scholarly journals Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Maria Guarino ◽  
Valentina Cossiga ◽  
Andrea Fiorentino ◽  
Giuseppina Pontillo ◽  
Filomena Morisco
Keyword(s):  
Health Care ◽  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Care Center ◽  
Social Distancing ◽  
The Impact

BACKGROUND The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. METHODS From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

scholarly journals Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study

10.2196/20874 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e20874 ◽  
Author(s):  
Maria Guarino ◽  
Valentina Cossiga ◽  
Andrea Fiorentino ◽  
Giuseppina Pontillo ◽  
Filomena Morisco
Keyword(s):  
Health Care ◽  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Care Center ◽  
Social Distancing ◽  
The Impact

Background The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. Objective The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. Methods From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. Results During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. Conclusions Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

scholarly journals Prescribing Pattern of Drugs Used in Chronic Liver Disease with Co Morbid Conditions and Assessment of Severity using MELD Score: A Prospective Observational Study

2020 ◽  
Vol 10 (5-s) ◽  
pp. 19-24
Author(s):  
Samreen Huma ◽  
Omer Nishat Fatima ◽  
Ishrath Ayesha ◽  
Jamal Mohammed Moiz ◽  
Shareef Mohammed Mohiuddin
Keyword(s):  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Prospective Observational Study ◽  
General Medicine ◽  
Meld Score ◽  
Chronic Liver ◽  
Prognostic Impact ◽  
Prescribing Pattern ◽  
Old Patients

Objectives: To study the prescribing pattern of drugs & its use in the treatment of CLD & assess the pattern of co-morbidities associated with CLD. To Study the mortality rate of the patient using MELD score at a department of general medicine at Osmania general Hospital to produce a result which would aid better rational drug use and improve quality of life. Methodology: A Prospective, observational study was carried out at OGH for a period of 6 months in 100 old patients. Population of either sex or ≥ 18 years of age were included. Conclusion: There is a considerable scope for improving prescribing pattern in CLD by minimizing the use, reduction of doses of drugs to reduce the consequence of hepatotoxicity and Antibiotic Resistance. The prognostic impact of individual comorbidities, on the other hand, may point to areas where cirrhosis and comorbid diseases interact. Studies of individual comorbidities may therefore improve our understanding of the pathophysiology of cirrhosis. MELD showed that the subjects were less likely to get a Liver transplant. Keywords: Chronic liver disease (CLD), Model for end stage liver disease (MELD), Diabetes Mellitus (DM), hypertension (HTN)

MRI‐based risk factors of hepatocellular carcinoma in patients with chronic liver disease: A prospective observational study

2019 ◽  
Vol 51 (2) ◽  
pp. 389-396 ◽  
Author(s):  
Tatsuya Shimizu ◽  
Utaroh Motosugi ◽  
Nobutoshi Komatsu ◽  
Shintaro Ichikawa ◽  
Taisuke Inoue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Prospective Observational Study ◽  
Chronic Liver

scholarly journals A Global, Prospective, Observational Study Measuring Disease Burden and Suffering in Patients With Ulcerative Colitis, Using the Pictorial Representation of Illness and Self-measure Tool

2020 ◽  
Author(s):  
Subrata Ghosh ◽  
Tom Sensky ◽  
Francesc Casellas ◽  
Louis-Charles Rioux ◽  
Tariq Ahmad ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Observational Study ◽  
Disease Severity ◽  
Disease Burden ◽  
Prospective Observational Study ◽  
Illness Perception ◽  
Rank Correlation ◽  
Pictorial Representation ◽  
The Impact

