Insights from an Exploratory Retrospective Cohort Study: Are Face-to-Face Follow-Up Consultations after Colonoscopy a Thing of the Past?

BACKGROUND: Colonoscopy is a commonly performed procedure, but most patients will not actually be found with colorectal cancer. Subsequent face-to-face consultations to explain post-colonoscopy findings are common despite the time and cost-saving benefits of teleconsultation, especially in a post-COVID-19 era. This exploratory retrospective study examined the proportion of post-colonoscopy follow-up consultations that could have been converted to teleconsultation within a tertiary hospital in Singapore. METHODS: A retrospective cohort of all patients who underwent colonoscopy in the institution from July to September 2019 was identified. All follow-up face-to-face consultations related to the index colonoscopy from the scope date to 6 months post-colonoscopy were traced. Clinical data relevant to the index colonoscopy and these consultations were extracted from electronic medical records. RESULTS: The cohort consisted of 859 patients (68.5% male, age range: 18-96 years). Of these, 15 (1.7%) had colorectal cancer, but the majority (n = 643, 74.9%) were scheduled for at least one post-colonoscopy visit - a total of 884 face-to-face clinical visits. The final sample was 682 (77.1%) face-to-face post-colonoscopy visits that did not involve any procedures performed or indicated the need for any subsequent follow-up. CONCLUSION: If such "unnecessary" post-colonoscopy consultations exist within our institution, then similar situations possibly occur elsewhere. As COVID-19 continues to periodically tax healthcare systems worldwide, preservation of resources will remain integral alongside quality standards of routine patient care. There is a need for detailed analyses and modeling to hypothesize potential savings by also considering the start-up and maintenance costs of switching to a teleconsultation-dominated system.

Multi-Model Fusion-Based Hierarchical Extraction for Chinese Epidemic Event.

In recent years, Coronavirus disease 2019 (COVID-19) has become a global epidemic, and some efforts have been devoted to tracking and controlling its spread. Extracting structured knowledge from involved epidemic case reports can inform the surveillance system, which is important for controlling the spread of outbreaks. Therefore, in this paper, we focus on the task of Chinese epidemic event extraction (EE), which is defined as the detection of epidemic-related events and corresponding arguments in the texts of epidemic case reports. To facilitate the research of this task, we first define the epidemic-related event types and argument roles. Then we manually annotate a Chinese COVID-19 epidemic dataset, named COVID-19 Case Report (CCR). We also propose a novel hierarchical EE architecture, named multi-model fusion-based hierarchical event extraction (MFHEE). In MFHEE, we introduce a multi-model fusion strategy to tackle the issue of recognition bias of previous EE models. The experimental results on CCR dataset show that our method can effectively extract epidemic events and outperforms other baselines on this dataset. The comparative experiments results on other generic datasets show that our method has good scalability and portability. The ablation studies also show that the proposed hierarchical structure and multi-model fusion strategy contribute to the precision of our model. Supplementary Information: The online version contains supplementary material available at 10.1007/s41019-022-00203-6.

Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review.

BACKGROUND: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. OBJECTIVE: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. METHODS: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ≥65 years, with cancer diagnoses and if the study assessed patients' acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. RESULTS: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. CONCLUSIONS: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability.

Evaluation of α-Interferon Applied in COVID-19 Therapy Regimen

OBJECTIVE: To use IFNα injection as inhalant for there is no proper dosage form for aerosol inhalation and evaluate the feasibility of IFN-α off-label use. METHODS: The clinical studies in SARS and MERS were reviewed to discuss the efficacy and safety of IFN-α application in COVID-19. Meanwhile, the features of aerosol inhalation, characteristics of IFN-α and related clinical researches were analyzed to argue the possibility of IFN-α aerosol inhalation. RESULTS: IFN-α seems to be effective in relieving early symptoms but likely invalid in reducing mortality of severe patients, however, the exact therapeutic effect calls for further clinical tests. Proper atomization of IFN-α injection won't reduce biological activity of the protein, but absorption and utilization of IFN-α in lung may be unsatisfactory for the lack of sorbefacient. More than that, ingredients in IFN-α injection may increase risk of adverse reaction. CONCLUSION: The aerosol inhalation of IFN-α injection should be fully evaluated on the side of patients. If there is a lack of proper atomization device or operation staff, subcutaneous injection of IFN-α may be a tentative administration.