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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317865

ABSTRACT

A primary indicator of success in the fight against COVID-19 is avoiding stress on critical care infrastructure and services (CCIS). However, CCIS will likely remain stressed until sustained herd immunity is built. There are also secondary considerations for success: mitigating economic damage;curbing the spread of misinformation, improving morale, and preserving a sense of control;building global trust for diplomacy, trade and travel;and restoring reliability and normalcy to day-to-day life, among others. We envision technology plays a pivotal role. Here, we focus on the effective use of readily available technology to improve the primary and secondary success criteria for the fight against SARS-CoV-2. In a multifaceted technology approach, we start with effective technology use for remote patient monitoring (RPM) of COVID-19 with the following objectives: 1. Deploy readily available technology for continuous real-time remote monitoring of patient vitals with the help of biosensors on a large scale. 2. Effective and safe remote large-scale communitywide care of low-severity cases as a buffer against surges in COVID-19 hospitalizations to reduce strain on critical care services and emergency hospitals. 3. Improve the patient, their family, and their community's sense of control and morale. 4. Propose a clear technology and medical definition of remote patient monitoring for COVID-19 to address an urgent technology need;address obfuscated, narrow, and erroneous information and provide examples;and urge publishers to be clear and complete in their disclosures. 5. Leverage the cloud-based distributed cognitive RPM platform for community leaders and decision makers to enable planning and resource management, pandemic research, damage prevention and containment, and receiving feedback on strategies and executions.

2.
JCO Oncol Pract ; 17(9): e1327-e1332, 2021 09.
Article in English | MEDLINE | ID: covidwho-1278135

ABSTRACT

PURPOSE: Telehealth has been an integral response to the COVID-19 pandemic. However, no studies to date have examined the utility and safety of telehealth for oncology patients undergoing systemic treatments. Concerns of the adequacy of virtual patient assessments for oncology patients include the risk and high acuity of illness and complications while on treatment. METHODS: We assessed metrics related to clinical efficiency and treatment safety after propensity matching of newly referred patients starting systemic therapy where care was in large part replaced by telehealth between March and May 2020, and 206 newly referred patients from a similar time period in 2019 where all encounters were in-person visits. RESULTS: Patient-initiated telephone encounters that capture care or effort outside of visits, time to staging imaging, and time to therapy initiation were not significantly different between cohorts. Similarly, 3 month all-cause or cancer-specific emergency department presentations and hospitalizations, and treatment delays were not significantly different between cohorts. There were substantial savings in travel time with virtual care, with an average of 211.4 minutes saved per patient over a 3-month interval. CONCLUSION: Our results indicate that replacement of in-person care with virtual care in oncology does not lead to worse efficiency or outcomes. Given the increased barriers to patients seeking oncology care during the pandemic, our study indicates that telehealth efforts may be safely intensified. These findings also have implications for the continual use of virtual care in oncology beyond the pandemic.


Subject(s)
COVID-19 , Neoplasms , Telemedicine , Humans , Neoplasms/therapy , Pandemics , SARS-CoV-2
3.
BMJ Case Rep ; 14(5)2021 May 12.
Article in English | MEDLINE | ID: covidwho-1226743

ABSTRACT

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but often severe complication of SARS-CoV-2 infection. While several case reports about MIS-A in the setting of COVID-19 have been published since the term was first coined in June 2020, a clear description of the underlying pathophysiology and guideline-based recommendations on the diagnostic and therapeutic approach are lacking. What has been reported is that in the absence of severe respiratory illness, MIS-A can present with hypotension or shock, high-grade fever, abdominal pain, diarrhoea and severe weakness days to weeks after SARS-CoV-2 infection. Here, we present a case of a 28-year-old man who presented with a rarely described initial symptom: unilateral neck swelling. His presentation, disease progression and treatment course provide further information about MIS-A as a complication and in formulating diagnostic guidelines.


Subject(s)
COVID-19 , SARS-CoV-2 , Abdominal Pain , Adult , Diarrhea , Fever/etiology , Humans , Male , Systemic Inflammatory Response Syndrome
4.
Curr Diab Rep ; 21(2): 5, 2021 01 15.
Article in English | MEDLINE | ID: covidwho-1092739

ABSTRACT

CONTEXT: Diabetes is a leading metabolic disorder with a substantial cost burden, especially in inpatient settings. The complexity of inpatient glycemic management has led to the emergence of inpatient diabetes management service (IDMS), a multidisciplinary team approach to glycemic management. OBJECTIVE: To review recent literature on the financial and clinical impact of IDMS in hospital settings. METHODS: We searched PubMed using a combination of controlled vocabulary and keyword terms to describe the concept of IDMS and combined the search terms with a comparative effectiveness filter for costs and cost analysis developed by the National Library of Medicine. FINDINGS: In addition to several improved clinical endpoints such as glycemic management outcomes, IDMS implementation is associated with hospital cost savings through decreased length of stay, preventing hospital readmissions, hypoglycemia reduction, and optimizing resource allocation. There are other downstream potential cost savings in long-term patient health outcomes and avoidance of litigation related to suboptimal glycemic management. CONCLUSION: IDMS may play an important role in helping both academic and community hospitals to improve the quality of diabetes care and reduce costs. Clinicians and policymakers can utilize existing literature to build a compelling business case for IDMS to hospital administrations and state legislatures in the era of value-based healthcare.


Subject(s)
Diabetes Mellitus , Inpatients , Delivery of Health Care , Diabetes Mellitus/therapy , Humans , Patient Readmission , United States
6.
PLoS One ; 15(11): e0241541, 2020.
Article in English | MEDLINE | ID: covidwho-934329

ABSTRACT

BACKGROUND: Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. METHODS: We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. RESULTS: Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23-1.71), dyspnea (RR 2.55, 95%CI 1.88-2.46), diabetes (RR 1.59, 95%CI 1.41-1.78), hypertension (RR 1.90, 95%CI 1.69-2.15). Congestive heart failure (OR 4.76, 95%CI 1.34-16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57-27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19-7.39) and reticular pattern (OR 5.54, 95%CI 1.24-24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. CONCLUSION: Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.


Subject(s)
COVID-19/mortality , Severity of Illness Index , COVID-19/epidemiology , Humans
7.
Circ Heart Fail ; 13(10): e007218, 2020 10.
Article in English | MEDLINE | ID: covidwho-805484

ABSTRACT

Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.


Subject(s)
Epidemics , Heart Failure/ethnology , Age of Onset , Asia/epidemiology , Health Services Needs and Demand , Heart Failure/diagnosis , Heart Failure/prevention & control , Humans , Needs Assessment , Prevalence , Preventive Health Services , Prognosis , Risk Assessment , Risk Factors , Time Factors
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