scholarly journals Maintaining access to maternal fetal medicine care by telemedicine during a global pandemic

2020 ◽  
pp. 1357633X2095746
Author(s):  
Andrea D Shields ◽  
Richard K Wagner ◽  
Dana Knutzen ◽  
Shad Deering ◽  
Peter E Nielsen
Keyword(s):  
Medical Treatment ◽  
Medical Decision ◽  
Full Time ◽  
The Novel ◽  
Treatment Model ◽  
Maternal Fetal Medicine ◽  
Fetal Medicine ◽  
Conventional Medical Treatment ◽  
Novel Coronavirus

Objective This study aims to compare a conventional medical treatment model with a telehealth platform for Maternal Fetal Medicine (MFM) outpatient care during the global novel coronavirus pandemic. Methods In this study, we described the process of converting our MFM clinic from a conventional medical treatment model to a telemedicine platform. We compared clinical productivity between the two models. Outcomes were analysed using standard statistical tests. Results We suffered three symptomatic COVID-19 infections among our clinical providers and staff prior to the conversion, compared with none after the conversion. We had a significant decrease in patient visits following the conversion (53.35 visits per day versus 40.3 visits per day, p < 0.0001). However, our average daily patient visits per full-time equivalent (FTE) were only marginally reduced (11.1 visit per FTE versus 7.6 visits per FTE, p < 0.0001), resulting in a relative decrease in adjusted work relative value units (6987 versus 5440). There was an increase in more basic follow-up ultrasound procedures, complexity (current procedural technology [CPT] code 76816 (10.7% versus 19.5%, relative risk [RR] 1.81, 95% CI 1.60–2.05, p < 0.0001)) over comprehensive follow-up ultrasound procedures, CPT code 76805 (17.2% versus 7.8%, RR 0.46, 95% CI 0.39–0.53, p < 0.0001) after conversion. Despite similar proportions of new consults, there was an increase in the proportion of follow-up visits and medical decision-making complexity evaluation and management CPT codes (e.g. 99214/99215) after the conversion (17.2% versus 24.6%, RR 1.43, 95% CI 1.26–163, p < 0.0001). There were no differences between amniocentesis procedures performed between the two time periods (0.3% versus 0.2%, p = 0.5805). Conclusion The rapid conversion of an MFM platform from convention medical treatment to telemedicine platform in response to the novel coronavirus pandemic resulted in protection of healthcare personnel and MFM patients, with only a modest decrease in clinical productivity during the initial roll-out. Due to the ongoing threat from the novel coronavirus-19, an MFM telemedicine platform is a practicable and innovative solution and merits the continued support of CMS and health care administrators.

scholarly journals SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Luise Schulte ◽  
José Diego Brito-Sousa ◽  
Marcus Vinicius Guimarães Lacerda ◽  
Luciana Ansaneli Naves ◽  
Eliana Teles de Gois ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Federal District ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
The Novel ◽  
Prevention Measures ◽  
Laboratory Findings ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

scholarly journals Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 749-753
Author(s):  
Wenyuan Li ◽  
Beibei Huang ◽  
Qiang Shen ◽  
Shouwei Jiang ◽  
Kun Jin ◽  
...  
Keyword(s):  
The Novel ◽  
Chain Reaction ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Oxygen Inhalation ◽  
New Strategy ◽  
Polymerase Chain ◽  
Novel Coronavirus ◽  
Specific Symptoms

Abstract In recent months, the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis with takeover more than 1 million lives worldwide. The long-lasting existence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not yet been reported. Herein, we report a case of SARS-CoV-2 infection with intermittent viral polymerase chain reaction (PCR)-positive for >4 months after clinical rehabilitation. A 35-year-old male was diagnosed with COVID-19 pneumonia with fever but without other specific symptoms. The treatment with lopinavir-ritonavir, oxygen inhalation, and other symptomatic supportive treatment facilitated recovery, and the patient was discharged. However, his viral PCR test was continually positive in oropharyngeal swabs for >4 months after that. At the end of June 2020, he was still under quarantine and observation. The contribution of current antivirus therapy might be limited. The prognosis of COVID-19 patients might be irrelevant to the virus status. Thus, further investigation to evaluate the contagiousness of convalescent patients and the mechanism underlying the persistent existence of SARS-CoV-2 after recovery is essential. A new strategy of disease control, especially extending the follow-up period for recovered COVID-19 patients, is necessary to adapt to the current situation of pandemic.

scholarly journals Understanding if, How, and Why Women with Prior Spontaneous Preterm Births are Treated with Progestogens: A National Survey of Obstetrician Practice Patterns

