Telemedicine in the Era of Covid-19: Teleconsultation Architecture Platform

Teleconsultation is a type of medical practice similar to face-to-face consultations, and it allows a health professional to give a consultation remotely through information and communication technologies. In the context of the management of the coronavirus epidemic, the use of teleconsultation practices can facilitate healthcare access and limit the risk of avoidable propagation in medical cabinets. This paper presents the monitoring of international teleconsultation referrals in the era of Covid-19 to facilitate and prevent the suspension of access to care, the most common architecture for teleconsultation, communication technologies and protocols, vital body signals, video transmission, and the conduct of teleconsultation. The aim is to develop a teleconsultation platform to diagnose the patient in real time, transmit data from the remote location to the doctor, and provide a teleconsultation. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Thoughts on diagnosis and treatment plan of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in large shelter hospitals in Shanghai.

The epidemic caused by the infection of severe acute respiratory syndrome coronavirus 2 omicron variant broke out in Shanghai in Mar. 2022. Omicron variant has characteristics such as strong concealment and rapid transmission, resulting in significant differences between the current round of epidemic and that in Wuhan. The number of infected patients (mainly asymptomatic infected patients) increased rapidly in a short term. Based on dynamic zero policy, shelter hospitals were set up in time in Shanghai to treat the patients. It is suggested that medical resources and patient characteristics should be taken into account in the independent cabin of a shelter hospital with more than 10 000 beds, and the clinical medical practice should be divided to 5 modes (universal education and management, community outpatient clinic, ward duty, emergency rescue, and temporary observation and transport) to optimize the allocation of medical resources, so as to further enhance the treatment capacity and efficiency of shelter hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Patient Survey in Medical Practices on their Visit during the SARS-CoV-2 Pandemic.

Background: Since the beginning of the SARS-CoV2 pandemic medical practices have implemented diverse protective measures to contain the pandemic, practice organization and structures were adapted. In order to get information about patients' perception of their doctors' visit during the pandemic, we conducted a patient survey in medical practices. Method(s): Cross-sectional study of 58 patients, who were interviewed in four medical practices (family physicians and specialists) in the South West of Munich from 02.04.-17.04.2020 on the following topics: "personal risk assessment", "sense of security and perception of protection measures in the practice setting", "importance of the doctor's visit" and "change of medication, nicotine consumption". By means of a questionnaire with 24 items, data were collected anonymously. Results are presented descriptively and via ANOVA as well as via linear regression. Result(s): The personal risk assessments for COVID-19-disease and for a severe course of COVID-19 were rated low moderate, independent of sex or age. Around 8% of the surveyed patients discussed their personal risk with their doctors. The sense of security in the practice setting was rated high. The rating of the protection equipment was good as well, and closely met expectations. The personal importance of the visit varied. Only 6% had considered cancelling their visit beforehand. A change of medication due to SARS-CoV-2 pandemic was not observed. Conclusion(s): The patient survey provides a snapshot of the outpatient setting from the patient's perspective in a hyperdynamic pandemic situation. Yet, due to the small study population, the results have to be interpreted with caution.Copyright © 2021, Deutscher Arzteverlag.

Enoxaparin Sodium Biosimilar in the Prophylactic Treatment of Veinous Thromboembolism and Thromboembolic Disease: Prophyvar Study

