g, with lowest birth weights in inland areas. The authors demonstrate birth weight to be associated with climatological factors; negative birth weight effects of maximum temperature exposure confirm results from animal studies. Consequently, a climate footprint is visible in the spatial birth weight differences., Introduction Over 2,000 years ago, Hippocrates had already postulated effects of 'warm and cold winds, seasons, and changes in weather' on health (Hippocrates, 1978). Currently, a large body of evidence [...]