DESCRIPTIVE COST ANALYSIS OF TELECONSULTATION IN UMMC DIABETES CLINIC

Introduction Teleconsultation has become an increasingly important service in managing T2DM especially with the ongoing COVID-19 pandemic and is assumed to be less costly to patients compared to physical visits. This study aimed to compare patients' cost for a teleconsultation session vs physical clinic visit. Methodology This was a cross-sectional study from June 2020 to December 2021 in UMMC which included patients who had successfully participated in teleconsultation sessions. Patient interviews were conducted to collect demographics, detailed cost items (direct/ indirect cost) and a self-administered Patient Satisfaction Questionnaire Short Form (PSQ-18). HbA1c and average self-monitoring blood glucose (SMBG) records at baseline and 3-months after teleconsultation were obtained from electronic medical records (EMR). Results A total of 36 patients were recruited. The median cost of attending a physical visit was significantly higher compared to teleconsultation (RM 123.41 [54.29, 219.51] vs RM 41.41 [30.55, 49.66];p<0.001) with a median cost difference of RM 81.24 [20.20,171.69]. Indirect costs (income loss from absence) made up the majority of the cost saving with teleconsultation (teleconsultation RM 10.71 [0.00,18.45], physical visit RM95.24 [0.00,182.74];p<0.001). There was a reduction in HbA1c (9.45% [7.98, 11.38] to 8.25% [7.42, 9.49];p<0.001) and average fasting SMBG (8.11 mmol/L [6.75, 9.70] to 7.20 mmol/L [6.22, 8.71];p=0.03) after 3 months of teleconsultation. Patients reported high satisfaction levels with teleconsultation, with an overall PSQ-18 score of 78%. Conclusion Teleconsultation service in UMMC Diabetes outpatient clinic was cost saving to patients compared to physical visits without compromising blood glucose control. Teleconsultation may be a viable option of healthcare provision for many patients and may be considered as part of routine care.

COVID-19 infection in patients with systemic lupus erythematosus: An insight into the Sabah SLE Registry

Background: The emergence of SARS COV-2 novel coronavirus has caused a worldwide pandemic affecting the immunocompromised. While high mortality rates have been reported among elderly and those with comorbidities, immune mediated diseases and those receiving immunosuppressants are susceptible and considered a population for coronavirus infection. We hereby present a series of COVID-19 cases among the SLE cohort in this region and the challenges faced. Methods: Retrospective analysis of medical records of SLE patients admitted for COVID-19 infection from 1 March 2020 to 1 March 2021 and we briefly describe the clinical course, treatment and outcome of these patients. Results: Ten cases of COVID -19 infection were reported from our cohort, two of which were fatal involving young females with newly diagnosed SLE. All patients received hydroxychloroquine prior and during the course of infection. Notably, four patients had active SLE which required escalation of immunosuppression just before and during COVID-19 infection. Among the two fatalities, one had active SLE (SLEDAI 27) with macrophage activating syndrome while another had active lupus nephritis with refractory thrombocytopenia (SLEDAI 24). Both patients received pulse methylprednisolone and immunoglobulin for SLE during the coronavirus infection. Out of the ten cases, one survivor developed pulmonary embolism three months after COVID. Conclusion: Our study has shown that patients with concurrent severe SLE flares and treated with immunosuppressive agents demonstrate more vulnerability for severe COVID-19 illness. This may possibly be due to reduced access to healthcare during the pandemic crisis, hampering patients from seeking immediate medical attention. Conversely, those with stable SLE disease or mild to moderate flare seemed to fare better with the coronavirus infection. In summary, maintaining good control of SLE may halt further progression of COVID-19 in this susceptible population.

Design and modeling of IoT IR thermal temperature screening and UV disinfection sterilization system for commercial application using blockchain technology

The increasing spread of the coronavirus across countries and with no sight of vaccine uncovered soon has prompted affected countries to impose strict containment measures. In view to ease the enormous strain on health systems;disinfection, decontamination, contact tracking, and isolation are a few health protocols that are to be observed by companies that resumed their activities to protect their employees from being infected. Hence, against a backdrop of heightened uncertainty, this project leverages on the advancement of technology to design and built a smart Infrared thermal scanning with a camera (Thermovis-Mi-FRAHT-800). An Ultraviolet-C spectrum disinfection system and integration of blockchain technology for data sharing, managing health records, and access control. SketchUp used as a 3D design platform for this project. This system designed with a precautionary measure which includes 3 conditions to be met for the automated barrier to be open which include temperature measurement, disinfection, and sanitization processes. Overall, a person spends less than a minute in the walk-through path chamber as the process takes 20 to 25 seconds each. By this calculation, we assume that 2 people would be able to get disinfected within a minute which comes up to 120 people per hour. Thus, reducing the number of monitoring staffs in direct contact with the stakeholders with potential infection issues. It is envisaged that developing this conceptual design would be the cornerstone in adhering to control measure through appropriate infection control and modification using current and future technologies. © 2020 IEEE