Objectives: Varenox is the first locally manufactured and approved biosimilar in Algeria. It is an enoxaparin sodium (ES) with established good analytical characterization and manufacturing quality control. The aim of the PROPHYVAR study was to generate real-life data in routine practices and to assess the safety and tolerability in the prophylaxis of venous thromboembolism (VTE). Method(s): This is an observational, prospective, multicenter study, conducted between April 2021 and May 2022. The primary safety outcome was the incidence of Adverse Events (AEs) related to the study drug. A sample size of 500 patients was calculated to estimate the proportion of patients with AEs. Assuming that approximately 10% will be lost to follow-up or not evaluable, 550 patients were needed to describe the impact of Varenox use. Result(s): The study was conducted in 25 different sites in Algeria, in 4 therapeutic areas: ICU, orthopedic surgery, obstetrics and nephrology;550 patients were included and received at least one injection of Varenox. The mean age was 47 years, women in majority (62.5%). The patients were overweight or obese (53%), with a history of arterial hypertension (25%), diabetes (7.5%) and renal failure (6.4%). Reasons for hospitalization were mainly fracture (15.5%), pregnancy (8.3%), COVID-19 (7%) or cancer (7%). The majority of patients were treated at prophylactic dose of 0.4ml (80%) or 0.6ml (10%). The median duration of follow-up was 24 days. A total of 38 patients experienced at least one AE (6.9%, CI95=[4.9%;9.4%]). Related AEs were reported in 10 patients (1.8%), mainly in nephrology (N=7 arterio-venous fistula). VTE events were reported in 6 patients (1.1%, CI95=[0.2%;2%]). Conclusion(s): This study suggests that Varenox is safe in the prophylaxis of VTE. To our knowledge this is the first large study describing the use of ES in current medical practice in Algeria.Copyright © 2023

The Study of 'Preparation Guidelines' Towards Phetchabun Government Officers and Health Massage Establishments

The purpose of research was to study practices, barriers, and solutions of Phetchabun health massage establishments under COVID-19 situation. Non-participant observation, informal interview, in-depth interview, and participation observation were carried out respectively. Purposive sampling was used with 15 health consumer protection officers in charge;11 district level, 2 provincial level, 2 regional level as well as each representative of 11 districts. Results after implementation of "Preparation Guidelines for Health Spa, Health Massage, and Beauty Massage to Promote Health Tourism During COVID-19 Pandemic" were categorized into two sections. Firstly, the practices, barriers, and solutions of government officer performances included preparation for reopening, monitoring of the provider practices, and performance report. Secondly, the provider operations consisted of doing "Self-Assessment of Health Establishment", logging-in webpage before reopening, and practices for clients included screening and report of patients under investigation, establishment monitor, service, and establishment cleaning. In summary, the preparation guidelines were purposed to reopen their business with numerous contents and messages written by official language, it caused establishment providers and practitioners difficultly understood when applying. LINE Application and making calls were easy and accessible methods for their communication to reach current data and to ensure exact information. Various encouragements and having compliments were also considerable to form trust and confidence among them, they also raised their proud.Copyright © 2023, World Informations Syndicate. All rights reserved.

Thoughts on diagnosis and treatment plan of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in large shelter hospitals in Shanghai

The epidemic caused by the infection of severe acute respiratory syndrome coronavirus 2 omicron variant broke out in Shanghai in Mar. 2022. Omicron variant has characteristics such as strong concealment and rapid transmission, resulting in significant differences between the current round of epidemic and that in Wuhan. The number of infected patients (mainly asymptomatic infected patients) increased rapidly in a short term. Based on dynamic zero policy, shelter hospitals were set up in time in Shanghai to treat the patients. It is suggested that medical resources and patient characteristics should be taken into account in the independent cabin of a shelter hospital with more than 10 000 beds, and the clinical medical practice should be divided to 5 modes (universal education and management, community outpatient clinic, ward duty, emergency rescue, and temporary observation and transport) to optimize the allocation of medical resources, so as to further enhance the treatment capacity and efficiency of shelter hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Evolution in Infectious Causes of Death in Liveborn Children in a Major Tertiary Children's Hospital: A Retrospective Autopsy Review of over 1200 Cases

