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Background The pandemic has accelerated the introduction of more flexible and cost-effective treatment forms. The efficacy of trastuzumab in the intravenous (IV) and SC forms is similar both in early and advanced HER2-positive breast cancer (BC) patients. Compared to IV administration, SC enables reduction of treatment costs and time, and saves equipment and human resources. SC formulation is more convenient for both patients and healthcare providers and may be implemented as a home-based therapy. Recently, systemic anticancer treatment (including chemotherapy) has been increasingly performed at home, improving patient comfort and reducing the burden on the healthcare system. Poland has already implemented home-based treatment with some biologic compounds;however, they have not included trastuzumab in BC patients. Objectives This RWE analysis aims to evaluate the organizational and therapeutic procedures related to the home-based treatment with SC trastuzumab and the attitudes of patients and healthcare providers to this approach. Material and methods The study enrolled early HER2(+) BC patients treated with trastuzumab during the COVID-19 pandemic. Monitoring and treatment duration were consistent with SmPC and reimbursement regulations in Poland. The first 3-6 doses of SC trastuzumab (alone or in combination with CHT) were administered at a cancer center in outpatient and inpatient settings. Subsequent doses were administered at home by 3 qualified breast nurses. Post-injection follow-up was used for educational purposes. Data were analyzed with descriptive statistics. The study was reviewed and approved by the local Bioethics Committee. Results The analysis included 20 patients treated in two comprehensive cancer centers in Poland with a median age of 59 years (range, 36-72 years). Seven patients (35%) were professionally active. The average distance from the place of residence to the cancer center was 24 km (range, 2-65 km). A total of 232 doses were administered (mean 11.6 doses per patient;range 6-14), 133 doses at home and 99 at the cancer center. The overall tolerance of trastuzumab was good and consistent with the known safety profile described in Summary of Product Characteristics. Only 1 patient (5%) discontinued treatment prematurely due to decreased LVEF;another 19 patients completed treatment as planned. For 19 patients (95%), the benefits of SC treatment included time savings, the ability to continue working, and avoiding crowded places and infection risk. 2 patients (10%) considered the nurse's visit privacy disturbing, while 18 (90%) would recommend home-based drug administration. The average duration of a nurse's stay at home was 60 minutes (range 30 to 130 minutes). No logistical or technical problems were reported, except for occasional patient lateness. Nurses positively assessed the treatment provided in the nursing office, which was a source of additional knowledge, and experience. The overall impression of home-based therapy was positive for both patients and nurses. The limitation of the study is the declarative nature of the data. Conclusions Home-based treatment with SC trastuzumab should be pursued due to its safety, ease of organization, positive perception by patients and nurses, and reducing healthcare system resources. It can be particularly valuable for disabled patients who have difficulty reaching the hospital and professionally active patients. Specialized, trained nurses can self-sufficiently carry out part of the prolonged trastuzumab treatment, reducing physician involvement.
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Cancer has become one of the major causes of death in the growing world population, affecting people irrespective of their age, sex and culture. Cancer diagnosis and therapy is a distressing procedure and affects the physical, emotional and mental well-being of the patient. Many studies have reported that cancer has a long-term impact on patient's lives leading to mood dysfunction, heart problems and chemotherapy toxicity. Modern-day healthcare systems are moving towards a patient-oriented approach and are designed around the patient's well-being, needs and preferences. Oncology nurses form the fundamental part of this system and provide the patient with the much-needed care, support and hope for life. Oncology nursing has developed and evolved briefly in the recent few decades due to the advancement in treatment procedures. As cancer care continues to progress, nurses play a vital role in the field of oncology. Specialized oncology nurses are providing clinical care, or as nurse researchers leading revolutionary oncology research. The future of oncology nursing is optimistic. Nursing care for cancer patients not only requires guidance through medication and treatment, but also offers encouragement and motivation to the patients. The present review provides an insight into the nursing care of cancer patients, its brief history, advancements and the current practices of oncology nursing. Future prospects of oncology nursing have also been discussed in detail.Copyright © 2022, Kuwait Medical Association. All rights reserved.
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Aim/Introduction: Technegas is fast becoming the gold standard for lung ventilation scintigraphy in Canada. Technegas is a carbonbased nanoparticle bound to 99mTc which is small enough to behave more like a gas than an aerosol. Due to its small size, Technegas can easily perfuse the peripheral airways and does not aggregate in the central airways like larger aerosol particles often do. Furthermore, since the Covid-19 pandemic began, there has been a significant drop in ventilation studies performed due to the risk of exposure to the virus when using traditional aerosols. Improved image quality, fast and easy administration, enhanced patient comfort, and ability to safely administer Technegas with Covid-19 positive patients makes Technegas far superior to traditional Tc-based aerosols. Material(s) and Method(s): A review of the literature comparing Technegas to other commonly used 99mTcbased lung ventilation imaging agents was conducted. Recent purchasers of Technegas units were interviewed to determine their motivation for switching to Technegas and their overall impression with using it after changing over. Result(s): The small particle size, reduced central airways deposition, and lack of lung clearance leads to improved count-statistics and better target-to-non-target ratio, which allows for SPECT imaging, which is not feasible when using traditional aerosols. Technologists report that administering Technegas is far easier and faster than administering traditional aerosols. Often patients only require 1 or 2 breaths of Technegas to achieve the desired count rate, as opposed to 5 or more minutes of breathing an aerosol. Technegas is a 'dry' aerosol, which means that it is considered a non-aerosol generating procedure, so it is safe to use on Covid-19 positive patients. Justifying the small start-up cost to purchase a Technegas generator was the limiting factor for departments delaying their switch to Technegas. Canada's health care system is publicly-funded, which often delays widespread access to technological advancements. The Covid-19 pandemic has increased demand for Technegas across Canada, which has resulted in increased funding to purchase more Generators. Conclusion(s): Technegas is far superior to other 99mTc-based aerosols used in ventilation imaging and is fast replacing Tc-based aerosols as the agent of choice in nuclear medicine departments across Canada.
