Patient Reported Experience of Clinical Care of Osteogenesis Imperfecta (OI) During The COVID-19 Pandemic

Background Research on the effects of the COVID-19 pandemic on people with rare diseases is limited. Few studies compare healthcare throughout the progression of the ongoing pandemic.Aims To assess the impact of lockdown on individuals with OI (Osteogenesis Imperfecta) across two consecutive years of the pandemic, to understand what challenges were encountered, and to analyse the experience of remote consultation.Methods Two independent surveys were distributed in August 2020 and April 2021. The primary survey was distributed following the first lockdown, and the second survey built on the experiences reported from the initial survey. The surveys explored four key themes- effects on therapy, alternatives to consultation, effect on mental health, and perceived risks of COVID-19.Results In the primary 2020 survey of the 110 respondents 69 (63%) had at least one appointment delayed due to lockdown, increasing to 89 of the 124 respondents (72%) in the follow-up survey. Of the 110 initial survey participants, 57 (52%) had a remote consultation, increasing to 92 of 124 (74%) in the follow-up survey. In the primary survey 63 of 91 (69%) expressed increasing anxiety due to lockdown, compared with 76 of 124 (61%) in the follow-up survey. In the primary survey 12 of 91 respondents (13%) expressed concerns at not seeing friends and family compared with 103 of 124 (83%) in the follow-up survey. In the second survey of 124 participants there were concerns regarding weight and diet (55, 44%), mobility (70, 56%), pain (71, 57%), and keeping physically active (89, 72%). The majority of participants felt they would have a worse illness and require longer rehabilitation than someone without OI (81 of 117 respondents, and 77 of 120 respectively), and the majority of participants (68%) had been vaccinated at the time of the second survey.Conclusions The pandemic has had widespread effects on both the mental and physical health of those with OI. These repercussions are likely to be felt for years to come. On the other hand, the pandemic has also revealed that in certain situations remote consultation may prove a viable long-lasting alternative to face-to-face appointments.

Telessaúde como ferramenta organizacional da rede de atenção à saúde

Objetivos: analisar as evidências científicas sobre a telessaúde como uma ferramenta para expansão e melhoria da Rede de Atenção à Saúde (RAS). Método: revisão integrativa da literatura, realizada, entre maio e junho de 2020, nas bases de dados National Library of Medicine (Pubmed), Centro Latino-Americano e do Caribe de Informações em Ciências da Saúde (BVS) e pelo Portal Periódicos CAPES/MEC. Utilizou-se os descritores: Telemedicina; telessaúde; remote consultation. Das 98 publicações identificadas, a amostragem foi de 10 artigos. Resultados: Os principais desafios foram: econômicos, sociais e institucionais. As potencialidades foram a reorganização dos serviços de saúde para garantir o acesso à população facilitando a teleconsulta no cenário da pandemia e a redução de custos. Conclusão: A articulação com as Políticas Públicas é ferramenta para expansão e reorganização da telessaúde na RAS para garantir acesso e continuidade do cuidado em tempos de pandemia, porém a implementação nos serviços é o maior desafio.

A Systematic Review of Telemedicine for Older Adults With Dementia During COVID-19: An Alternative to In-person Health Services?

Introduction: Older adults with dementia have been significantly at more risk for not receiving the care needed and for developing further mental health problems during COVID-19. Although the rise in telemedicine adoption in the healthcare system has made it possible for patients to connect with their healthcare providers virtually, little is known about its use and effects among older adults with dementia and their mental health.Objective: This systematic review aimed to explore the use, accessibility, and feasibility of telemedicine in older adults with dementia, as well as examine the potential mental health impacts of these technologies, through reviewing evidence from studies conducted during COVID-19.Methods: PubMed, Scopus, and Web of Science databases were searched with the following keywords: (COVID* OR SARS-CoV-2 OR Coronavirus) AND (“mental health” OR Depression OR Stress) AND (Dementia OR Multi-Infarct Dementia OR Vascular Dementia OR Frontotemporal Dementia) AND (elder OR Aging OR Aging OR Aged) AND (Telemedicine OR “Remote Consultation” OR telehealth OR technology).Results: A total of 7 articles from Asia, Europe, and the United States were included in this review. Throughout the studies cognitive and mental health assessments (e.g., MoCA, FAST, etc.) were performed. Despite the barriers, telemedicine was noted as a feasible approach to assist individuals with dementia in connecting with their service providers and family while reducing complications related to travel (e.g., difficulty moving, traffic, distance).Conclusions: Due to the COVID-19 pandemic, finding alternative ways to provide services to older adults with dementia through technology may continue to become more necessary as time goes on.