2018 ◽  
Vol 08 (04) ◽  
pp. e315-e324
Author(s):  
Jack Gallagher ◽  
Jennifer Gudeman ◽  
Kylee Heap ◽  
Joy Vink ◽  
Susan Carroll
Keyword(s):  
Eligible Patient ◽  
Preterm Births ◽  
Physician Education ◽  
Maternal Fetal Medicine ◽  
Fetal Medicine ◽  
Vaginal Progesterone ◽  
Hydroxyprogesterone Caproate ◽  
Representative Random Sample ◽  
Nationally Representative

Objective In 2017, the Society for Maternal-Fetal Medicine (SMFM) Guideline Committee reaffirmed that 17α-hydroxyprogesterone caproate (17-OHPC) to prevent preterm birth (PTB) is underutilized. We sought to determine what drove progestogen treatment choice of obstetricians managing pregnant women with histories of 1+ singleton spontaneous PTBs (< 37 weeks) who then delivered singleton gestations within the previous 12 months. Subjects We recruited a nationally representative random sample of obstetricians to abstract medical records of study-qualified patients. Of the 423 study-qualified physicians contacted, 358 (85%) participated; 56 (16%) maternal fetal medicine specialists and 302 (84%) general obstetrician/gynecologists (OB/GYNs) extracted data from 991 eligible patient charts. Results Almost three-fourths of patients (73.6%) were treated with 17-OHPC; 18.6% received vaginal progesterone, and 11.8% were not treated. Key drivers of physicians' choice to (1) prescribe branded 17-OHPC were “FDA (Food and Drug Administration) approval” (52% relative influence [RI]) and “SMFM guidelines” (24% RI); (2) prescribe vaginal progesterone were “ease of administration” (32% RI) and “shortened cervix” (16% RI); and (3) not provide prophylaxis were “patient not informed of risk” (35% RI) and “no shortened cervix” (29% RI). Conclusion Study findings support SMFM's contention of continued 17-OHPC underutilization to prevent PTB. Need for additional physician education merits assessment along with appropriate follow-up actions.

scholarly journals Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 584
Author(s):  
Decsa Medika Hertanto ◽  
Henry Sutanto ◽  
Soebagijo Adi
Keyword(s):  
Diabetic Nephropathy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
The Novel ◽  
Functional Impairments ◽  
Left Posterior ◽  
Novel Coronavirus ◽  
Peripheral Artery Diseases ◽  
Leg Amputation

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

scholarly journals Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care

Heart ◽  
2020 ◽  
Vol 106 (20) ◽  
pp. 1549-1554 ◽  
Author(s):  
Benoy Nalin Shah ◽  
Dominik Schlosshan ◽  
Hannah Zelie Ruth McConkey ◽  
Mamta Heena Buch ◽  
Andrew John Marshall ◽  
...  
Keyword(s):  
Heart Valve ◽  
Waiting Times ◽  
Severe Disease ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
The Novel ◽  
Future Care ◽  
Novel Coronavirus

The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict ‘normal’ practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic—such as increased use of virtual clinics—should be further developed and evaluated.

scholarly journals The Online Education Mode and Reopening Plans for Chinese Schools During the COVID-19 Pandemic: A Mini Review

2020 ◽  
Vol 8 ◽  
Author(s):  
Xuanzhen Cen ◽  
Dong Sun ◽  
Ming Rong ◽  
Gusztáv Fekete ◽  
Julien S. Baker ◽  
...  
Keyword(s):  
Online Education ◽  
Prevention And Control ◽  
World Health ◽  
Classroom Teaching ◽  
Full Time ◽  
The Novel ◽  
The World ◽  
Novel Coronavirus ◽  
Health Organization ◽  
And Control

Recently, an unprecedented coronavirus pandemic has emerged and has spread around the world. The novel coronavirus termed COVID-19 by the World Health Organization has posed a huge threat to human safety and social development. This mini review aimed to summarize the online education mode and plans for schools to resume full-time campus study in China during COVID-19. Chinese schools have made significant contributions to the prevention and control of the transmission of COVID-19 by adopting online learning from home. However, normal opening and classroom teaching have been affected. For education systems at all levels, online education may be an effective way to make up for the lack of classroom teaching during the epidemic. To protect staff and students from COVID-19, the timing of students returning to full-time campus study needs to be considered carefully. Reviewing and summarizing of the Chinese education system's response to the virus would be of great value not only in developing educational policy but also in guiding other countries to formulate educational countermeasures.

scholarly journals Case Report: Disposition of Symptomatic Probable COVID-19

2020 ◽  
Vol 4 (3) ◽  
pp. 336-339
Author(s):  
Aleq Jaffery ◽  
John Slakey ◽  
David Zodda ◽  
Douglas Finefrock
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Distress Syndrome ◽  
Healthcare Providers ◽  
The Novel ◽  
Moderate Risk ◽  
Risk Of Progression ◽  
Novel Coronavirus ◽  
Tools And Techniques

