Equity in Telemedicine for Older Adults During the Covid-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Weihong Kuang ◽  
Guojun Zeng ◽  
Yunbo Nie ◽  
Yan Cai ◽  
Jin Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Paradigm Shift ◽  
Drug Prescription ◽  
Rapid Change ◽  
Policy Makers ◽  
West China Hospital ◽  
West China ◽  
Effective Strategies ◽  
Online Treatment ◽  
Treatment Disparities

UNSTRUCTURED The COVID-19 pandemic spurred unprecedented progress on a paradigm shift to telemedicine to limit exposure to the virus. Telemedicine has many benefits. In the West China Hospital of Sichuan University, we use it to do COVID-19 related tele-educations to health professionals and general population, tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, at our practices, we are noticing that many older adults could not make appointment with doctors due to their difficulty using the internet-based platform. We worried that older adults who need healthcare the most are not well prepared for this rapid change. We need to pay attention to avoid causing treatment disparities for vulnerable older adults 60 years of age and over. Researchers and policy makers should work together to study effective strategies and make proper policies to mitigate barriers older adults face when using telemedicine.

scholarly journals Equity in telemedicine for older adults during the COVID-19 pandemic

2021 ◽  
Author(s):  
Weihong Kuang ◽  
Guojun Zeng ◽  
Yunbo Nie ◽  
Yan Cai ◽  
Jin Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Professionals ◽  
Paradigm Shift ◽  
Drug Prescription ◽  
The Internet ◽  
Careful Attention ◽  
The West ◽  
West China Hospital ◽  
West China ◽  
Online Treatment

Abstract The coronavirus disease 2019 (COVID-19) pandemic has spurred an unprecedented paradigm shift to telemedicine across healthcare fields in order to limit exposure to the virus. At the West China Hospital of Sichuan University, telemedicine has been used to perform COVID-19-related tele-education to health professionals and the general population, as well as tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, many older adults could not make appointments with doctors due to difficulty using the internet-based platform. Careful attention needs to be paid by future researchers and policymakers in order to mitigate barriers older adults face when using telemedicine.

West China Hospital Back Pain Treatment Measures

2010 ◽  
Author(s):  
Ernest Volinn ◽  
Bangxiang Yang ◽  
Jing He ◽  
Xiaoming Sheng ◽  
Jian Ying ◽  
...  
Keyword(s):  
Back Pain ◽  
Pain Treatment ◽  
West China Hospital ◽  
West China ◽  
Treatment Measures

scholarly journals Severe hypernatremia in children after surgical resection of hepatic echinococcosis: a rare and potentially fatal complication

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kewei Li ◽  
Yijun Liu ◽  
Xiaolong Xie ◽  
Rongxing Zhou ◽  
Bo Xiang
Keyword(s):  
Alveolar Echinococcosis ◽  
Disease Free Survival ◽  
West China Hospital ◽  
Free Survival ◽  
West China ◽  
Neurologic Sequelae ◽  
Scolicidal Agent ◽  
Hepatic Echinococcosis ◽  
Disease Free

Abstract Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.

scholarly journals Changes in Tobacco Use Patterns during COVID-19 and Their Correlates among Older Adults in Bangladesh

2021 ◽  
Vol 18 (4) ◽  
pp. 1779
Author(s):  
Sabuj Kanti Mistry ◽  
Armm Mehrab Ali ◽  
Md. Ashfikur Rahman ◽  
Uday Narayan Yadav ◽  
Bhawna Gupta ◽  
...  
Keyword(s):  
Older Adults ◽  
Tobacco Use ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Policy Makers ◽  
Use Patterns ◽  
Telephone Interviews ◽  
Related Information ◽  
Structured Questionnaire

The present study explored the changes in tobacco use patterns during the COVID-19 pandemic and their correlates among older adults in Bangladesh. This cross-sectional study was conducted among 1032 older adults aged ≥60 years in Bangladesh through telephone interviews in October 2020. Participants’ characteristics and COVID-19-related information were gathered using a pretested semi-structured questionnaire. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic (6 months prior to the survey). Nearly half of the participants (45.6%) were current tobacco users, of whom 15.9% reported increased tobacco use during the COVID-19 pandemic and all others had no change in their tobacco use patterns. Tobacco use was significantly increased among the participants from rural areas, who had reduced communications during COVID-19 compared to pre-pandemic (OR = 2.76, 95%CI:1.51–5.03). Participants who were aged ≥70 years (OR = 0.33, 95% CI: 0.14–0.77), widowed (OR = 0.36, 95% CI: 0.13–1.00), had pre-existing, non-communicable, and/or chronic conditions (OR = 0.44, 95% CI: 0.25–0.78), and felt themselves at the highest risk of COVID-19 (OR = 0.31, 95% CI: 0.15–0.62), had significantly lower odds of increased tobacco use. Policy makers and practitioners need to focus on strengthening awareness and raising initiatives to avoid tobacco use during such a crisis period.

