Feasibility of telemedicine in the management strategy of patients with lymphoma amid the COVID-19 pandemic in Spain, a prospective study (Preprint)

2021 ◽  
Author(s):  
Raul Cordoba ◽  
Alberto Lopez-Garcia ◽  
Daniel Morillo ◽  
Maria-Angeles Perez-Saenz ◽  
Elham Askari ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Digital Health ◽  
Hematologic Malignancies ◽  
Patient Portal ◽  
Health Strategy ◽  
Potential Risk Factors ◽  
Hospital Visits ◽  
A Prospective Study ◽  
The Impact

BACKGROUND Recurrent hospital visits were potential risk factors for COVID-19 contagion. OBJECTIVE The aims of this prospective observational study was to analyze the consequences of COVID-19 pandemic in the health care of patients with lymphoma and the impact of telemedicine strategies such as the patient portal in their management. METHODS All data were obtained from the electronic medical record (EMR). Variables such as age, sex, matter of the visit, use of patient’s portal, changes in management, impact in clinical trials and suffering from COVID-19 contagion were recorded. RESULTS 290 patients were attended in the lymphoma clinic accomplishing 437 appointments. The median age was 66 years (range 18-94), and 157 (54.13%) were male. Of them, 109 out of 290 (37.58%) were aged older then 70 years. Regarding number of visits, 214 patients (73.79%) had only 1 visit to the hospital. Only 23 patients (7.93%) didn’t have access to patient’s portal. During the follow-up, only 7 patients (2.41%) suffered from COVID-19, with a median age of 66 years (51-80). CONCLUSIONS Telemedicine such as patient’s portal are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to hospital and a very low contagion rate. This experience allowed us to continue with a new digital health strategy in the follow up of patients with hematologic malignancies. CLINICALTRIAL Not registered.

Vascular anastomoses in intrauterine growth in monochorionic twins

2020 ◽  
Vol 48 (6) ◽  
pp. 539-543
Author(s):  
Michał Lipa ◽  
Przemysław Kosinski ◽  
Paweł Stanirowski ◽  
Mirosław Wielgos ◽  
Dorota Bomba-Opon
Keyword(s):  
Injection Technique ◽  
Digital Analysis ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Blood Exchange ◽  
Sharing Patterns ◽  
A Prospective Study ◽  
The Impact ◽  
Umbilical Cords

AbstractObjectivesTo evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins.MethodsA prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up.ResultsVascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins’ birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31).ConclusionsVascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.

Belastung von Patienten und Gesundheitssystem durch Pleuraverweildrainage zur Versorgung chronischer Pleuraergüsse

2019 ◽  
Vol 7 (2) ◽  
pp. 84-85
Author(s):  
Axel Tobias Kempa
Keyword(s):  
Length Of Hospital Stay ◽  
Chest Drain ◽  
Long Term Outcomes ◽  
Talc Pleurodesis ◽  
In Situ Methods ◽  
Hospital Visits ◽  
The Impact

Background: Indwelling pleural catheters (IPC) offer an alternative to talc pleurodesis in recurrent effusion, especially in patients wishing to avoid hospitalization. Two randomized trials have demonstrated reduced time in hospital using IPCs versus talc pleurodesis in malignant pleural effusion (MPE). However, the impact of IPCs on hospital services and patients has not been well studied. Objectives: To analyze long-term outcomes of IPCs and understand the hospital burden in terms of requirement for hospital visits and contacts with healthcare, while the IPC was in situ. Methods: IPC insertions in a tertiary pleural center were analyzed retrospectively. Reviews of patients with IPCs in situ considered «additional» to routine clinical follow-up were defined pre-hoc. Results: A total of 202 cases were analyzed: 89.6% MPE group (n = 181) and 10.4% non-MPE group (n = 21). There were a median 3.0 (interquartile range [IQR] 3) and 2.0 (IQR 2) ipsilateral pleural procedures prior to each IPC insertion in non-MPE and MPE groups, respectively (p = 0.26), and a mean 1.3 (SD 1.7) planned IPC-related outpatient follow-up visits per patient. There were 2 (9.5%) and 14 (7.7%) IPC-related infections in non-MPE and MPE groups, respectively. Four (19.0%) and 44 (24.3%) patients required additional IPC-related reviews in non-MPE and MPE groups, respectively (p = 0.6), and these occurred within 250 days post IPC insertion. Conclusions: Although IPCs decrease initial length of hospital stay compared to talc pleurodesis via chest drain, IPCs are associated with significant hospital-visit burden, in addition to planned visits and regular home IPC drainages. IPC-using services need to be prepared for this additional work to run an IPC service effectively.

