Virtual Healthcare; Its Potential and its Challenges for Population Health Management. A Systematic Search and Narrative Summary

Since the COVID-19 pandemic, virtual healthcare (VHC) experienced record expansion in availability and utilization. This new utilization of healthcare resources must be used effectively, efficiently, equitably and safely. This paper reviews data on VHC technologies to determine generally, across a broad spectrum of clinical conditions, what forms of VHC hold potential for population health management. The Medline and Cochrane Databases were systematically searched from 2015 to 2020. Qualifying publications included umbrella reviews, systematic reviews, in English, with an abstract and full text electronically available, evaluated a virtual intervention, reported a clinical outcome, with comparison groups, included statistical analyses, and used quality or risk-of-bias assessment tools in the data analysis. Study exclusion criteria included duplicate reviews, missing data, and extreme heterogeneity. Extracted data included authorship, year, database(s) searched, countries, review design, article design, articles and participants per review, purpose, article date ranges, quality and risk-of-bias tools, virtual technologies, patient characteristics, comparison methods, clinical category, outcome(s), pooled statistics, and summary findings. Ninety-three publications were narrowed to 48 publications containing 3,451 peer-reviewed articles and 2,569,614 participants evaluating dozens of virtual technologies in the care of 26 groupings of clinical conditions. The VHC outcomes of these 26 groups included 11 groups and two subgroups were superior to comparators, eight groups and two subgroups were equal to or not inferior to comparators, and six groups with one subgroup were inferior to comparators. VHC has broad clinical applications which are frequently, but not always, superior to or equal to comparators. The underpinnings of successful interventions are grounded in the technology-enabled self-management feedback loop and behavioral theory. Cost and value assessments have yet to be widely published. Social determinants may increase the risk of reduced access to VHC and should be addressed. Due to its safety, effectiveness, and scalability, VHC has significant potential for population health management

Medullary Carcinoma of the Thyroid with Bone Metastasis

A woman with medullary carcinoma of the thyroid and a past history of breast cancer was found to have metastatic bone lesions. It was initially assumed that this was due to recurrent breast carcinoma, but bone biopsy revealed medullary carcinoma of thyroid origin. Although clinical bone metastasis is a rare event in patients with medullary carcinoma, quite clearly such an occurrence is possible. Medullary carcinoma should be considered in the differential diagnosis of patients with metastatic bone lesions