INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE

Introduction: COVID-19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym's closure and the need to stay home didn't allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home-based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home-based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara. Methods: On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm-up, strenght and balance exercises alternate to indoor walking, cool-down. Patients received an explicative iconographic via e-mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection. Results: All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred. Conclusions: Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID-19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.

Significance of vocal tract geometrical variations and loudness on airflow and droplet dispersion in a two-dimensional representation of [f]

The significance of respiratory droplet transmission in spreading respiratory diseases such as COVID-19 has been identified by researchers. Although one cough or sneeze generates a large number of respiratory droplets, they are usually infrequent. In comparison, speaking and singing generate fewer droplets, but occur much more often, highlighting their potential as a vector for airborne transmission. However, the flow dynamics of speech and the transmission of speech droplets have not been fully investigated. To shed light on this topic, two-dimensional geometries of a vocal tract for a labiodental fricative [ f ] were generated based on real-Time MRI of a subject during pronouncing [ f ]. In these models, two different curvatures were considered for the tip tongue shape and the lower lip to highlight the effects of the articulator geometries on transmission dynamics. The commercial ANSYS-Fluent CFD software was used to solve the complex expiratory speech airflow trajectories. Simultaneously, the discrete phase model of the software was used to track submicron and large size respiratory droplets exhaled during [ f ] utterance. The simulations were performed for high, normal, and low lung pressures to explore the influence of loud, normal, and soft utterances, respectively, on the airflow dynamics. The presented results demonstrate the variability of the airflow and droplet propagation as a function of the vocal tract geometrical characteristics and loudness. © 2021 American Society of Mechanical Engineers (ASME). All rights reserved.

Like a fish in water

In this article, the author offers his reflections on the potential benefit of catastrophic change at various levels, and by so doing paves the way toward the process of mourning past certainties and acceptance of our new psychoanalytic reality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients.

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03±26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%-69.5%], 44.2% of patients were decannulated [95%CI 33.96%-54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%-23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%-19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p=0.34), decannulation (RR1.35, p=0.27), complications (RR0.75, p=0.09) and time to decannulation (SMD 0.46, p=0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p=0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.

Phone follow-up (PFU) for breast cancer survivors (CS) during covid-19 pandemic: A single breast unit experience

Background: The COVID-19 outbreak became a public health emergency, leading to radical changes in care management. Hospitals are considered at risk for viral contamination and telemedicine allows CS to remain out of the hospitals. In our Institution all data concerning cancer patients are available through an Oncologic Web-based Electronic Medical Record (EMR): thus, the clinicians are able to access at any time CS medical history. From the start of COVID-19 pandemic we adopted EMR-assisted PFU instead of usual follow-up visit and this study aims to prospectively assess how breast CS perceived PFU. Method: We emailed to all breast CS managed by PFU a 15-item survey. Answers were measured with Likert scales. The correlation between CS characteristics and answers were analysed with Pearson test. Results: From February 2nd to May 20th, 107 out of 261 (41%) women fulfilled the survey. The median age was 61 (range 41-86), median follow up was 43 months (range 1-115). Most of the CS (67.3%) had high school diploma or higher degrees. About half of the CS were previously treated with adjuvant chemotherapy and 80% adjuvant endocrine therapy. 78.5% were able to reach the hospital autonomously. 66.4% suffered from COVID-19 related anxiety for their health and the majority (85%) were waiting for follow up visit to feel relief. 96.3% pts believed to have understood medical advice during PFU and were satisfied for the time and the opportunity to ask clarifications. 92% agreed with the decision to switch the usual followup visit in PFU. However, only 41.1% CS would like to have PFU in the future. We found a significant correlation between educational degree and comprehension during the visit (p=0.04) and with expectation for PFU feasibility (p=0.046). Age and educational level were significantly correlated with the ability to reach the hospital (p=0.046). CS treated with endocrine therapy were meaningfully correlated with the PFU satisfaction (p=0.048) Conclusions: PFU is an important tool to avoid hospital contacts during COVID-19 pandemic and the majority of CS who agree to participate in the survey agreed and felt satisfied from this procedure. The number of CS willing to have PFU in non-emergency situations invites to investigate the possibility to have routine PFU at least for a subset of the CS. Prospective randomized trials are warranted to assess the reliability of PFU compared to standard follow-up visit to implement telemedicine in daily clinical practice.

The recommended lifetime immunization schedule from the board of vaccination calendar for life in Italy: A continuing example of impact on public health policies.

