Jacksonville is the largest city by population in the USA state of Florida, and the largest city by area in the contiguous United States.

It is the county seat of Duval County, with which the city government consolidated in 1968. Consolidation gave Jacksonville its great size and placed most of its metropolitan population within the city limits; with an estimated population of 853,382 in 2014, it is the most populous city proper in Florida and the Southeast, and the 12th most populous in the United States.

Jacksonville is the principal city in the Jacksonville metropolitan area, with a population of 1,345,596 in 2010.

Mayo Clinic Jacksonville.

Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida.

The department is nationally recognized as a premier referral center for the treatment of spasmodic torticollis.

The Department provide patient care at the UF Health Neuroscience Institute, as well as outpatient care at UF Health Neurosciences – Emerson. They also provide pediatric neurosurgery services to Wolfson Children's Hospital.

The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida.

A study's purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care.

A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children's Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population 1).

James describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers.

In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9-2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine-Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services 2).

Aguilera AM, Wood DL, Keeley C, James HE, Aldana PR. Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida. J Neurosurg Pediatr. 2015 Oct 23:1-5. [Epub ahead of print] PubMed PMID: 26496631.
James HE. Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories. J Neurosurg Pediatr. 2016 Dec;25(6):753-757. PubMed PMID: 27589599.
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