Background: Infections have historically been a leading cause of death, particularly in children. Medical advances, including vaccines and antimicrobials, have significantly decreased infection-related deaths, but infections remain a cause of pediatric mortality, especially in premature infants. The types of infections implicated in childhood deaths have changed with these advances, for example, meningitis and meningococcal infections were leading causes in 1981 but not in the later period. The incidence and etiologies of infection- related deaths may be altered by major events that modify not only medical practices but also societal attitudes and activities. Examples of such events include the HIV/AIDS epidemic that began in the early 1980s and the more recent COVID-19 pandemic. In order to investigate changes in infection-related pediatric deaths over time, we analyzed and compared autopsy cases performed during 5-year span prior to both the HIV/AIDS epidemic and the COVID-19 pandemic in which infections contributed to death. Method(s): Review of all autopsy cases performed at our institution between 1/1/1975-1/1/1980 and between 1/1/2015-1/1/2020 was performed to identify cases in which infection directly contributed to death, comprising 1262 cases. Only liveborn children were considered, and neonatal sepsis from amniotic sac infections was excluded. Comparison of decedent characteristics and infectious etiologies between the two time periods was performed, identifying age, race, sex, gestational age (for decedents less than 3 months of age), and etiologic class of agent (bacterial, viral, fungal or parasitic). TORCH infections and vaccine-preventable illnesses were specifically assessed. Proportions were compared using 1 (assessing TORCH, vaccine-preventable, and prematurity deaths)- or 2-tailed (all others) z-tests, with significance calculated at the < 0.05 level. Result(s): In the 1970s cohort, 300 infectious autopsy cases were identified in liveborn children;73 were identified in the 2010s. Compared to the 2010s cohort, the 1970s decedents were more likely to be white (85% v 53%, p=0.012), comprise children aged 1-5 and 13+ (22% v 6.8% [p=0.003] and 16.4% v 8.3% [p=0.036]), and were less likely to be premature (66.7% v 80.4%, p=0.039). Vaccine-preventable illnesses (for example: measles) accounted for 36 deaths in the 1970s cohort but only 2 in the 2010s cohort (p=0.009). Thirteen children died of TORCH infections (CMV, toxoplasmosis and HSV) versus 5 in the 2010s (CMV and HSV), which did not reach statistical significance. Conclusion(s): Pediatric mortality secondary to infections has decreased significantly compared to fifty years ago, especially in younger children and in relation to vaccine-preventable infections such as meningococcal disease. This drop is largely attributed to medical advances, including vaccines and antimicrobial medications. Additional contributing factors could include practices adopted post-HIV/AIDS, especially in the community. Further exploration of how such changes in medical and social practice impacted mortality and comparing them to changes occurring in the intra/post-COVID-19 era, is helpful. Yet, with the increased survival of premature infants, they remain at risk of devastating consequences from infections.

Some key aspects of telemedicine development to support human illness: a systematic review

The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.

Annual Retention Survey Results

Fiona Ellwood looks at the current recruitment landscape.

Augmented Reality for medical practice: A comparative study of Deep learning models for Ct-scan segmentation

The coronavirus disease has hardly affected medical healthcare systems worldwide. Physicians use radiological examinations as a primary clinical tool for diagnosing patients with suspected COVID-19 infection. Recently, deep learning approaches have further enhanced medical image processing and analysis, reduced the workload of radiologists, and improved the performance of radiology systems. This paper addresses medical image segmentation;we present a comparative performance study of four neural networks 'NN' models, U-Net, 3D-Unet, KiU-Net and SegNet, for aid diagnosis. Additionally, we present his 3D reconstruction of COVID-19 lesions and lungs and his AR platform with augmented reality, including AR visualization and interaction. Quantitative and qualitative assessments are provided for both contributions. The NN model performed well in the AI-COVID-19 diagnostic process. The AR-COVID-19 platform can be viewed as an ancillary diagnostic tool for medical practice. It serves as a tool to support radiologist visualization and reading. © 2022 IEEE.

[Medical care in GP practices during the Covid-19 pandemic: A questionnaire-based survey among general practitioners and medical practice assistants asking for their opinion about changes, needs and burdens]. / Die hausärztliche Versorgung während der COVID-19-Pandemie: eine Fragebogenerhebung unter Hausärzt*innen und Medizinischen Fachangestellten zu ihrer Perspektive auf Veränderungen, Bedarfe und Belastungen.

INTRODUCTION: The coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic. METHODS: In March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire. RESULTS: 657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively). DISCUSSION: General practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care. CONCLUSION: The subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.

Generation of waste personal protective equipment (PPE) related to COVID-19 using quantitative forecasting technique.