Introduction: The novel coronavirus disease 2019 (COVID-19) presents a challenge for healthcare providers in terms of diagnosis, management, and triage of cases requiring admission. Case Report: A 47-year-old male with symptoms suspicious for COVID-19, pulse oximetry of 93% on room air, and multifocal pneumonia was risk stratified and safely discharged from the emergency department (ED) despite having moderate risk of progression to acute respiratory distress syndrome. He had resolution of his symptoms verified by telephone follow-up. Conclusion: Various risk-stratifying tools and techniques can aid clinicians in identifying COVID-19 patients who can be safely discharged from the ED.

scholarly journals Predicting the Impact of COVID-19 on Australian Universities

2020 ◽  
Vol 13 (9) ◽  
pp. 188 ◽  
Author(s):  
Arran Thatcher ◽  
Mona Zhang ◽  
Hayden Todoroski ◽  
Anthony Chau ◽  
Joanna Wang ◽  
...  
Keyword(s):  
International Student ◽  
Department Of Education ◽  
Full Time ◽  
The Novel ◽  
Full Time Equivalent ◽  
Policy Makers ◽  
Education Industry ◽  
Novel Coronavirus ◽  
The Impact ◽  
Australian Universities

This article explores the impact of the novel coronavirus (COVID-19) upon Australia’s education industry with a particular focus on universities. With the high dependence that the revenue structures of Australian universities have on international student tuition fees, they are particularly prone to the economic challenges presented by COVID-19. As such, this study considers the impact to total Australian university revenue and employment caused by the significant decline in the number of international students continuing their studies in Australia during the current pandemic. We use a linear regression model calculated from data published by the Australian Government’s Department of Education, Skills, and Employment (DESE) to predict the impact of COVID-19 on total Australian university revenue, the number of international student enrolments in Australian universities, and the number of full-time equivalent (FTE) positions at Australian universities. Our results have implications for both policy makers and university decision makers, who should consider the need for revenue diversification in order to reduce the risk exposure of Australian universities.

scholarly journals Coronaphobia in patients with fibromyalgia

2021 ◽  
Author(s):  
Sevinç Külekçioğlu ◽  
Merve Akyüz ◽  
Özenç İnan ◽  
Alp Çetin
Keyword(s):  
Fibromyalgia Syndrome ◽  
Control Group ◽  
The Novel ◽  
Locomotor System ◽  
Global Pandemic ◽  
Study Results ◽  
Group 2 ◽  
Novel Coronavirus ◽  
Group 1

Objectives: This study aims to evaluate the level of coronaphobia caused by the novel coronavirus disease 2019 (COVID-19) pandemic in patients with fibromyalgia syndrome (FMS) and to compare the results in patients without FMS. Patients and methods: Between August 2020 and October 2020, a total of 61 patients who were admitted to our outpatient clinic were included. The patients were divided into two groups as Group 1 (n=30; 2 males, 28 females; mean age: 43.2±9.3 years; range, 21 to 61 years) consisting of patients who were newly diagnosed or under follow-up for FMS and Group 2, the control group, (n=31; 4 males, 27 females; mean age: 49±10.7 years; range, 25 to 66 years) consisting patients who presented with any locomotor system complaint and were not diagnosed with FMS. Sociodemographic data of the patients and comorbidities were recorded. All the patients in both groups completed the COVID-19 Phobia Scale (C19P-S). Results: The C19P-S total score and psychological, psychosomatic, social, and economic subscale scores were statistically significantly higher in the FMS group than the control group (p<0.05). Conclusion: Our study results suggest that FMS patients have more concerns in this extraordinary global pandemic situation. Early detection of coronaphobia and timely psychological support are critical for individuals prone to psychological disorders, such as FMS.

scholarly journals Application of scenario type of simulation training in the context of distance learning for doctors obstetricians-gynecologists

2021 ◽  
Vol 1 (3) ◽  
pp. 120-121
Author(s):  
L. V. Kaushanskaya ◽  
A. A. Bychkov ◽  
A. A. Frolov ◽  
M. P. Lelik ◽  
M. V. Astanina ◽  
...  
Keyword(s):  
Medical Education ◽  
Distance Learning ◽  
Simulation Training ◽  
Educational Programs ◽  
Educational Process ◽  
Full Time ◽  
The Novel ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Epidemiological Situation

 The pandemic of the novel coronavirus infection (COVID-2019) has brought significant changes to the learning process, in particular to the process of continuing medical education. The use of distance education methods has significantly helped to reduce the growth of the incidence rate, contributed to the implementation of educational programs in full. In connection with the increase in the proportion of the vaccinated population, the process of transition of the educational process to full-time mode is possible. But in order to maintain a favorable epidemiological situation, some part of the educational process can remain in a remote form.

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