Andrew J. Weaver, Jenalee Corsello, P. Chirico, M. Cooper
Pulmonary sequestration is a rare congenital abnormality that is often diagnosed in childhood. There are two types of sequestration which are differentiated by the presence, or lack of, pleural lining dividing the aberrant lung tissue from the functional lung. Data for the management of this pathology in adults remains scarce. Here we present a case of intralobar pulmonary sequestration in an adult. The management of this patient comprised of surgical treatment involving lobectomy and ligation of the feeding vessel. The patient had an uneventful recovery, and the final pathology revealed a chronic infection in the sequestration.
{"title":"A Rare Case of Right Lower Lobe Intralobar Pulmonary Sequestration in an Adult","authors":"Andrew J. Weaver, Jenalee Corsello, P. Chirico, M. Cooper","doi":"10.33470/2379-9536.1339","DOIUrl":"https://doi.org/10.33470/2379-9536.1339","url":null,"abstract":"Pulmonary sequestration is a rare congenital abnormality that is often diagnosed in childhood. There are two types of sequestration which are differentiated by the presence, or lack of, pleural lining dividing the aberrant lung tissue from the functional lung. Data for the management of this pathology in adults remains scarce. Here we present a case of intralobar pulmonary sequestration in an adult. The management of this patient comprised of surgical treatment involving lobectomy and ligation of the feeding vessel. The patient had an uneventful recovery, and the final pathology revealed a chronic infection in the sequestration.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katharina Mitchell, C. Crigger, Tyler L Overholt, T. Trump, J. Barnard, O. Al-Omar, Hilary Morley
Dysfunctional voiding (DV) affects approximately 40% of patients populating pediatric urology clinics. We administered the Dysfunctional Voiding Symptom Score [DVSS] survey and dehydration severity chart (Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. We compiled 29 DV patients (ages 3-15, 20 females, 9 males, 29 Caucasian) and 21 non-urologic patients (ages 2-17, 11 males, 10 females, 1 Hispanic, 1 African American, 20 Caucasian) from 2016 to 2018. The DV population had significantly higher scores in 7/ 10 items within the DVSS and overall scores compared to non-urologic patients p < 0.05, p = 0.0004 respectively. This suggests the DVSS results yield significantly different results among DV and non-DV patients.
{"title":"Dysfunctional Voiding: Does a validated urine color scale correlate with dysfunctional voiding severity score?","authors":"Katharina Mitchell, C. Crigger, Tyler L Overholt, T. Trump, J. Barnard, O. Al-Omar, Hilary Morley","doi":"10.33470/2379-9536.1344","DOIUrl":"https://doi.org/10.33470/2379-9536.1344","url":null,"abstract":"Dysfunctional voiding (DV) affects approximately 40% of patients populating pediatric urology clinics. We administered the Dysfunctional Voiding Symptom Score [DVSS] survey and dehydration severity chart (Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. We compiled 29 DV patients (ages 3-15, 20 females, 9 males, 29 Caucasian) and 21 non-urologic patients (ages 2-17, 11 males, 10 females, 1 Hispanic, 1 African American, 20 Caucasian) from 2016 to 2018. The DV population had significantly higher scores in 7/ 10 items within the DVSS and overall scores compared to non-urologic patients p < 0.05, p = 0.0004 respectively. This suggests the DVSS results yield significantly different results among DV and non-DV patients.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43595689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Clinicians are increasingly relying on genetic testing to pinpoint definite diagnoses. A more general diagnosis of neuropathy or neuromuscular disease like myopathy can be narrowed down substantially using genetic testing. Because carrier status is of utmost importance in reproductive matters, pathogenic results can prognosticate the future course of the illness and help plan ahead for treatment and social supports. Given the expense of genetic testing, it is important to assess the cost-benefit ratio to determine whether it is worthwhile to collect genetic samples. The purpose of the study was to determine the likelihood of obtaining a conclusive confirmatory diagnosis through genetic testing (measured as the percent of positive results obtained out of all the submitted samples). Methods: A single clinician’s record of genetic test outcomes was reviewed spanning four years from July 2015 to June 2019 to identify those who had submitted genetic samples to Invitae, a commercial lab in California that offers affordable genetic testing. All patients were evaluated for complaints of neuromuscular and neuropathic nature using the standard of care workup that included a physical exam, lab tests, nerve conduction study (NCS), electromyography (EMG), and/or muscle biopsy before sending out for genetic testing. The positive, negative, and indeterminate genetic diagnoses were tabulated, and the individual disease entities’ prevalence was determined. results: Of the patients who participated in genetic testing, 96 were diagnosed with neuropathic conditions and 59 with neuromuscular conditions. The patients’ health records did not have to be mined for results because the clinician’s Invitae account contained de-identified requisition numbers linked to their results. The patients in the neuromuscular group had twice as many positive results as those in the neuropathic group. There were about three times as many normal results in the neuropathic group compared to the neuromuscular group. Around half of all test samples showed indeterminate results containing variants of unknown significance (VOUS), which were not indicative of any pathology and were considered inconclusive. conclusion: Based on the study findings, there were 17.7% and 35.6% positive (meaning pathogenic) results, respectively, among neuropathic and neuromuscular cases sent off for genetic analysis. While 38 out of 155 total cases makes up a small, 24.5% yield of abnormal results, genetic studies are still a worthwhile addition to investigating neuropathic and neuromuscular cases.
