ABSTRACT
Introduction: Endoscopic full-thickness resection (EFTR) represents a feasible and effective resection procedure for non-lifting colorectal lesions or difficult anatomic locations. However, EFTR has been associated with a non-irrelevant rate of adverse events (AEs);for this, it is commonly performed during hospitalization. The outbreak of COVID-19 forced national healthcare systems to prioritize hospitalization and treatment of COVID-19 patients, postponing the hospitalization for elective nonlife-saving procedures. So, all colorectal EFTR were performed as outpatient procedures during the first three months-national lockdown established in 2020. This retrospective analysis aimed to assess the feasibility and safety of EFTR as an outpatient procedure. Aims & Methods: Database of consecutive colorectal EFTR procedures performed at the outpatient clinic during the Italian first national lockdown (March to May 2020) was retrospectively analyzed. After 3 hours of observation at the recovery room, all patients were discharged with the advice to stay close to the hospital for 48-72 hours to ensure faster management of any delayed AEs. Patients were then scheduled for follow-up endoscopy 3-6 months after EFTR. Result(s): 12 EFTR were performed as an outpatient procedure. 4/12 (33.3%) were under antiplatelet/anticoagulant therapy. The median size of the lesions was 15.08mm +/- 3.23mm and 13.67mm +/- 3.27mm. 10/12 (83.3%) of the lesions were recurrences on the scar of previous endoscopic resection, whereas 2/12 (16.7%) were T1 carcinoma with indications for endoscopic resection. All EFTR were successfully performed with a 100% of R0 resection rate. Resection was reported to be difficult in a total of 5 (41.6%) procedures (3/12 (25%) dysfunction of the snare, 1/12 (8.3%) difficult incorporation of the lesion and 1/12 (8.3%) difficult reaching of the lesion). Intraprocedural bleeding occurred in 4/12 (33.3%) and was managed endoscopically with Argon Plasma Coagulation (APC). No perforation or delayed bleeding requiring medical or repeated endoscopic intervention occurred. One patient (8.3%) reported recurrent abdominal pain of unknown cause the night after the procedure. 3-6 months endoscopic follow-up was obtained in all patients without signs of recurrence/ residual lesion (100%). Conclusion(s): Outpatient EFTR of colorectal lesions is safe and feasible, with a similar success rate and AEs to EFTR performed in hospitalized patients. Thus, a strict self-observation with the possibility the access directly to the endoscopic service allowing an adequate and cost-effectiveness management for the post-EFTR AEs.
ABSTRACT
Specific 5G Release 17 work items are dealing with critical medical applications. Moreover, the adoption of mobile health (m-health) and e-health has been accelerated by the COVID-19 pandemic. This paper first examines the requirements of critical medical applications that 5G is expected to support. Then it illustrates possible data protection, management, and privacy issues. Finally, it shows a first implementation of an m-health framework supporting physical distance management. Experimental results show that, by exploiting 5G connectivity and the computing capacity provided by an accelerated edge cloud, the proposed framework can detect physical distance violations faster than a user equipment (UE)-based implementation, while saving UE energy.
ABSTRACT
In 5G Release 17 specific work items are dealing with medical applications. Moreover, the COVID-19 pandemic has accelerated the adoption of mobile-health (m-health) and e-health. This paper proposes the implementation of a m-health framework supporting social distancing management. Experimental results show that by exploiting 5G connectivity and the computational power provided by an accelerated edge cloud, the proposed framework can perform social distancing verification faster than a user equipment (UE)-based deployment. © 2021 IEEE.