The Vaccination Calendar for Life is an alliance of scientific and professional societies of public health physicians, paediatricians and general practitioners in Italy which provides a periodical update on the ideal, scientifically driven vaccination calendar throughout lifetime. Since 2012, the Lifetime Immunization Schedule has represented a benchmark for Regional and National Authorities to set up the updated list of vaccines provided actively and free of charge to infants, children, adolescents, adults and the elderly by inclusion in the Triennial National Vaccination Plan (TNVP), and in the Essential Levels of Care (LEA). The impact of the different editions of the Lifetime Immunization Schedule on the TNVP was deep, representing the inspiring source for the present vaccination policy. The 2019 edition called for more attention to pregnant women immunization; risk groups vaccination; uniform high coverage with the MMRV vaccine; extension of Meningococcal B vaccination also at adolescent age; use of quadrivalent conjugate meningococcal vaccine also at 1 year of life; progressive decrease of the age of free-of-charge offer of influenza to ≥ 60 and then to ≥ 50 year-old population; implementation of flu immunization ages 6 months-6 years; HPV vaccination also offered to 25-year old women at the time of the first screening (gender neutral immunization already offered); sequential PCV13-PPV23 pneumococcal vaccination in 65 year-old subjects; increased coverage with rotavirus vaccine in infants and zoster vaccine in the elderly.

Maintain and increase vaccination coverage in children, adolescents, adults and elderly people: Let's avoid adding epidemics to the pandemic: Appeal from the Board of the Vaccination Calendar for Life in Italy: Maintain and increase coverage also by re-organizing vaccination services and reassuring the population.

The Board of the Vaccination Calendar for Life (Bonanni et al., 2014, 2017) [1,2]), a coalition of four major scientific and professional societies of public health physicians, pediatricians and general practitioners in Italy, made an appeal to health authorities in order to sustain vaccination in COVID-19 times. The five pillars to maintain and increase vaccination coverage at all ages are described as follows: 1) Guarantee paediatric vaccination coverage to all newborns and paediatric boosters and adolescent immunizations, not interrupting active calls and scheduled sessions. 2) Re-organise the way paediatric and adolescent vaccinations are offered. 3) Set-up recovery programs for vaccinations not carried out after the start of the COVID-19 emergency. 4) Provide the preparation of tenders for the supply of flu vaccines with suitable quantities to increase coverage in all Regions and Autonomous Provinces with extreme urgency. 5) Prepare plans to increase coverage for influenza, pneumococcal, tetanus diphtheria and shingles. The Board of the Calendar for Life appeals to the National and Local Health Authorities for a strong and coordinated commitment in favor of the widest offer and acceptance of vaccinations, whose vital importance for collective health is now even more evident to all, in order to avoid that delays in the necessary initiatives should add damage from other epidemics to those suffered by our population due to the COVID-19 pandemic.

Electronic medical record (EMR)-assisted phone follow-up (PFU) for breast cancer survivors (CS) during COVID-19 pandemic: An Italian single institution experience

Background: The COVID-19 outbreak became a public health emergency, leading to radical changes in care management. Telemedicine was adopted to minimize hospitals exposure for CS. In our region all patients (pts) data are available through an EMR: thus, the clinicians are able to access at any time CS medical history. From the start of COVID-19 pandemic we adopted EMR-assisted PFU instead of usual follow-up (FU) visit. This study aims to prospectively assess how breast CS perceived PFU. Methods: We emailed to all breast CS managed by PFU a 15-items survey. Answers were measured with Likert scales. The correlation between CS characteristics and answers were analyzed with Pearson test. Results: From February 2nd to May 20th, 107 out of 261 (41%) pts fulfilled the survey. The median age was 61, median FU was 43 months. 67.3% had high school diploma or higher degrees. 52% CS previously received chemotherapy whereas 80% adjuvant endocrine therapy. 78.5% could reach the hospital autonomously. 66.4% suffered from COVID-19 related anxiety for their health and 85% were waiting for FU visit to feel relief. 96.3% CS believed to have understood medical advice during PFU and were satisfied for the time and the opportunity to ask clarifications. 92% agreed with the decision to switch the usual FU visit in PFU. However, only 41.1% CS would like to have PFU in the future. We found a significant correlation between educational degree and comprehension during the visit (p=0.04) and with expectation for PFU feasibility (p=0.046). Age and educational level were significantly correlated with the ability to reach the hospital (p=0.046). CS treated with endocrine therapy were meaningfully correlated with the PFU satisfaction (p=0.048). Conclusions: PFU was an important tool to avoid hospital contacts during COVID-19 pandemic and the majority of CS in the survey agreed and felt satisfied from this procedure. The number of CS willing to have PFU in non-emergency situations invites to investigate routine PFU at least for a subset of CS. Prospective randomized trials are warranted to assess the reliability of PFU compared to standard FU visit to implement telemedicine in daily clinical practice. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.