Stanford University School of Medicine| Doctor of Medicine '22+
University of Massachusetts, Amherst | Master of Public Policy '18
Smith College| BA in Biological Sciences '17
Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation.
Journal of medical Internet research
2022; 24 (8): e38792
BACKGROUND: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination-dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap.OBJECTIVE: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care.METHODS: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients.RESULTS: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic's capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19-related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient's own.CONCLUSIONS: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers' preferences.
View details for DOI 10.2196/38792
View details for PubMedID 35921146
The Intergenerational Health Effects of the Deferred Action for Childhood Arrivals Program on Families With Mixed Immigration Status
2022; 22 (5): 729-735
View details for Web of Science ID 000877504000005
Update on Cutaneous Signs to Assist in the Diagnosis of Dermatomyositis.
Current rheumatology reports
PURPOSE OF REVIEW: Dermatomyositis (DM) is a heterogeneous idiopathic inflammatory myopathy that can be challenging to diagnose. Learning about the cutaneous manifestations in DM can assist with prompt diagnosis as well as subgroup classification. This review highlights recent data regarding cutaneous signs in DM and their associations with myositis-specific antibodies (MSAs).RECENT FINDINGS: Several novel DM skin signs have recently been reported. Novel and confirmatory data have helped to define more clearly the associations between various cutaneous manifestations and MSAs. Awareness of the diverse cutaneous phenotypes can help with the timely diagnosis of DM. As some MSAs are associated with atypical skin features and/or characteristic patterns of clinical findings, knowledge of these associations can help clinicians to recognize DM patients. Understanding how the prevalence and presentation of various cutaneous signs differ among ethnically diverse patients is a high priority for further study.
View details for DOI 10.1007/s11926-022-01070-w
View details for PubMedID 35404005
Clubfoot Activity and Recurrence Exercise Study (CARES).
Journal of pediatric orthopedics
2022; 42 (1): e91-e96
BACKGROUND: Approximately half of treated clubfoot patients initially corrected with the Ponseti method experience relapse that requires additional treatment. The consequences of relapse on childhood activity levels have not been well studied. Ponseti noted lower functional ratings at 18-year follow-up in clubfoot patients who had undergone tibialis anterior tendon transfer for relapse.METHODS: Clubfoot Activity and Recurrence Exercise study (CARES) is an observational, prospective cohort study that compares physical activity in 30 clubfoot patients without and with relapse. Eligible participants were 5 to 10 years old, diagnosed with idiopathic clubfoot at birth, and had not received any clubfoot treatment for at least 6 months before study. Recruitment for this study occurred in-person and through Facebook clubfoot groups. Consented participants wore Fitbits secured to their wrists for at least 14 days, and completed a demographic survey, Child Health Questionnaire (CHQ), and the clubfoot disease-specific instrument (CDSI). Participants' daily activity was monitored through Fitabase.RESULTS: Participants without and with clubfoot relapse had similar daily step counts, distance walked, and step intensities, except for moderately active step intensity, which was higher in the clubfoot relapse group. Total steps, total distance, distances (very active, moderately active), minutes (very active, fairly active), and lightly active intensity of steps were significantly higher for participants whose families earn more than $100,000 per year. Various physical activities and sports were reported by both groups in daily activity sheets. Neither demographics nor the CDSI or the CHQ scores significantly differed between the 2 groups. Step counts of children with clubfoot with or without relapse were similar to published levels for healthy children.CONCLUSION: Children with clubfoot initially treated with the Ponseti method who undergo treatment for relapse have comparable physical activity to those who have not relapsed. They also have comparable step counts to that of the general pediatric population. These reassuring findings can guide conversations with parents when addressing concerns regarding their children's physical activity after treatment for relapse of clubfoot deformity.LEVEL OF EVIDENCE: Level II-therapeutic studies-investigating the results of treatment.
View details for DOI 10.1097/BPO.0000000000001973
View details for PubMedID 34889836
The Intergenerational Health Effects of the DACA Program on Families With Mixed Immigration Status.
Children of undocumented mothers with Deferred Action for Childhood Arrivals (DACA) have better mental health outcomes than children of DACA-ineligible mothers. This study explored the intergenerational health effects of DACA on undocumented parents and their children in families with mixed immigration status.Forty-eight semi-structured interviews were selected from a study on life transitions of fifty undocumented immigrants. Prevalent themes related to the intergenerational health effects of DACA on undocumented immigrants were identified through thematic analysis of the transcripts, and quotes were selected to illustrate themes in the participants' own words.Thirty-three of the fourty-eight respondents were DACA recipients. Twenty-six respondents were parents with a total of 61 children, 73.8% of whom were U.S-born. Four themes were identified: 1) DACA recipients reported decreased familial stress because of protection from deportation and increased access to health care, 2) both DACA and DACA-ineligible parents prioritized regular pediatrician visits for their children, but DACA-ineligible parents suffered from poor health because of decreased access to health care, 3) adults with DACA mirror the health behaviors of their DACA-ineligible parents, and 4) the poor health access of DACA-ineligible family members appeared to stress DACA recipients and U.S-born children in these families.DACA decreases children's fear of parental deportation and loss. However, the suffering of DACA-ineligible parents and family members may stress their children and influence their health-seeking behavior in adulthood. Health care access for all members of immigrant families needs to be examined, since their well-being impacts the well-being of their children.