scholarly journals Upholding the EU's Commitment to ‘Animal Testing as a Last Resort' Under REACH Requires a Paradigm Shift in How We Assess Chemical Safety to Close the Gap Between Regulatory Testing and Modern Safety Science

2021 ◽  
pp. 026119292110408
Author(s):  
Julia Fentem ◽  
Ian Malcomber ◽  
Gavin Maxwell ◽  
Carl Westmoreland
Keyword(s):  
European Commission ◽  
Paradigm Shift ◽  
Modern Science ◽  
Transformational Change ◽  
Weight Of Evidence ◽  
Animal Testing ◽  
Chemical Safety ◽  
Policy Makers ◽  
Safety Science ◽  
Animal Safety

Animal use for testing chemicals under REACH continues to increase, despite advances in non-animal safety science during the past 15 years. The application of modern science and technology, and the use of ‘next generation’ weight-of-evidence assessment approaches, are embedded in EU guidance for establishing the safety of cosmetics and foods – and of the ingredients used in these products. However, this is still not the case for the regulation of chemicals. Under the new Chemicals Strategy for Sustainability, thought leaders in human health and environmental protection are calling on the European Commission to quickly embrace the benefits of modern and innovative non-animal safety science, in place of outdated animal testing, if the EU is to be a leader in safe and sustainable innovation under the European Green Deal transformational change ambitions. The European Commission also needs to enable companies to meet their legal obligation to only conduct animal testing as a last resort, by providing a more flexible, science-based and consistent regulatory framework for assuring chemical safety, which supports the integration of data from different sources. We are at a tipping point for closing the gap between regulatory chemicals testing and modern safety science. It is time to join forces, across policy makers, scientists, regulators and lawyers, to lead the paradigm shift needed to deliver what EU citizens want – namely, chemicals and products that are safe and sustainable, without resorting to animal testing.

scholarly journals Cascaded Segmentation Network based on Double Branch Boundary Enhancement

2021 ◽  
Author(s):  
Li Zeng ◽  
Hongqiu Wang ◽  
Xin Wang ◽  
Miao Tian ◽  
Shaozhi Wu
Keyword(s):  
Cervical Cancer ◽  
Region Of Interest ◽  
Target Volume ◽  
Single Image ◽  
Cancer Dataset ◽  
West China Hospital ◽  
West China ◽  
Common Causes ◽  
Model Computer ◽  
Deep Learning Model

Cervical cancer is one of the most common causes of cancer death in women. During the treatment of cervical cancer, it is necessary to make a radiation plan based on the clinical target volume (CTV) on the CT image. At present, CTV is manually sketched by physicists, which is time-consuming and laborious. With the help of deep learning model, computer can accurately draw the outline of CTV in Colleges and universities. The CDBNet proposed in this paper is a cascaded segmentation network based on double-branch boundary enhancement. First, classification network determines whether a single image contains a region of interest (ROI), and then the segmentation network uses DBNet to segment more accurately at the ROI contour. In this paper, we propose CDBNet, a cascaded segmentation network based on doublebranch boundary enhancement. First, classification network determines whether a single image contains a region of interest (ROI), and then the segmentation network uses DBNet to segment more accurately at the ROI contour. The CDBNet proposed in this paper was verified on the cervical cancer dataset provided by the Department of Radiation Oncology, West China Hospital, Sichuan Province. The average dice and 95HD of the delineation results are 86.12% and 2.51mm. At the same time, the classification accuracy rate of whether the image contains ROI can reach 93.19%, and the average Dice of the image containing ROI can reach 70%.

scholarly journals Safety and Efficacy of Neostigmine Against Residual Neuromuscular Blockade in Pediatric Patients During Recovery From General Anesthesia: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Hongyang Chen ◽  
Lei Yang ◽  
Zining Wang ◽  
Di Yang ◽  
Weiyi Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Oxygen Saturation ◽  
Pediatric Patients ◽  
Neuromuscular Block ◽  
Length Of Hospital Stay ◽  
West China Hospital ◽  
West China ◽  
Medical Expenses ◽  
Residual Neuromuscular Block ◽  
Endotracheal Extubation