Experiences of remote consulting for patients and neurologists during the COVID-19 pandemic in Scotland

BackgroundRemote consulting is an emerging model in managing chronic neurological conditions and has been widely implemented during the COVID-19 pandemic. The objective of this national survey was to investigate the initial experiences of remote consulting for neurologists and patients with established neurological conditions under follow-up during the first COVID-19 phase.MethodsIn collaboration with the Scottish Association of Neurological Sciences and the Neurological Alliance of Scotland, we conducted a web-based survey of neurologists and patients between October and November 2020.FindingsData was available for 62 neurologists and 201 patients. The consensus among neurologists was that remote consulting is a satisfactory way of delivering healthcare in selected groups of patients. For practical and technical reasons, there was preference for phone over video consultations (phone 63% vs video 33%, p=0.003). The prevailing opinion among clinicians was that considerable training interventions for remote consultation skills are required (‘yes’ 63% vs ‘no’ 37%, p=0.009) to improve clinician consultation skills and successfully embed this new model of care.Most patients perceived remote consultations as safe, effective and convenient, with 89% of patients being satisfied with their remote consultation experience. Although traditional face-to-face consultations were the favoured way of interaction for 62% of patients, a significant proportion preferred that some of their future consultations be remote.InterpretationAlthough not a replacement for face-to-face consultations, this survey illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations for doctors and patients. More research is required to identify overall safety and applicability.

Public perception of NHS general practice during the first six months of the COVID-19 pandemic in England

Background: In March 2020, the delivery of NHS general practice consultations was rapidly modified to mitigate the spread of COVID-19. Remote triage and consultations became the default, with adapted models for face-to-face contact if clinically required. This study aimed to gain insight into public perception of these adaptations. Methods: Two online surveys were developed, and conducted in August and September 2020. Survey A, open to adults (>18 years) receiving the link to it, considered respondents’ perspectives on healthcare contacts since March 2020, and their understanding of the adapted delivery. Survey B, open to survey A respondents only, then considered how healthcare communication had been received and individual preferences for this. Survey participation was voluntary. Results: The perceptions of 150 members of the public were obtained. 105 had considered contacting general practice, although half avoided this or delayed doing so for longer than usual. While some patients did so ‘to help the NHS’, others experienced reduced access for reasons including concerns about telephone consultations and about COVID-19 safety. Some however reported benefitting from remote consultation availability and regular texts/emails from their practice. 68% (102/150) of respondents were unaware that patients with COVID-19 were seen separately from other patients during general practice appointments. 27% in survey B who had avoided or delayed contact said they would have felt more comfortable contacting general practice had they known this. Conclusions: Experience and use of the adapted general practice models varied. Some patients felt their access to healthcare was reduced, often due to technological requirements. For some who found attending face-to-face appointments difficult however, remote contact was advantageous. Most of those surveyed were unaware of the COVID-19 control measures in place during face-to-face general practice consultations. Assessment of adapted delivery model accessibility and clearer public messaging about the changes may help reduce inequalities.

Next-generation rheumatoid arthritis specialized telemedicine enabled by IoT and AI

Ageing populations in developed countries place strain on healthcare systems and when ageing populations live far away from the specialists they require to treat their chronic diseases, the logistics can be challenging to say the least. This is a particularly acute issue in Japan, which is made up of small islands. The COVID-19 pandemic has served to emphasise the need for better systems for remote medical consultations. Dr Fumiaki Nonaka at Goto Chuou Hospital and Professor Atsushi Kawakami and Dr Shinya Kawashiri at Nagasaki University Hospital have collaborated with Microsoft to create the first remote consultation systems for rheumatoid arthritis (RA) that uses mixed reality. Early detection is crucial to managing RA but it is often difficult to make an accurate diagnosis and treatment of the disease in remote islands. This issue became particularly pressing in the context of COVID-19. Working with Microsoft, the researchers sought to develop a method of viewing and rendering the joints in 3D. Microsoft adapted their Azure Kinect DK cameras into a rig covering three different angles of any joint and an array of seven microphones was also installed. Using a reality headset called HoloLens2, the images of the joint can be rendered a 3D hologram to the user, enabling doctors to freely observe the joint from any direction. Combining this with Microsoft's Teams, a face-t-face consultation is facilitated.

Finnish e-health services intended for citizens – national and regional development

Electronic health care (e-health) services intended for Finnish citizens have been recently developed nationally, regionally, and locally through several projects and programs. This study aimed to investigate the development and availability of e-health services for Finnish citizens in specialized and primary health care and private medical service providers from 2011 to 2020. In addition, the differences between the availability of services in different sectors and regional differences between hospital districts were investigated. Data were collected using web-based questionnaires in 2011, 2014, 2017, and 2020 from “Use of information and communication technology surveys in Finnish health care”. This study covers all 21 hospital districts, nearly all primary health care centers, and a sample of private medical service providers. Quantitative data were analyzed using SPSS software (version 25). The availability of an e-health service was calculated as a percentage of all respondents in each sector. The results of this study show that public and private health care organizations extensively offered health care services on their websites. Almost all organizations had information on well-being, provided services, contact methods, and locations, as well as options to send electronic feedback. Remote consultation, electronic appointment booking services, and telephone counseling were also extensively offered. This study revealed that the volume of e-health services increased from 2011 to 2020. For instance, remote consultation services and information exchange through encrypted email increased rapidly during follow-up periods in all service sectors. Comparing service sectors revealed that specialized health care covers e-health services more extensively than do primary health care and private service providers. According to this study, there are also clear differences in the availability of services between hospital districts and no hospital district offered all studied services. These results suggest the need to clarify national and regional development responsibilities and standardize the availability of e-health services within and between hospital districts.

EP.WE.268Impact of COVID-19 on surgical services in a District General Hospital in the UK: benefits versus drawbacks

Background COVID-19 outbreak led to significant changes in health services worldwide. This study aims to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward. Methods Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants. Results The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future. Conclusion COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.