Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
Annals of the Rheumatic Diseases ; JOUR:675-675, 81.
Article in English | Web of Science | ID: covidwho-2088692
2.
Annals of the Rheumatic Diseases ; 81:440, 2022.
Article in English | EMBASE | ID: covidwho-2009122

ABSTRACT

Background: Patients with systemic lupus erythematosus (SLE) are at increased risk of severe COVID-19 due to the underlying disease, comorbidities and use of immuno-suppressants (IS). An alternative option would be to adopt telemedicine (TM) to maintain medical care while minimizing exposure. Despite being widely adopted during the pandemic, the evidence supporting the use of TM in rheumatology has been limited. Objectives: We primarily aimed to evaluate the effectiveness to maintain disease activity control using TM delivered care compared to conventional in-person follow-up in patients with lupus nephritis (LN). The secondary objectives were to compare the patient reported outcomes, safety and cost-of-illness from the patient's perspective between the 2 modes of health care delivery. Methods: This was a 1-year, single-center, RCT conducted at a regional hospital in Hong Kong. From May 2020, consecutive adult patients with a SLE according to the 2019 EULAR/ACR classifcation criteria followed up at the LN clinic were invited to participate in the study. Participants were randomized 1:1 to either TM (TM group) or standard FU (SF group). Patients randomized to receive TM FU were scheduled for a video consultation via a commerical software ZOOM. Patients in the SF group received standard in-person outpatient care. SLE disease activity at each consultation was assessed by SLEDAI-2k and physician global assessment (PGA). Results: A total of 144 patients with LN were randomized and 3 patients self-withdrew from the study. The mean age was 44.5±11.4 years and the median time from diagnosis to randomization was 168 months (range: 1-528). Most of the patients had class III, IV or V LN (87.2%) and were on prednisolone (89.4%, median dose 5mg daily). Many of them (68.1%) were on IS. While 66.0% of the patients were in lupus low disease activity state (LLDAS), none had disease remission. There were no baseline differences, including demographics, SLEDAI-2k (TM: 3.8±2.3, SF: 3.2±2.2, p=0.13, PGA (TM: 6.2±6.5, SF: 4.6±5.9, p=0.13) and SLE damage index (TM: 1.1±1.3, SF: 0.8±1.1, p=0.10), between the 2 groups. At one year, 80.0% and 80.2% of the patients in the TM group and SF group were in LLDAS or remission respectively. SLE disease activity indices including SLEDAI-2k, PGA, proteinuria amount and serum anti-ds-DNA level remained similar between the 2 groups. Within the study period, 28 (40%) patients in the TM group and 21 (29.6%) patients in the SF group had disease fare (p=0.20). There were no differences in the SF-36, lupusQoL and HADS scores between the 2 groups at the end of the study. The overall patient satisfaction score was higher in the TM group with a signifcantly shorter waiting time before seeing doctors. At the end of the study, 67.9% of the overall participants agreed to (versus 15.0% who did not agree to) use TM as a mode of future FU. The mean indirect costs of illness (HKD26,681 vs HKD12,016, p=0.20) and the out-of-pocket costs for health care services were similar between the 2 groups (TM: HKD13,547 vs SF: HKD12,297, p=0.83) in one year. The total number of FU was similar (TM: 6.0±2.0, SF: 5.7±1.7, p=0.40). However, signifcantly more patients in the TM group (29/70, 41.4% vs 4/71, 5.6%;p<0.01) requested change mode of FU. The proportion of patients requiring hospitalization during the study period was also higher in the TM group (TM: 23/70, 32.9% vs 11/71, 15.5%;p=0.02). After adjusting for age and pred-nisolone dosage, not being in LLDAS at baseline was the predictor of hospitalization (OR 3.4, 95%CI 1.20-9.65). None of the participants was tested positive for COVID-19. Conclusion: TM FU resulted in similar 1-year disease activity control and better satisfaction in patients with LN compared to standard care. However, a signifcant proportion of patients cared by TM required in-person visits or were hospitalized. The results of the study suggest that TM delivered care could help minimizing exposure to COVID-19, but it needs to be complemented by physical visits, particularly in those with unstable d sease.