With the prolonged COVID-19 pandemic worldwide, lifestyles have totally changed and the characteristics of waste generation have also changed accordingly. Among the various wastes related to COVID-19, waste personal protective equipment (PPE), which was used to prevent infection of COVID-19, can be an indirect route for the infection of COVID-19. Hence, it requires proper management with estimating waste PPE generation. In this study, the estimation of generation amount of waste PPE in consideration of lifestyle and medical practice is proposed by quantitative forecasting technique. In the quantitative forecasting technique, the generation source of waste PPE consisted of household and test/treatment of COVID-19. For case study in Korea, the amount of waste PPE generated from household is evaluated by applying the quantitative forecasting technique reflecting the population and measures in lifestyle due to COVID-19. Also, the estimated amount of waste PPE generation from test and treatment of COVID-19 was evaluated to have a meaningful reliability compared with other observed values. This quantitative forecasting technique can estimate the amount of waste PPE generation related to COVID-19 and develop safe management measures for waste PPE in many other countries by modifying country-specific lifestyles and medical practices.

OSA patients' opinions concerning their disease and treatment during the pandemic

The COVID-19 pandemic has changed the operation of healthcare systems worldwide reducing hospital based services, and increasing telemedicine solutions for the diagnosis and treatment of obstructive sleep apnoea (OSA). Aim(s): to evaluate the opinion of OSA patients concerning their disease during the COVID pandemic,their treatment and follow up. Method(s): A telephone questionnaire based survey was conducted on OSA patients treated with CPAP including basic information (age, gender, marriage, education level, etc.), opinion towards the changes of medical practice during the pandemic, history of OSA, Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), DAR-5 (anger), PHQ-4(depression and anxiety), Heaviness of Smoking Index (HSI) and Loneliness scale (LS). Adherence on CPAP was assessed objectively by telemonitoring. Result(s): 100 OSA patients 54.3+/-12.5 years (72% males) were evaluated presenting with ESS: 4.3+/-2.95, AIS: 3.14+/-3.3, PHQ-4: 2.29+/-1.72, DAR-5: 6.7+/-1.95 and HSI 3.5+/-.1.7. Mean CPAP use was 5.8+/-1.65 with 2.9+/-2.5years OSA history (96% used CPAP the same as before the pandemic). 41% considered themselves as high risk group for severe disease due to COVID because they suffered from OSA, and 25% believed CPAP could be protective from COVID. Patients infected with COVID (31%) did not change their CPAP use. 30% believed they received worse healthcare facilities than before and 16% presented worse sleep quality. Conclusion(s): During the pandemic, OSA patients continued to use their CPAP as before;however they believed that they should have better healthcare facilities. They considered themselves as a high risk group for COVID infection.

Estimands and their Estimators for Clinical Trials Impacted by the COVID-19 Pandemic: A Report from the NISS Ingram Olkin Forum Series on Unplanned Clinical Trial Disruptions

The COVID-19 pandemic continues to affect the conduct of clinical trials globally. Complications may arise from pandemic-related operational challenges such as site closures, travel limitations and interruptions to the supply chain for the investigational product, or from health-related challenges such as COVID-19 infections. Some of these complications lead to unforeseen intercurrent events in the sense that they affect either the interpretation or the existence of the measurements associated with the clinical question of interest. In this article, we demonstrate how the ICH E9(R1) Addendum on estimands and sensitivity analyses provides a rigorous basis to discuss potential pandemic-related trial disruptions and to embed these disruptions in the context of study objectives and design elements. We introduce several hypothetical estimand strategies and review various causal inference and missing data methods, as well as a statistical method that combines unbiased and possibly biased estimators for estimation. To illustrate, we describe the features of a stylized trial, and how it may have been impacted by the pandemic. This stylized trial will then be revisited by discussing the changes to the estimand and the estimator to account for pandemic disruptions. Finally, we outline considerations for designing future trials in the context of unforeseen disruptions.Copyright © 2022 American Statistical Association.

Telemedicine applications in diabetology: Digital consulting hours and online training-implementation in daily practice.