View details for DOI 10.1016/j.acap.2021.07.016
View details for PubMedID 34320415
- Ghida, EL-Banna, et al. "Clubfoot Activity and Recurrence Exercise Study (CARES)." Journal of Pediatric Orthopaedics (2021). Ghida, EL-Banna, et al. "Clubfoot Activity and Recurrence Exercise Study (CARES)." Journal of Pediatric Orthopaedics (2021). 2021
Arthrodesis of the Foot or Ankle in Adult Patients with Congenital Clubfoot.
2019; 11 (12): e6505
Background Although clubfoot that was corrected in childhood rarely recurs in adulthood, persistent deformities or arthritic pain may require further treatment during adulthood. Little evidence exists on the operative procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood, for residual or recurrent deformity or pain. Objective The objective of this study is to characterize the types and frequencies of procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood. Methods A two-pronged approach was employed to describe the operative procedures used in adult clubfoot patients. First, a literature review of all reported cases of operative treatment in adult clubfoot patients who were previously treated in childhood was performed. Second, an analysis of the operative treatments used in adult patients with a diagnosis of congenital clubfoot was conducted using a large, administrative claims database. Results In the literature review, arthrodesis was the most cited operative treatment and reported in four out of the eight studies included. Osteotomies were also reported in the literature. In the database analysis, 94 hindfoot arthrodesis procedures were identified in 73 patients, out of 1,198 adult patients in the database with a diagnosis of congenital clubfoot. Sixty-two patients out of 1,198 adult clubfoot patients received osteotomies. An insufficient number of total ankle arthroplasties were reported for further analysis. Conclusions Operative treatment in adult clubfoot patients who were treated for congenital clubfoot in childhood includes hindfoot arthrodesis and osteotomy procedures. Total ankle arthroplasty has not been reported in the literature for these patients.
View details for DOI 10.7759/cureus.6505
View details for PubMedID 32025426
View details for PubMedCentralID PMC6988724
Nanoscale "fluorescent stone": Luminescent Calcium Fluoride Nanoparticles as Theranostic Platforms
2016; 6 (13): 2380–93
Calcium Fluoride (CaF2) based luminescent nanoparticles exhibit unique, outstanding luminescent properties, and represent promising candidates as nanoplatforms for theranostic applications. There is an urgent need to facilitate their further development and applications in diagnostics and therapeutics as a novel class of nanotools. Here, in this critical review, we outlined the recent significant progresses made in CaF2-related nanoparticles: Firstly, their physical chemical properties, synthesis chemistry, and nanostructure fabrication are summarized. Secondly, their applications in deep tissue bio-detection, drug delivery, imaging, cell labeling, and therapy are reviewed. The exploration of CaF2-based luminescent nanoparticles as multifunctional nanoscale carriers for imaging-guided therapy is also presented. Finally, we discuss the challenges and opportunities in the development of such CaF2-based platform for future development in regard to its theranostic applications.
View details for DOI 10.7150/thno.15914
View details for Web of Science ID 000396551600009
View details for PubMedID 27877242
View details for PubMedCentralID PMC5118602
Upconverting NIR Photons for Bioimaging
2015; 5 (4): 2148–68
Lanthanide-doped upconverting nanoparticles (UCNPs) possess uniqueanti-Stokes optical properties, in which low energy near-infrared (NIR) photons can beconverted into high energy UV, visible, shorter NIR emission via multiphoton upconversionprocesses. Due to the rapid development of synthesis chemistry, lanthanide-doped UCNPscan be fabricated with narrow distribution and tunable multi-color optical properties. Theseunique attributes grant them unique NIR-driven imaging/drug delivery/therapeuticapplications, especially in the cases of deep tissue environments. In this brief review, weintroduce both the basic concepts of and recent progress with UCNPs in material engineeringand theranostic applications in imaging, molecular delivery, and tumor therapeutics. The aimof this brief review is to address the most typical progress in basic mechanism, materialdesign as bioimaging tools.
View details for DOI 10.3390/nano5042148
View details for Web of Science ID 000367615500033
View details for PubMedID 28347113
View details for PubMedCentralID PMC5304770