3.
Ieee Transactions on Automation Science and Engineering ; : 13, 2022.
Article in English | Web of Science | ID: covidwho-1819854

ABSTRACT

The COVID-19 pandemic shows growing demand of robots to replace humans for conducting multiple tasks including logistics, patient care, and disinfection in contaminated areas. In this paper, a new autonomous disinfection robot is proposed based on aerosolized hydrogen peroxide disinfection method. Its unique feature lies in that the autonomous navigation is planned by developing an atomization disinfection model and a target detection algorithm, which enables cost-effective, point-of-care, and full-coverage disinfection of the air and surface in indoor environment. A prototype robot has been fabricated for experimental study. The effectiveness of the proposed concept design for automated indoor environmental disinfection has been verified with air and surface quality monitoring provided by a qualified third-party testing agency.

4.
Annals of the Rheumatic Diseases ; 80(Suppl 1):860-861, 2021.
Article in English | ProQuest Central | ID: covidwho-1501562

ABSTRACT

Background:Patients with lupus nephritis (LN) might be more susceptible to COVID-19 due to the underlying disease, co-morbidities and use of immunosuppressants. We hypothesized that telemedicine (TM) could be a well-accepted mode of health-care delivery minimizing the risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while maintaining disease control in these patients.Objectives:To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with LN during COVID-19.Methods:This was a single-center randomized-controlled study. Consecutive patients followed at the LN clinic were randomized to either TM (TM group) or standard FU (SF group) in a 1:1 ratio. Patients in the TM group received scheduled follow-ups via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared.Results:From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had attended at least 2 FU visits. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group (mean 0.67±0.69 vs 0.45±0.60, p=0.003) (Table 1). The mean FU duration was 19.8±4.5 weeks. When comparing the most recent visit, the mean waiting time between entering the clinic waiting room (virtual or real) and seeing a rheumatologist (virtual or in-person) was significantly shorter in the TM group (22.5±28.6 vs 68.9±40.7 minutes, p< 0.001) (Figure 1A). The mean overall patient satisfaction score was higher in the TM group (mean 2.19±0.61 vs 1.89±0.78, p=0.042). The results of the post-consultation satisfaction questionnaire are shown in Figure 1B. The number of visits was similar in the two groups (TM: 3.1±1.3 vs SF: 3.0±1.2, p=0.981). However, there was a trend suggesting that alternative mode of FU was requested more frequently in the TM group than the SF group (TM: 12/60, 20.0% and SF: 5/62, 8.1%;p=0.057). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p=0.049) within the FU period, which was no longer statistically significant after adjusting for the baseline PGA. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p=0.919). None of the patients had COVID-19.Conclusion:TM resulted in better patient satisfaction and could achieve similar disease control in patients with LN in the short-term when compared to standard care.Table 1.Baseline clinical data of the recruited patients and comparison between the telemedicine/standard follow-up groupsOverall (n=122)Telemedicine group (n=60)Standard follow-up group (n=62)P-valueAge in years44.4±11.544.1±11.744.7±11.50.779Gender: Female111 (91.0)55 (91.7)56 (90.3)0.796Disease duration in years15.1±9.016.2±8.714.0±9.10.115Nephritis class III, IV or V108 (88.5)54 (90.0)54 (87.1)0.42724 hour urine proteinuria in gram0.51±0.630.53±0.600.50±0.650.712Current use of prednisolone112 (91.8)57 (95.0)55 (88.7)0.323Daily prednisolone dose in mg5.51±4.215.69±4.175.34±4.290.570Use of immunosuppressant90 (73.8)46 (76.7)44 (71.0)0.474SLEDAI-2K3.65±2.334.00±2.343.30±2.290.097PGA0.56±0.650.67±0.690.45±0.600.003LLDAS78 (63.9)36 (60.0)42(67.7)0.251Remission0 (0)0 (0)0 (0)n/aPresence of comorbidity87 (71.3)40 (66.7)47 (75.8)0.264SDI0.93±1.151.08±1.280.78±0.980.243HAQ-DI0.23±0.460.25±0.470.21±0.440.571HADS: Anxiety scale Depression scale6.07±4.12 5.72±4.316.20±4.19 5.73±3.935.93±4.09 5.70±4.680.720 0.724Data are reported as mean ± SD or number (%). LLDAS: lupus low disease activity state;SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index;HAQ-DI: Health Assessment Questionnaire Disability Index;and HADS: Hospital Anxiety and Depression Scale.Disclosure of Interests:Ho SO: None declared, Evelyn Chow: None declared, Tena K. Li: None declared, Sze-Lok Lau: None declared, Isaac T. Cheng: None declared, Cheuk-Chun Szeto: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer.