P5307A consumer-direct digital health intervention for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised controlled trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Redfern ◽  
T Usherwood ◽  
G Coorey ◽  
J Mulley ◽  
A Scaria ◽  
...  
Keyword(s):  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Control Group ◽  
Physically Active ◽  
Ehealth Literacy ◽  
Health Strategy ◽  
Randomised Controlled ◽  
And Control

Abstract Background Digital health interventions linked to electronic health records offer patients an innovative approach to support cardiovascular disease (CVD) risk management. Purpose Test the effectiveness of a consumer-directed digital health strategy on medication adherence and cardiovascular health outcomes in patients presenting to primary care who are at moderate to high risk of CVD. Methods Randomised controlled trial (RCT) with 12 month follow-up. Intervention group received an interactive digital health strategy for CVD management. The intervention was integrated with patient's electronic health record to enable automated population of risk factor and medication data (Figure). Control group received usual care. Primary outcome was the proportion of patients taking guideline-recommended BP and cholesterol-lowering medications on at least 80% of days (administrative data). Secondary outcomes included mean SBP, LDL-cholesterol, BMI and proportion meeting risk targets for physical activity, achieving smoking cessation, quality of life (EQ5D) and ehealth literacy (eHEALS). Results Intervention (n=486) and control (n=448) groups were well matched at baseline (Table). Mean age of participants was 67±8.1 years, 77% were male, 41% had existing CVD. At 12 months, there was no significant difference between the groups for medication days covered or mean cholesterol and BP (Table). However, there were significantly more patients in the intervention than control group who were physically active and had high ehealth literacy (Table). Table 1. Primary and Secondary Outcomes Baseline 12 months Outcome Control (n=448) Intervention (n=486) Control (n=431) Intervention (n=460) p value* Taking BP and cholesterol medication on ≥80% of days, % 29.7 28.9 29.9 32.8 0.485 SBP (mmHg), mean±SD 139.0±16.6 137.3±15.9 136.3±16.1 136.4±17.6 0.921 LDL (mmol/L), mean±SD 2.6±1.0 2.6±1.0 2.5±0.9 2.4±1.0 0.240 BMI (kg/m2), mean±SD 29.7±5.1 29.9±5.7 29.4±5.0 29.7±5.7 0.508 Proportion achieving BP and LDL target, % 11.2 12.3 11.7 16.5 0.065 Physically active, % 84.0 85.4 79.7 87.0 0.016 Current smoker, % 12.9 13.0 12.0 8.1 0.087 eHEALS, mean±SD 27.0±6.4 27.0±6.4 26.4±7.5 28.3±6.3 0.002 *Comparing intervention and control at 12 month follow-up. Conclusions The integrated digital health strategy did not significantly impact on days of medication covered however, patients in the intervention had higher physical activity and ehealth literacy. The RCT highlights the importance of conducting robust research if we are to understand the potential value of digital health interventions. Acknowledgement/Funding This work was supported by a Project Grant from the National Health and Medical Research Council of Australia

scholarly journals The impact of meningitis on the motor function of adult survivors in Harare, Zimbabwe

1999 ◽  
Vol 55 (1) ◽  
pp. 6-10
Author(s):  
Jennifer Jelsma ◽  
Helen Lilley ◽  
Helen Smith ◽  
Jens Mielke ◽  
James Hakim ◽  
...  
Keyword(s):  
Functional Disability ◽  
Functional Limitation ◽  
Adult Survivors ◽  
Stepwise Logistic Regression ◽  
Motor Impairments ◽  
Forward Stepwise ◽  
The One ◽  
A Prospective Study ◽  
The Impact

Objective: The study aimed to document the spectrum of motor impairments and the degree of functional limitation of those who survived adult meningitis and to identify which factors were associated with a poor functional outcome and mortality.Methods: A prospective study was undertaken in the central hospitals in Harare, Zimbabwe. Twenty six adult patients who had survived meningitis were interviewed between one and five months post-admission. Seventeen of these were examined in the clinic for signs of impairment. Nine did not attend the follow-up session and were interviewed at home. The Barthel Activities of Daily Living Index (BI) was administered to all twenty six subjects.Results: Twenty subjects were HIV sero-positive. Eight subjects died in the time period between the one month interview and the final follow-up five months later. The majority of the seventeen examined in the clinic, demonstrated sensory and motor disturbances. Seven of the twenty six subjects scored eighteen or less on the BI. Forward stepwise logistic regression revealed that a low BI was the only variable which significantly predicted mortality (p.<0.01). The odds of a patient with a low BI dying were 63 times the odds of a patient dying who had a normal BI.Discussion and Conclusions: Survivors of meningitis in this study displayed a diversity of impairments and disabilities. Rehabilitation intervention is recommended to provide functional reeducation and support for those with a low BI and to mitigate against the effects of the impairments. A measure of functional disability should be included in the examination of these clients as functional impairment appears to be a predictor of mortality.