{"title":"Utility and yield of genetic testing leading to a definitive neuromuscular or neuropathic diagnosis at a rural outpatient neurology clinic affiliated with a university health center in West Virginia over 4 years.","authors":"Holly Farkosh, Dominika Lozowska","doi":"10.33470/2379-9536.1345","DOIUrl":"https://doi.org/10.33470/2379-9536.1345","url":null,"abstract":"Background: Clinicians are increasingly relying on genetic testing to pinpoint definite diagnoses. A more general diagnosis of neuropathy or neuromuscular disease like myopathy can be narrowed down substantially using genetic testing. Because carrier status is of utmost importance in reproductive matters, pathogenic results can prognosticate the future course of the illness and help plan ahead for treatment and social supports. Given the expense of genetic testing, it is important to assess the cost-benefit ratio to determine whether it is worthwhile to collect genetic samples. The purpose of the study was to determine the likelihood of obtaining a conclusive confirmatory diagnosis through genetic testing (measured as the percent of positive results obtained out of all the submitted samples). Methods: A single clinician’s record of genetic test outcomes was reviewed spanning four years from July 2015 to June 2019 to identify those who had submitted genetic samples to Invitae, a commercial lab in California that offers affordable genetic testing. All patients were evaluated for complaints of neuromuscular and neuropathic nature using the standard of care workup that included a physical exam, lab tests, nerve conduction study (NCS), electromyography (EMG), and/or muscle biopsy before sending out for genetic testing. The positive, negative, and indeterminate genetic diagnoses were tabulated, and the individual disease entities’ prevalence was determined. results: Of the patients who participated in genetic testing, 96 were diagnosed with neuropathic conditions and 59 with neuromuscular conditions. The patients’ health records did not have to be mined for results because the clinician’s Invitae account contained de-identified requisition numbers linked to their results. The patients in the neuromuscular group had twice as many positive results as those in the neuropathic group. There were about three times as many normal results in the neuropathic group compared to the neuromuscular group. Around half of all test samples showed indeterminate results containing variants of unknown significance (VOUS), which were not indicative of any pathology and were considered inconclusive. conclusion: Based on the study findings, there were 17.7% and 35.6% positive (meaning pathogenic) results, respectively, among neuropathic and neuromuscular cases sent off for genetic analysis. While 38 out of 155 total cases makes up a small, 24.5% yield of abnormal results, genetic studies are still a worthwhile addition to investigating neuropathic and neuromuscular cases.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43816424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Arora, Krystyna Bronchard, M. Murphy, Stephen J. Peterson
In March of 2020, life as we knew it changed in a series of seemingly insurmountable challenges. The inpatient medicine ward of New York-Presbyterian Brooklyn Methodist Hospital (NYPBMH), a large Weill Cornell Medicine university hospital located in Park Slope, New York, is a high volume and high acuity institution. On March 5th, 2020, the hospital confirmed its first case of Covid-19 pneumonia. From that day on, the number of Covid-19 hospitalizations grew exponentially, and by mid-April, the hospital peaked at 403 admitted positive patients with nearly 110 on mechanical ventilation. We completed 356 COVID swabs in March with 207 positive results, a 58% positivity rate. In April, we completed 468 swabs with 232 positive results, a 49% positivity rate. This number fell to 10% in May as individuals isolated.