Since the start of the coronavirus disease 2019 (COVID-19) pandemic-related restrictions, digital consultation hours and online training have become an integral part of the care of people with diabetes in both in- and outpatient practices specializing in diabetes. Despite advancing digitalization and the use of modern diabetes technology, only a few model projects and specialized practices with dedicated diabetes teams were previously using these new communication options. With the improvement of the technology, the framework conditions, the expansion of the information technology (IT) infrastructure and, above all, the expectations of the patients, the digital consultation hour is also, even after COVID-19, a good addition and alternative to in-person consultations. To start digital consultations requires careful preparation. In addition to personal willingness to expand patient communication, appropriate structural and process quality standards are necessary in medical practice. Legal requirements, technical prerequisites, and integration into the existing practice workflow must be implemented. Digital consultation hours and online training are presented from the perspective of a diabetes consultant and diabetologist from a practice specializing in diabetes. Difficulties at the beginning, practical tips for a successful start, the advantages of video consultation, and problems in daily practice routine are presented. Demographic developments, increasing prevalence of diabetes, fewer treatment facilities, diabetologists and diabetic teams, location-independent consultation, and also the expectations of our patients support the implementation of digital consultation hours in daily practice. Although not yet optimal, the significantly improved remuneration is also an incentive for the new developments in communication. Treatment structures in diabetology practice and treatment success are improved by digital consultation hours.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Monte Carlo Dropout for Uncertainty Analysis and ECG Trace Image Classification

Cardiovascular diseases (CVDs), such as arrhythmias (abnormal heartbeats) are the prime cause of mortality across the world. ECG graphs are utilized by cardiologists to indicate any unexpected cardiac activity. Deep Neural Networks (DNN) serve as a highly successful method for classifying ECG images for the purpose of computer-aided diagnosis. However, DNNs can not quantify uncertainty in predictions, as they are incapable of discriminating between anomalous data and training data. Hence, a lack of reliability in automated diagnosis and the potential to cause severe decision-making issues is created, particularly in medical practises. In this paper, we propose an uncertainty-aware ECG classification model where Convolutional Neural Networks (CNN), combined with Monte Carlo Dropout (MCD) is employed to evaluate the uncertainty of the model, providing a more trustworthy process for real-world scenarios. We use ECG images dataset of cardiac and covid-19 patients containing five categories of data, which includes COVID-19 ECG records as well as data from other cardiovascular disorders. Our proposed model achieves 93.90% accuracy using this dataset. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction

Collaboration and teamwork are well-established cornerstones of modern clinical and academic medicine as well as research, including radiology. Mentorship is also part and parcel of daily medical practice and training. As it is, there is a wide range of opinions on the effectiveness of standard mentorship models. In some cases, academic departments may offer mentorship to fulfill a requirement rather than as a sign of commitment to ensuring that all mentees receive the guidance they seek. Although mentor-mentee relationships might have arisen organically, and such situations are still possible, the overall lack of face-to-face interactions in many departments in the COVID era suggests the need to emphasize formal mentoring programs. We appreciate the overall successes of mentorship in medicine as well as radiology, while acknowledging that, like anything, it is not perfect. Because the processes of decision making and career planning are similar across fields, a peer-to-peer cross-specialty mentorship model could yield untold benefits to early-career radiologists who may receive valuable advice from friends or colleagues outside of medicine, or simply outside of radiology, at crucial points in their careers. There is no ideal formula or format for mentoring, however. We endorse the theory or intentions of mentorship and believe that its effectiveness can take several forms. Having a formal program in place, with built-in flexibility to address our rapidly changing times, remains highly desirable. Our proposal is to expand this notion to a "whatever works,” "anything goes,” or, in the spirit of the COVID era, a hybrid model. © 2022 Elsevier Inc.

Supporting staff at a low secure mental health setting during the COVID-19 pandemic

Why you should read this article: • To learn about some adaptations to practice adopted by a low secure mental health unit during the COVID-19 pandemic • To be aware of interventions used to enable staff to continue to support patients during the COVID-19 pandemic • To appreciate that staff's experience of the adaptations to practice and the well-being support offered to them during the pandemic can be used to inform post-pandemic practice The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted the work of healthcare professionals in forensic mental health settings, but also prompted them to adopt new ways of working that have benefits and challenges. A low secure mental health unit in the UK adapted its ways of working during the pandemic by providing staff who could work remotely with the necessary equipment. The unit also implemented a stepped psychological response, as recommended by The British Psychological Society, to assist its staff to continue to support patients. This article describes the unit's response to the pandemic and discusses the findings of two evaluations – staff experiences of remote working and of a group relaxation session. The findings could help inform post-pandemic practice in forensic mental health settings.