ABSTRACT
Several studies have evaluated the impact of radiological phenotyping in the management of COVID-19 pneumonia (G. Scioscia et al. Arch Bronconeumol (Engl Ed). 2021 Jul 28). Moreover, among the various procedures, the prone position (PP) appears to be effective in improving alveolar gas exchange. Therefore, we have tested the efficacy of PP in different COVID-19 radiological phenotypes (PH). The study was conducted on COVID-19 patients admitted in our Unit between November 2020 and April 2021. The patients with a PaO2/FiO2 (P/F) <= 200 mmHg on blood gas analysis underwent PP cycles. In relation to PP ability, they were divided into two groups (Prone and Supine) and the groups were then compared. We enrolled 60 patients (29 Prone and 22 Supine). Of all patients, we calculated the post-PP P/F gain, resulting in 51.7+/-30.2 mmHg in PH1, 50.3+/-24.2 in PH2 and 55.0+/-19.7 mmHg in PH3. Although there were no significant differences in mortality rates between phenotypes, a post-PP gain >=20% seems to be a safety cut-off of response to PP. Hence, 83.3% PH2, 66.7% PH1 and 55% PH3 were identified as "responders" In conclusion, our findings suggest that PP is a procedure that should be performed;it improves gas exchange even if it shows different efficacy based on the radiological phenotype. Therefore, a gain of >=20% PaO2/FiO2 post-PP could be considered a discriminating marker of efficacy of this therapeutic approach.
ABSTRACT
Objectives The spread of COVID-19 pandemic changed the approach in the management of neoplasms. Telemedicine was one of the tools we experienced to maintain the continuity of care for the patients. Our goal is to evaluate the impact of telemedicine in patients management during follow up visits and its emotional impact. Methods We enrolled 79 women with gynecological cancer. SUTAQ questionnaire was used to highlight patients perception about telemedicine. The questionnaire consists of 22 items divided into different subscales: 'Enhanced care'(EC), 'Satisfaction' (ST), 'Privacy and Discomfort'(PD), 'Care personnel concerns' (CPC), ' Increased accessibility' (IA) and ' Telemedicine as a Substitution' (TMS) scales Results Enrolled women had a mean age of 55 years (35 women ≤ 55 years and 44 women ≥ 55 years). The majority of them (61.54%;n=48) achieved a high school diploma or higher while (n=30) had a low educational level (middle school or lower);87.3% (n=69) were employed and 70.89% (n=56) lived with their partner. Younger women had a better perception towards telemedicine for TMS (mean=3.68) compared to older ones (mean=3.05). The difference was statistically significant (p=0.025). The PD subscale was in favor of higher educated women (mean=2.57) compared to lower educated ones (mean=3.28;p=0.042). No significant differences were observed between intensive and non intensive treatment. EC, ST, IA, and PD reached good responsiveness towards telemedicine, irrespectively of care level. Conclusions Telemedicine has been a well-evaluated tool, not only among younger and higher educated women but even by women needing intensive care.