5.
24th International Conference on Medical Image Computing and Computer Assisted Intervention, MICCAI 2021 ; 12902 LNCS:571-581, 2021.
Article in English | Scopus | ID: covidwho-1469644

ABSTRACT

Localization and characterization of diseases like pneumonia are primary steps in a clinical pipeline, facilitating detailed clinical diagnosis and subsequent treatment planning. Additionally, such location annotated datasets can provide a pathway for deep learning models to be used for downstream tasks. However, acquiring quality annotations is expensive on human resources and usually requires domain expertise. On the other hand, medical reports contain a plethora of information both about pnuemonia characteristics and its location. In this paper, we propose a novel weakly-supervised attention-driven deep learning model that leverages encoded information in medical reports during training to facilitate better localization. Our model also performs classification of attributes that are associated to pneumonia and extracted from medical reports for supervision. Both the classification and localization are trained in conjunction and once trained, the model can be utilized for both the localization and characterization of pneumonia using only the input image. In this paper, we explore and analyze the model using chest X-ray datasets and demonstrate qualitatively and quantitatively that the introduction of textual information improves pneumonia localization. We showcase quantitative results on two datasets, MIMIC-CXR and Chest X-ray-8, and we also showcase severity characterization on COVID-19 dataset. © 2021, Springer Nature Switzerland AG.

6.
International Journal of Rheumatic Diseases ; 24(SUPPL 2):319-321, 2021.
Article in English | EMBASE | ID: covidwho-1458357

ABSTRACT

Background: Telemedicine (TM) has been widely advocated and used to follow up patients with rheumatic diseases during the COVID-19 outbreak. However, there is no evidence supporting its use in systemic lupus erythematosus. We aimed to evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during the pandemic. Methods: This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. Results: From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group (table). After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group with a significantly shorter waiting time from entering the clinic waiting room (virtual or real) to seeing a rheumatologist (figure). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p=0.049) with higher baseline PGA (OR = 1.15, 95% CI 1.07-1.23) being the independent predictor. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p = 0.919). None of the patients had COVID-19. Conclusion: TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA. (Table Presented).

7.
Annals of the Rheumatic Diseases ; 80(SUPPL 1):895, 2021.
Article in English | EMBASE | ID: covidwho-1358797

ABSTRACT

Background: It is important to weigh the potential risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with the patients' choice of TM use in lupus nephritis. Objectives: In this study, we aimed to examine the clinical variables associated with a higher preference for TM follow-up in patients with lupus nephritis. Methods: Consecutive patients followed at the lupus nephritis clinic were contacted for their preferred mode of follow-up. The demographic, socioeconomic and clinical data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher PGA and family monthly income (≥ USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (Table 1). These predictors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income ≥USD3,800 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak. Conclusion: When choosing the mode of care delivery between TM and clinic visit, the patient's disease activity as well as employment and economic status appeared to be important.

8.
Journal of Communication Management ; 2021.
Article in English | Scopus | ID: covidwho-1270779

ABSTRACT

Purpose: This study explores the interaction effects of organizational conflict history and employees' situational perceptions of COVID-19 on negative megaphoning and turnover intention. Design/methodology/approach: Survey data (N = 476) were collected from US citizens, who self-identified as full-time employees, through Amazon Mechanical Turk (MTurk) in August 2020. Findings: Organizational conflict history (i.e. highly conflict-prone vs less conflict-prone workplaces) interacts with employees' situational perceptions of COVID-19 (i.e. inactive vs active publics) in affecting employees' negative megaphoning and turnover intention toward their organizations. Employees who are active publics on COVID-19 in highly conflict-prone workplaces reported the highest negative megaphoning and turnover intention. On the contrary, employees who are inactive publics on COVID-19 in less conflict-prone workplaces reported the lowest negative megaphoning and turnover intention. Practical implications: COVID-19 is an uncontrollable, exogenous crisis for organizations. While it is expected that employees in highly conflict-prone workplaces would report higher negative megaphoning and turnover intention, this study found that employees' situational perceptions of COVID-19 would further exacerbate the effects. This finding reflects the importance of managing organizational conflicts continuously and preemptively while also segmenting and cultivating relationships with employees based on their situational perceptions of issues and crises. Originality/value: This study identified the significance of the interaction of cross-situational factors (e.g. employees' recollection of organizational conflict history) and situational factors (e.g. employees' situational perceptions of issues) in affecting employees' negative behavioral intentions in crisis situations, even if the crises are exogenous and uncontrollable. © 2021, Emerald Publishing Limited.