{"title":"How One NYC Hospital Handled the Covid-19 Pandemic- The Chief Residents’ Perspective","authors":"S. Arora, Krystyna Bronchard, M. Murphy, Stephen J. Peterson","doi":"10.33470/2379-9536.1353","DOIUrl":"https://doi.org/10.33470/2379-9536.1353","url":null,"abstract":"In March of 2020, life as we knew it changed in a series of seemingly insurmountable challenges. The inpatient medicine ward of New York-Presbyterian Brooklyn Methodist Hospital (NYPBMH), a large Weill Cornell Medicine university hospital located in Park Slope, New York, is a high volume and high acuity institution. On March 5th, 2020, the hospital confirmed its first case of Covid-19 pneumonia. From that day on, the number of Covid-19 hospitalizations grew exponentially, and by mid-April, the hospital peaked at 403 admitted positive patients with nearly 110 on mechanical ventilation. We completed 356 COVID swabs in March with 207 positive results, a 58% positivity rate. In April, we completed 468 swabs with 232 positive results, a 49% positivity rate. This number fell to 10% in May as individuals isolated.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43057877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Franks, Makala Murphy, Madison Griffis, Rebekah Franks, Colin M. Franks, G. Petty
Alpha-gal allergy, or mammalian meat allergy, is described as the development of IgE antibodies to the oligosaccharide galactose-a-1,3-galactose following a bite from the tick species Amblyomma americanum (Lone Star tick) or Dermacentor variabilis (Wood tick). Dermatologic or gastrointestinal symptoms are usually delayed by four to six hours after exposure, making the diagnosis difficult. Due to the use of mammalian proteins in many common medications, surgical equipment, and prosthesis, unexpected reactions can occur. In the United States, this pathology is predominately seen in the southeast but has been associated with other tick species on every continent except Antarctica. As the habitat for Amblyomma and Dermacentor continues to move further north due to changing patterns in deer population and weather, the incidence of alpha-gal syndrome has increased in the states outside its normal southeastern locale, especially in people with occupations and hobbies that require time outdoors in wooded areas.
α-半乳糖过敏，或称哺乳动物肉类过敏，是指在被蜱类美洲安氏蜱（Lone Star tick）或可变皮蜱（Dermacentor variabilis）叮咬后，产生针对低聚糖半乳糖-1,3-半乳糖的IgE抗体。皮肤病或胃肠道症状通常在暴露后延迟四至六小时，使诊断变得困难。由于哺乳动物蛋白质在许多常见的药物、手术设备和假体中的使用，可能会发生意想不到的反应。在美国，这种疾病主要发生在东南部，但除南极洲外，其他大陆的蜱虫物种都与这种疾病有关。由于鹿的种群和天气模式的变化，Amblyomma和Dermacentor的栖息地继续向北移动，在东南部正常地区以外的州，阿尔法-加尔综合征的发病率有所增加，尤其是那些有职业和爱好的人，需要在林区户外活动。
{"title":"Alpha-Gal Allergy: a new threat to Appalachia","authors":"A. Franks, Makala Murphy, Madison Griffis, Rebekah Franks, Colin M. Franks, G. Petty","doi":"10.33470/2379-9536.1348","DOIUrl":"https://doi.org/10.33470/2379-9536.1348","url":null,"abstract":"Alpha-gal allergy, or mammalian meat allergy, is described as the development of IgE antibodies to the oligosaccharide galactose-a-1,3-galactose following a bite from the tick species Amblyomma americanum (Lone Star tick) or Dermacentor variabilis (Wood tick). Dermatologic or gastrointestinal symptoms are usually delayed by four to six hours after exposure, making the diagnosis difficult. Due to the use of mammalian proteins in many common medications, surgical equipment, and prosthesis, unexpected reactions can occur. In the United States, this pathology is predominately seen in the southeast but has been associated with other tick species on every continent except Antarctica. As the habitat for Amblyomma and Dermacentor continues to move further north due to changing patterns in deer population and weather, the incidence of alpha-gal syndrome has increased in the states outside its normal southeastern locale, especially in people with occupations and hobbies that require time outdoors in wooded areas.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45551886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shauna Assadzandi, E. Crocetti, Courtney S. Pilkerton, A. Ashcraft, C. Shrader
B ackground : Due to the combination of age, comorbidities, and close living quarters, residents at long-term care facilities (LTCFs) are at particularly high risk of severe symptoms and death due to COVID-19. M ethods : This cross-sectional study examines the relationship between demographic characteristics, symptom severity, and length of viral shedding in 49 residents testing positive for SARS-CoV-2 at a LTCF in West Virginia (WV). r esults : Over half of the residents were asymptomatic, while nearly a quarter experienced severe symptoms. Women were more likely to be asymptomatic, and age was not associated with symptom severity. While no specific medical condition was associated with symptom severity, having more chronic illnesses was associated. The length of time from initially positive to PCR negative ranged from 2 to 63 days, with an average of 29 days. c onclusion : Given the variability in PCR testing reliability, 30 days of isolation and two consecutive negative PCR tests are recommended before reintegrating residents.