Assessing disparities in engagement in a post-discharge virtual visit follow-up program.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 100-100
Author(s):  
Abdullateef Abdulkareem ◽  
Nathan Handley ◽  
Samantha Burdette ◽  
Adam Binder
Keyword(s):  
Socioeconomic Status ◽  
Language Proficiency ◽  
English Language ◽  
Urban Setting ◽  
Transitions Of Care ◽  
Area Deprivation ◽  
Patient Portal ◽  
Post Discharge ◽  
The Impact

100 Background: Transitions of care are a frequent focus of quality improvement initiatives. In attempt to improve upon the transitions of care for oncology patients, our institution implemented a post discharge virtual visit follow-up program. Previous studies have suggested that socioeconomic status impacts engagement in technology based interventions. Herein, we report the impact of socio-economic status based on area deprivation index (ADI) on engagement with the program. Methods: All patients admitted to the elective chemotherapy service were included. Retrospective analysis of characteristics of each participant was conducted. Data included eligibility (access to the internet, appropriate device, English language proficiency, ability to set up video visit and a patient portal account) for video visit, interest in participating, completion of the visit and any interventions performed during the visit. In addition, ADI was calculated for each individual. Patients were classified into quartiles based on ADI (quartiles increased with ADI). Chi squared testing was performed to assess whether socioeconomic status affected enrollment in video visits. Simple descriptive analysis was also performed. Results: One hundred seven unique patients were included for review. Of these, 33 (31%), 39 (36%), 16 (15%) and 19 (18%) were in quartile(Q) 1, 2, 3 and 4 respectively. Eligibility per quartile was 29 (88%), 34(87%), 13(81%), and 15(83%). ADI quartile did not significantly affect virtual visit eligibility (p = .50). A total of 91 patients (85%) were eligible for video visits; of these, 46 patients declined. Of the 46 patients that declined 9 (19%), 20 (43%), 8 (17%), and 9 (19%) were in Q1, Q2, Q3 and Q4 respectively. Fifteen patients cited technology issues as reasons for declining telehealth visits - 10 (67%) from Q1 and Q2 and 5 (33%) from Q3 and Q4. The vast majority cited lack of interest as reason for declining. Conclusions: ADI as a measure of socioeconomic status did not significantly affect eligibility for or enrollment in video visits. This may be explained by more ubiquitous access to internet services in a large urban setting. Current research is currently being conducted to understand patient barriers to engagement in virtual visits.

scholarly journals The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

2021 ◽  
Vol 64 (5) ◽  
pp. 16-20
Author(s):  
Alina Malic ◽  
◽  
Evelina Lesnic ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Prospective Study ◽  
Treatment Effectiveness ◽  
Similar Rate ◽  
Control Group ◽  
Diabetic Patients ◽  
A Prospective Study ◽  
Prospective Longitudinal ◽  
The Impact

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

scholarly journals Antipsychotic treatment, psychoeducation & regular follow up as a public health strategy for schizophrenia: Results from a prospective study

2017 ◽  
Vol 146 (1) ◽  
pp. 34 ◽  
Author(s):  
ChannaveerachariNaveen Kumar ◽  
Jagadisha Thirthalli ◽  
KudumalligeK Suresha ◽  
BasappaK Venkatesh ◽  
Udupi Arunachala ◽  
...  
Keyword(s):  
Public Health ◽  
Prospective Study ◽  
Antipsychotic Treatment ◽  
Public Health Strategy ◽  
Health Strategy ◽  
A Prospective Study

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 Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0243804
Author(s):  
Anne Sverdrup Efjestad ◽  
Hege Ihle-Hansen ◽  
Vidar Hjellvik ◽  
Knut Engedal ◽  
Hege Salvesen Blix
Keyword(s):  
Age Groups ◽  
Acetylcholinesterase Inhibitors ◽  
Prescription Database ◽  
Prescription Pattern ◽  
Before And After ◽  
Norwegian Prescription Database ◽  
Total Prescription ◽  
A Prospective Study ◽  
The Impact

Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

SP5.1.1 The harsh reality of a long waiting list for bariatric surgery, a prospective study regarding health-related quality of life (HRQoL) among morbid obese patients following bariatric surgery versus those on a waiting list, a two-year follow-up study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jose Rodicio ◽  
María Moreno ◽  
Tamara Vico ◽  
Emilio Negrete ◽  
Covadonga Valdés ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Bariatric Surgery ◽  
Bodily Pain ◽  
Waiting List ◽  
Emotional Role ◽  
A Prospective Study ◽  
The Impact

Abstract Aims The aims of this study were to assess the changes in HRQoL during the 2 years follow-up between patients who underwent surgery and those on a long waiting list . Methods Between January to December 2017, 70 surgical patients and 69 patients on the waiting list were interviewed at baseline, 12-month and 24-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL) questionnaires. Socio-demographics, clinical, and surgical-related variables were collected. Results 139 patients were analyzed, with similar baseline characteristics. Analyzing the entire sample: the higher the BMI, the worse the scores in the IWQoL. Performing more qualified work improves several aspects of the SF-12v2. In contrast, patients with depression tended to score worse on all dimensions of both questionnaires, women scored worse on the Self-Esteem domain and men improved on the Mental Health one. At 12 and 24-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P&lt;.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically differences among Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary domains (P&lt;.05) at 12 months, but differences were not found at 24 months. Conclusions The quality of life of patients undergoing bariatric surgery is normalized one year after surgery, while patients on the waiting list get worse. Knowing the benefits of bariatric surgery, working on programs with long waiting lists should move us to fight against an unfair and unacceptable situation.

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