Abstract Introduction: with the wide application of muscle relaxants in clinic, the anesthesiologists pay more and more attention to the residual neuromuscular block. While the pediatric patients have poor tolerance to hypoxia, compared to adult patients, the residual neuromuscular block do more harm to them in recovery period of anesthesia, such as respiratory failure, hypoxia, asphyxia and even death. In order to reduce the risk of the residual neuromuscular block complications, we design the following regression cohort study to conform the safety and effectiveness of routine use of neostigmine after operation.Methods: This study was a retrospective cohort study (ChiCTR1900028048), approved by the ethics committee of West China Hospital, Sichuan University. We reviewed pediatric patients who received surgical treatment in West China Hospital, Sichuan University from January 1, 2018 to September 30, 2019.The exposure factor was the use of neostigmine during the period of anesthesia recovery. Inclusion criteria: the pediatric surgery department patients who underwent general anesthesia in West China Hospital, Sichuan University. Exclusion criteria: cases without medical electronic records; Cases with missing outcome data; No muscle relaxants were used during general anesthesia. The outcomes included: lowest pulse oxygen saturation after endotracheal extubation; incidence of hypoxemia after endotracheal extubation; in-hospital mortality; length of hospital stay; medical expenses. IBM SPSS Statistics 23.0 software was used for statistical analysis.1:1 propensity score matching was used to eliminate the influence of confounding factors. For continuous variables, student t test was used . For categorical variables, the chi-square test was used. The results were considered statistically significant, if p value < 0.05. Subgroup analysis was performed according to the age (<2 years / 3-5 years or >6 years) and the dose of neostigmine (low dose group <=0.02mg/kg or high dose group >0.02mg/kg).Results: A total of 4358 pediatric patients were included. After 1:1 propensity score matching, 1820 pediatric patients were included for statistical analysis. In-hospital mortality (1/910 vs 0/910, p = 0.32), lowest pulse oxygen saturation after endotracheal extubation (98.90±3.05 vs 98.78±3.48, p = 0.43), incidence of hypoxemia after endotracheal extubation (23/910 vs 21/910, p=0.76), length of hospital stay (5.66±6.11 vs 5.88±6.59, p= 0.46), and medical expenses (17967.04±21325.86 vs 17406.96±18358.17, p=0.55) showed no significantly statistical differences between the pediatric patients with or without neostigmine application to reverse the neuromuscular blockade during anesthesia recovery. Subgroup analysis found no significant associations between the outcomes and age of the patients or the dose of neostigmine.Conclusion: For pediatric patients, neostigmine application to reverse the neuromuscular blockade was not significantly associated with in hospital mortality, lowest pulse oxygen saturation after endotracheal extubation, incidence of hypoxemia after endotracheal extubation, medical expenses, or length of hospital stay. However, as some confounding factors cannot be eliminated in this retrospective study, the results of this study are needed to be confirmed by future prospective studies.Trial registration: Medical records based study for the recovery effect of antagonitst of muscle relaxant in pediatric patients, ChiCTR1900028048, Registered 8 September 2019, https://www.chictr.org.cn/showproj.aspx?proj=46686

scholarly journals Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital

2020 ◽  
Vol 3 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Jun Zhang ◽  
Weili Wu ◽  
Xin Zhao ◽  
Wei Zhang
Keyword(s):  
Crisis Intervention ◽  
Psychological Intervention ◽  
Psychological Impact ◽  
Psychological Problems ◽  
Internet Technology ◽  
Social Psychological ◽  
West China Hospital ◽  
West China ◽  
Face To Face ◽  
Novel Coronavirus

Abstract The novel coronavirus pneumonia (COVID-19) epidemic has brought serious social psychological impact to the Chinese people, especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions. To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic, we developed a new psychological crisis intervention model by utilizing internet technology. This new model, one of West China Hospital, integrates physicians, psychiatrists, psychologists and social workers into Internet platforms to carry out psychological intervention to patients, their families and medical staff. We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.

scholarly journals The Expression of Snail, Galectin-3, and IGF1R in the Differential Diagnosis of Benign and Malignant Pheochromocytoma and Paraganglioma

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Liling Deng ◽  
Tao Chen ◽  
Huan Xu ◽  
Yuanmei Li ◽  
Mingyan Deng ◽  
...  
Keyword(s):  
Survival Time ◽  
Tumor Tissue ◽  
Malignant Pheochromocytoma ◽  
Positive Staining ◽  
West China Hospital ◽  
West China ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Galectin 3 ◽  
Potentially Malignant

Objective. The aim of this study was to investigate the expression of Snail, galectin-3, and IGF1R in benign and malignant pheochromocytoma and paraganglioma (PPGL) and explore their role in the diagnosis of malignant PPGL. Methods. We retrospectively collected and analyzed surgical tumor tissue from 226 patients initially diagnosed with PPGL who underwent surgery from Jan. 2009 to Jan. 2016 at West China Hospital, Sichuan University. We observed and quantified the expression of Snail, galectin-3, and IGF1R in paraffin-embedded samples by immunohistochemical staining. Results. The significant difference in survival time among the three groups (benign PHEO, benign PGL, and potentially malignant PPGL) was compared by Kaplan-Meier survival analysis. The positive staining of Snail, galectin-3, and IGF1R in the benign PHEO group was significantly lower than that in the other three groups (P<0.001). The Kaplan-Meier survival plots indicated that the survival time of the patients with intense positive staining was significantly lower than that of the patients with weak positive staining. Conclusion. The intense expression of Snail, galectin-3, and IGF1R may be valuable indicators for the diagnosis of malignant PPGL.

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