{"title":"COVID-19 Disease and Viral Characteristics in a Long-Term Care Facility","authors":"Shauna Assadzandi, E. Crocetti, Courtney S. Pilkerton, A. Ashcraft, C. Shrader","doi":"10.33470/2379-9536.1341","DOIUrl":"https://doi.org/10.33470/2379-9536.1341","url":null,"abstract":"B ackground : Due to the combination of age, comorbidities, and close living quarters, residents at long-term care facilities (LTCFs) are at particularly high risk of severe symptoms and death due to COVID-19. M ethods : This cross-sectional study examines the relationship between demographic characteristics, symptom severity, and length of viral shedding in 49 residents testing positive for SARS-CoV-2 at a LTCF in West Virginia (WV). r esults : Over half of the residents were asymptomatic, while nearly a quarter experienced severe symptoms. Women were more likely to be asymptomatic, and age was not associated with symptom severity. While no specific medical condition was associated with symptom severity, having more chronic illnesses was associated. The length of time from initially positive to PCR negative ranged from 2 to 63 days, with an average of 29 days. c onclusion : Given the variability in PCR testing reliability, 30 days of isolation and two consecutive negative PCR tests are recommended before reintegrating residents.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42400223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital medicine is the country’s fastest growing medical specialty. The role of hospitalists has evolved greatly in the past few decades. Hospitalists have become the quarterbacks in the effort to fight against the COVID-19 pandemic. The pandemic has brought about a transformational change to the practice of Hospital Medicine.
{"title":"Hospitalists Stare down the COVID-19 Pandemic","authors":"Sutoidem Akpanudo","doi":"10.33470/2379-9536.1349","DOIUrl":"https://doi.org/10.33470/2379-9536.1349","url":null,"abstract":"Hospital medicine is the country’s fastest growing medical specialty. The role of hospitalists has evolved greatly in the past few decades. Hospitalists have become the quarterbacks in the effort to fight against the COVID-19 pandemic. The pandemic has brought about a transformational change to the practice of Hospital Medicine.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41819396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous pneumothorax is a rare but potentially life-threatening condition during pregnancy. We discuss a case of recurrent spontaneous pneumothorax during a single pregnancy. The pneumothorax occurred twice during the pregnancy in the second and third trimesters. Both pneumothoraxes were managed conservatively as due to the low prevalence of this condition, management guidelines are few. We report our management of recurrent spontaneous pneumothorax during pregnancy to support the literature and current guidelines.
{"title":"Recurrent Spontaneous Pneumothorax During Pregnancy; A Case Report","authors":"Andrew J. Weaver, Wai-kin Hau, M. Cooper","doi":"10.33470/2379-9536.1312","DOIUrl":"https://doi.org/10.33470/2379-9536.1312","url":null,"abstract":"Spontaneous pneumothorax is a rare but potentially life-threatening condition during pregnancy. We discuss a case of recurrent spontaneous pneumothorax during a single pregnancy. The pneumothorax occurred twice during the pregnancy in the second and third trimesters. Both pneumothoraxes were managed conservatively as due to the low prevalence of this condition, management guidelines are few. We report our management of recurrent spontaneous pneumothorax during pregnancy to support the literature and current guidelines.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49288302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients. We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. Early in the pandemic, telemedicine visits increased for those with chronic respiratory and cardiovascular issues, anxiety, and depression. Patient and physician feedback was positive, and time required averaged 12 to 18 minutes. The cost savings from the 15% of telemedicine patients who would have otherwise sought urgent or emergency care is significant, and almost 45% would have still made an appointment later, further risking exposure and increasing outpatient volume. In this sense, telemedicine could be considered to have “flattened the curve” for potentially overwhelmed outpatient facilities just as mitigation interventions were implemented to do the same for acute inpatient beds. We share our experience for consideration by those who will implement a similar transition and those who choose to advocate for continuing payment and platform flexibility. We also hope that residency training requirements can adapt to consider a telemedicine visit comparable to one completed in-person.
{"title":"Mr. Watson, come here-I want to see you: One rural residency program’s rapid pivot to telemedicine during the pandemic","authors":"W. Crump, Diana M Nims, D. Hatler","doi":"10.33470/2379-9536.1314","DOIUrl":"https://doi.org/10.33470/2379-9536.1314","url":null,"abstract":"Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients. We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. Early in the pandemic, telemedicine visits increased for those with chronic respiratory and cardiovascular issues, anxiety, and depression. Patient and physician feedback was positive, and time required averaged 12 to 18 minutes. The cost savings from the 15% of telemedicine patients who would have otherwise sought urgent or emergency care is significant, and almost 45% would have still made an appointment later, further risking exposure and increasing outpatient volume. In this sense, telemedicine could be considered to have “flattened the curve” for potentially overwhelmed outpatient facilities just as mitigation interventions were implemented to do the same for acute inpatient beds. We share our experience for consideration by those who will implement a similar transition and those who choose to advocate for continuing payment and platform flexibility. We also hope that residency training requirements can adapt to consider a telemedicine visit comparable to one completed in-person.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42899370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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