Abstract Background The understanding the Impact of ulcerative COlitis aNd Its assoCiated disease burden on patients study [ICONIC] was a 2-year, global, prospective, observational study evaluating the cumulative burden of ulcerative colitis [UC] using the Pictorial Representation of Illness and Self-Measure [PRISM] tool that is validated to measure suffering, but has not previously been used in UC. Methods ICONIC enrolled unselected outpatient clinic attenders with recent-onset UC. Patient- and physician-reported outcomes including PRISM, the Short Inflammatory Bowel Disease Questionnaire [SIBDQ], the Patient Health Questionnaire [PHQ-9], and the Simple Clinical Colitis Activity Indexes [patient: P-SCCAI; physician: SCCAI] were collected at baseline and follow-up visits every 6 months. Correlations between these measures were assessed using Spearman’s rank correlation coefficient. Results Overall, 1804 evaluable patients had ≥1 follow-up visit. Over 24 months, mean [SD] disease severity measured by P-SCCAI/SCCAI reduced significantly from 4.2 [3.6]/3.0 [3.0] to 2.4 [2.7]/1.3 [2.1] [p <0.0001]. Patient-/physician-assessed suffering, quantified by PRISM, reduced significantly over 24 months [p <0.0001]. P-SCCAI/SCCAI and patient-/physician-assessed PRISM showed strong pairwise correlations [rho ≥0.60, p <0.0001], although physicians consistently underestimated these disease severity and suffering measures compared with patients. Patient-assessed PRISM moderately correlated with other outcome measures, including SIBDQ, PHQ-9, P-SCCAI, and SCCAI (rho = ≤-0.38 [negative correlations] or ≥0.50 [positive correlations], p <0.0001). Conclusions Over 2 years, disease burden and suffering, quantified by PRISM, improved in patients with relatively early UC. Physicians underestimated burden and suffering compared with patients. PRISM correlated with other measures of illness perception in patients with UC, supporting its use as an endpoint reflecting patient suffering.

Time to Recovery in Diabetes and Comorbidities Following Hurricane Katrina

2010 ◽  
Vol 4 (S1) ◽  
pp. S33-S38 ◽  
Author(s):  
Tina K. Thethi ◽  
C. Lillian Yau ◽  
Lizheng Shi ◽  
Sharice Leger ◽  
Prathima Nagireddy ◽  
...  
Keyword(s):  
Health Care ◽  
Hurricane Katrina ◽  
Natural Disaster ◽  
Care Delivery ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
The Impact

ABSTRACTBackground:The impact of a natural disaster on self-care and health care delivery has been well documented. The objective of the study was to document the recovery pattern from the impact of a natural disaster such as Hurricane Katrina on clinical and biochemical measures of diabetes and its comorbidities.Methods:Patients were selected from Tulane University Hospital and Clinic, Southeast Louisiana Veterans Health Care System, and the Medical Center of Louisiana at New Orleans. Adults with diabetes and A1cmeasurement 6 months before (pre-K) Hurricane Katrina (February 28, 2005–August 27, 2005) and 6 to 16 months after (post-K) Katrina (March 1, 2006–December 31, 2006) were identified within the 3 facilities. Follow-up data (January 1, 2007–December 31, 2007) were 1 year after the first post-K visit. The outcome measures were hemoglobin A1c(HbA1c), systolic and diastolic blood pressure (BP), and lipids (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], triglycerides).Results:Averaged across the 3 facilities, the parameters significantly different in the follow-up period compared with pre- and post-K were HbA1c(P= .04), HDL, and systolic and diastolic BP (P< .0001). Parameters with significantly different patterns of change in the 3 facilities over time were HbA1c, HDL, systolic and diastolic BP (P< .0001), and low-density lipoprotein (P< .01).Conclusions:Our results suggest that a variety of clinical and biochemical parameters related to diabetes and its comorbidities affected by natural disaster have varied the rate of recovery to predisaster levels.(Disaster Med Public Health Preparedness. 2010;4:S33-S38)

Polypill therapy and frailty in elderly: Time to stop treating everything

2021 ◽  
Vol 12 (4) ◽  
pp. 39-42
Author(s):  
Sunil Kumar ◽  
Parth Godhiwala ◽  
Amrutha Garikapati ◽  
Shraddha Jain
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Related Condition ◽  
Medicine Department ◽  
Risk Of Death ◽  
Age Related ◽  
One Year ◽  
The Impact

Background: Frailty is a reversible age-related condition of increased vulnerability and risk of death or unplanned hospitalization. Frailty and polypill therapy are common in elderly, although little is known about the impact, they may have on each other. Aims and Objective: The study was a prospective observational study, designed with an aim to observe the six-month and one-year outcomes of elderly patients on polypill therapy. Material and Methods: Three hundred forty-two patients aged more than 60 years on polypill treatment were enrolled in this study, which were on regular follow up in our rural hospital at geriatric units of medicine department. Results: At the end of one year, 38.1% were in severe frailty (FIRE >0.7) category, out of which death happened at the end of one year were 41.6%. 47.6% required repeated hospitalisations that were on polypill therapy. Conclusions: A reduction of polypill therapy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypill in the development, reversion or delay of frailty.