9.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S50, 2021.
Article in English | EMBASE | ID: covidwho-1214877

ABSTRACT

Background: During the COVID-19 pandemic, older adults are missing routine care appointments despite increasing availability of telehealth video visits. We conducted a needs assessment of two Residential Care Facilities for the Elderly (RCFE) in Northern California as a first step to improving access to telehealth visits for older community dwelling individuals. Methods: We conducted voluntary surveys of the independent community dwelling adults of two RCFEs. Site A houses residents who are mostly Caucasian and middle and upper middle class. Site B provides subsidized senior housing and serves a large group of residents who are non-English speakers. Surveys ascertained residents' preferred devices as well as comfort level, support, and barriers regarding telephonic and video visits. Results: Of the 700 surveys distributed, 249 surveys were completed and returned (36%). The average age of participants was 84.6 (SD = 6.6) and 77% were female. At site A, 89% of participants had a bachelor's degree or beyond and 99% listed English as their preferred language. At Site B, 43% had a bachelor's degree or beyond, and 13% preferred English while 73% preferred Mandarin. Regarding remote visits, 37% of all participants felt comfortable connecting with their healthcare team through video visits with computer being the most preferred device (23%) followed by smartphone (19%) and iPad/tablet (11%). Regarding perceived barriers, there were substantial differences depending on the site. Participants at Site A reported not knowing how to connect to the platform (24%), not being familiar with the technology (22%), and difficulty hearing (14%) as the top three barriers, whereas for the participants at Site B, the top three barriers were not being able to speak English well (55%), lack of interest in seeing provider outside of clinic (35%), and not knowing how to connect to the platform (35%). Conclusions: Significant barriers exist for older adults in RCFEs with telehealth visits with their care team. The largest barriers include difficulty with technology or using the video visit platform, language barriers, and lack of desire to see provider outside of clinic. Due to site specific differences in reported telemedicine barriers, any intervention to improve access should be tailored to the specific needs of that site.

10.
J Appl Physiol (1985) ; 130(5): 1305-1316, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1211609

ABSTRACT

In the neonatal respiratory distress syndrome (NRDS) and acute respiratory distress syndrome (ARDS), mechanical ventilation supports gas exchange but can cause ventilation-induced lung injury (VILI) that contributes to high mortality. Further, surface tension, T, should be elevated and VILI is proportional to T. Surfactant therapy is effective in NRDS but not ARDS. Sulforhodamine B (SRB) is a potential alternative T-lowering therapeutic. In anesthetized male rats, we injure the lungs with 15 min of 42 mL/kg tidal volume, VT, and zero end-expiratory pressure ventilation. Then, over 4 h, we support the rats with protective ventilation-VT of 6 mL/kg with positive end-expiratory pressure. At the start of the support period, we administer intravenous non-T-altering fluorescein (targeting 27 µM in plasma) without or with therapeutic SRB (10 nM). Throughout the support period, we increase inspired oxygen fraction, as necessary, to maintain >90% arterial oxygen saturation. At the end of the support period, we euthanize the rat; sample systemic venous blood for injury marker ELISAs; excise the lungs; combine confocal microscopy and servo-nulling pressure measurement to determine T in situ in the lungs; image fluorescein in alveolar liquid to assess local permeability; and determine lavage protein content and wet-to-dry ratio (W/D) to assess global permeability. Lungs exhibit focal injury. Surface tension is elevated 72% throughout control lungs and in uninjured regions of SRB-treated lungs, but normal in injured regions of treated lungs. SRB administration improves oxygenation, reduces W/D, and reduces plasma injury markers. Intravenous SRB holds promise as a therapy for respiratory distress.NEW & NOTEWORTHY Sulforhodmaine B lowers T in alveolar edema liquid. Given the problematic intratracheal delivery of surfactant therapy for ARDS, intravenous SRB might constitute an alternative therapeutic. In a lung injury model, we find that intravenously administered SRB crosses the injured alveolar-capillary barrier thus reduces T specifically in injured lung regions; improves oxygenation; and reduces the degree of further lung injury. Intravenous SRB administration might help respiratory distress patients, including those with the novel coronavirus, avoid mechanical ventilation or, once ventilated, survive.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Animals , Humans , Lung , Male , Rats , Respiration, Artificial , Rhodamines , SARS-CoV-2 , Surface Tension
SELECTION OF CITATIONS
SEARCH DETAIL