Assessment of physicians’ satisfaction with a virtual tumour board in a French academic centre during the COVID-19 pandemic

Introduction & Objectives: During the COVID-19 pandemic, physicians were instructed to avoid face-to-face meetings. Virtual Tumour Boards (vTBs) were therefore established. Our objective was to assess physicians’ satisfaction with vTB use during the crisis. Materials & Methods: Twenty-eight physicians in onco-urology involved in a vTB in a single department in Paris, France, were asked to answer an online survey between March 17th and April 28th, 2020. A validated scale employed for teleconsultations was adapted to assess physician satisfaction with the vTB (e.g. Telehealth Usability Questionnaire - TUQ) including additional criteria such as ergonomic, learnability and satisfaction items. A satisfying experience was defined as TUQ score >85. Participants were stratified into two groups, senior and junior, to assess any differences in opinion. Results: A total of 23/28 physicians (82.1%) responded to the questionnaire (median age: 36-years [IQR: 32-40], male: female ratio 2.8, 11 senior physicians (47.8%)). Overall, 164 medical cases were discussed, representing a 23.4% decrease when compared to the similar period in 2019 (n=214). Median TUQ score was 100 [IQR: 92-109] and 22 participants (95.7%) reported a satisfying experience with no significant difference between senior and junior physicians. Limitations include the small sample size, monocentric design, use of a modified telehealth questionnaire in order to fit the vTB, and potential bias inherent in self-reporting. Conclusions: The vTB was a rapid and effective way to deal with onco-urology cases. vTB adherence was high and we believe that this way of working will continue beyond the current crisis.

Septic shock and reversible right ventricle dysfunction

Background: Right ventricle involvement during sepsis is often misunderstood, although it is described that an altered performance of the right ventricle is present in 2/3 of cases of moderate to severe forms of sepsis. Clinical Case: 30 years old woman without known cardiovascular risk factors with a history of multiple psychiatric disorders. Access to the emergency departement of our hospital complaining asthenia and hypotension. The patient underwent cardiological evaluation with EKG findings of sinus tachycardia and diffuse ST-T anomalies and bidimensional echocardiogram negative for biventricular kinetic anomalies. Laboratory evidence of creatinine 2.07 mg/dl, slight increase in inflammation indices (CRP 38 mg/dl) and anemia (HB: 9.2 g/l). Swab for SARS-COV2 was negative. The patient was then admitted to the local department of Medicine. During hospitalization, evidence of hypotension and progressive worsening of inflammation indices. Due to addominal pain, the patient underwent EGDS showing hiatal hernia. Subsequent onset of fever, with negative urine culture and positive blood cultures for S. Epidermidis. In addition, due to the detection of involuntary movements of the limbs and eyelids she was subjected to cerebral MRI in suspicion of encephalitis, that was excluded. At a subsequent cardiological and echocardiographic evaluation, finding of “Hypocontractile right ventricle, volume overload of the right sections with paradoxical movement of the interventricular septum, PAPs: 50 mmHg”. On chestabdomen CT scan “absence of focal pulmonary lesions and bilateral pleural effusions, patent pulmonary circulation, absence of thrombotic filling defects”. The patient was therefore transferred to our cardiology departement with diagnosis of septic shock. During hospitalization, evidence of hypokalemia, long QT interval (> 500 msec) and self-limiting polymorphic ventricular tachycardia. After long-term therapy with inotropics and antibiotics, we found a significant clinical improvement with echocardiographic evidence of complete recovery of right ventricular performance. The case described is a paradigmatic example of reversible alteration of right ventricle systolic function during septic shock (severe sepsis). The different pathogenetic determinants, however, are still debated. There are two possible hypotheses: inflammatory myocardial right ventricle involvement (myocarditis) or vasculitic involvement of right ventricle, sustained by inflammatory stress and bacteremia.

COVID-19 Pandemic and Balance of Constitutional Rights.

ABSTRACT: In 2020 the World Health Organization declared the Covid-19 to be a pandemic. Governments around the world are facing a tough challenge that could jeopardise the national healthcare systems. Safeguarding the rights of Covid patients and all citizens - especially those who are now even more vulnerable than they were before - is part of this challenge. This work aims to examine the issues arising from the current emergency in terms of how individuals' constitutional rights have been balanced and how much people at the highest risk amid this pandemic - the homeless, the inmates in prison, geriatric and psychiatric patients, and doctors on the Covid frontline - have been protected. This analysis focuses mostly on one of the worst-hit countries by the SARS-CoV-2: Italy.