scholarly journals Analyzing the Impact of Implementing a Systems-Based Hematologist into the Healthcare Delivery System at an Academic Medical Center

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4467-4467 ◽  
Author(s):  
Charles S Greenberg ◽  
Caroline Dupre Vaughn ◽  
Alice Boylan ◽  
Jerry E Squires ◽  
Sharon DeGrace ◽  
...  
Keyword(s):  
Health Care ◽  
Liver Disease ◽  
Replacement Therapy ◽  
Chronic Liver Disease ◽  
Platelet Factor 4 ◽  
Blood Management ◽  
Platelet Factor ◽  
Academic Medical ◽  
Outpatient Settings ◽  
The Impact

Abstract There remains a clinical shortage of benign hematologists to manage the growing number of patients with non-malignant yet life-threatening and chronic blood diseases. The American Society of Hematology proposed creating System-Based Hematologist (SBH) positions to meet this need. The purpose of this study was to provide quantitative data regarding the impact that a SBH has on health care delivery in both the inpatient and outpatient settings. In 2011, the Department of Medicine successfully negotiated a Medical Directorship position for a SBH for the MUSC Health System. The position functions within the hospital as a part of the Medical Acute Critical Care Service Line, and the clinical service run by the SBH conducts inpatient consults daily. A benign hematology outpatient clinic was also established and is located on the hospital campus. In the years 2013-2014, clinic referrals of new patients grew 20% and the inpatient consult service grew by 38%. The SBH managed all hemophilia admissions from the emergency room and the use of recombinant blood products was reduced by an average of 35% per patient. The SBH evaluated the performance characteristics of the ROTEM instrument, recommended the instrument be purchased by the hospital for clinical use and collaborated to establish algorithms to guide replacement therapy. In CT Surgery, an anesthesiologist was trained in ROTEM and blood management who then served as the champion that implemented the ROTEM-based system for intra- and post- operative CABG care. From 2013 to 2014, we found that the use of FFP in CABG patients decreased from 25.8% to 12.7%. Platelet usage per patient dropped from 0.72 to 0.43. Cryoprecipitate decreased from 0.37 to 0.2 per patient. A ROTEM -based algorithm was also implemented to manage pre-procedure replacement therapy in patients with a coagulopathy from chronic liver disease. This protocol has led to reduction in fresh frozen plasma use from 3 units per patient to 0.4 units per patient, and has eliminated the use of pre-procedure INR correction as a target for promoting hemostasis. The ROTEM-guided algorithm resulted in safe and satisfactory outcomes for all liver disease patients requiring interventional procedures, as well as substantial cost savings. In addition, the SBH established a heparin-induced thrombocytopenia monitoring program. The EMR was specifically modified to provide guidance regarding calculating the 4T score and decision support for heparin-platelet factor 4 antibody testing and use of heparin alternatives. The SBH consults on patients that have positive heparin-platelet factor 4 assays and helps guide safe anticoagulation therapies in those patients that require treatment. Following the implementation of this program, serotonin release assays were reduced by 70% and there was also a substantial reduction in the use of direct thrombin inhibitors of 78%. Clinical outcomes in all patients today have been satisfactory with no major thrombotic complications apart from one patient that could not receive anticoagulation due to recent surgery, who fully recovered despite having DVT/PE. One patient that had a negative heparin platelet factor 4 assay became positive upon repeat testing and suffered arterial thrombosis that has resolved without any residual deficit. The SBH also educates medical students, interns, residents and fellows in the inpatient and outpatient settings. The addition of a nurse practitioner was necessary as the program has developed a rapid access anemia clinic to diagnose and treat pre-and post-op anemia. The MUSC SBH position is transitioning to play a role in a patient blood management program that will serve the entire healthcare network. In conclusion, this study documents a SBH can reduce cost of HITT management, blood product utilization in CABG and pre-procedure management of the coagulopathy in chronic liver disease as well as hemophilia management. The clinical services provided by the SBH in the clinics and outpatient setting can further enhance the education of students, residents and fellows in academic medical centers. The SBH must have the administrative support to initiate and implement programs through productive collaboration with colleagues within the health care system.The ASH program to encourage implementation of SBH positions and training should provide rewarding career opportunities for hematologists interested in non-malignant hematologic disorders. Disclosures No relevant conflicts of interest to declare.

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