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Aim: In the context of the COVID-19 pandemic, the radiation oncology department at our institution aimed to adapt its approach by analyzing and expanding the use of hypofractionation in order to be able to continue treating patients according to prescribed timelines, to reduce the risks of patient and staff exposure to COVID-19 and minimize the risks of service interruptions due to departmental outbreaks. Process: Site specific treatment groups were asked to review existing literature on hypofractionation. Practice guides were then developed for each tumour site and a hypofractionation policy was created. To ensure close follow-up of this policy, weekly meetings were established in each treatment group in which all cases were reviewed. The use of non-hypofractionated schedules had to be justified by the treating physician. Data were collected to analyze the impact of these measures on the service. Patients were surveyed to gauge the level of safety felt during their treatments. Benefits/Challenges: When the same number of patients treated per year is maintained, hypofractionation increases availability at treatment machines, allowing reallocation of human resources. For example, technologists could be allocated to other tasks such as quality improvement initiatives, patient education and research. Hypofractionation also reduces overall costs to cancer programs, where potential savings from the reduced costs could be reinvested in new technologies and radiotherapy equipment. Fewer fractions also increase patient comfort, reduce the number of visits and improve waiting room management. This approach also increases the capacity to prepare for the next wave of patients that is anticipated post-pandemic due to decreased access to diagnosis and care during the past two years. Impact/Outcomes: The use of hypofractionation quickly became common practice in our centre. In only a few months, the number of fractions given per new treatment start fell from 10.81 in 2019-2020 to 8.29 in 2020-2021. The sustainability of this practice change is maintained, as hypofractionation is now standard practice for most tumour sites at our institution. Satisfaction amongst patients regarding this change during the first wave of the pandemic was very high (70% very satisfied and 30% satisfied). Radiotherapy centres facing human resource shortages as well as the health care network as a whole would benefit from expanding the use of hypofractionation in their centres. Copyright © 2022
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Aim: Extended reality (XR) is a spectrum of technologies encompassing augmented reality (AR), virtual reality (VR), augmented virtuality (AV), mixed reality (MR). This scoping review maps out current utilisation and future prospects of XR-assisted surgery. Method: A systematic search of PubMed, Scopus, Embase was performed. Primary studies describing surgical procedures on human subjects, dentistry, anaesthetic procedures for surgery were included. Non-surgical, rehabilitation, bedside, veterinary procedures, robotic surgery were excluded. Studies were classified into preoperative planning, intraoperative navigation/guidance, patient pain, patient anxiety, surgical training, surgeon confidence. Results: 213 studies were included for analysis. Thirty-six studies on pre-operative planning noted VR improved surgeon's understanding of anatomical sites, leading to reduced operating time and surgical trauma. Fifty-nine studies on intra-operative planning noted AR headsets highlight 'negative structures', reducing chance of accidental incision. Fourteen studies on patients' pain found VR-induced meditative state resulted in less analgesics for patient comfort. Twelve studies on patient anxiety found VR failed to change patients' physiological parameters such as arterial blood pressure, cortisol levels, heart rate. Sixty-eight studies explored surgical training, with VR being most cost-effective. Thirteen studies documented increased surgeon confidence. Conclusions: XR-assisted surgery's growth is fuelled by hardware and software innovations. Training and pre-operative planning are mostly achieved by VR;intraoperative guidance is mostly supplemented with AR. The other sections of XR spectrum, AV and MR, are underexplored. Working time restrictions during surgical training, COVID-19's impact on limiting physical presence and increasing complexity of surgical procedures means that XR-assisted surgery may assume a greater role in coming decades.
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Background: Awake prone positioning (APP) under CARP protocol is widely used in the management of patients with coronavirus disease (COVID-19) in recent years. The primary objective of this study was to compare the outcome. Aim: Compare the outcome of COVID-19 patients who received early versus late awake prone position in terms of oxygenation, patient comfort, increased nonventilatory days, and final outcome. Settings and design: Single centre, retrospective and observational study. Materials and methods: Analysis of data collected for a randomized controlled trial in adult patients with acute hypoxemic respiratory failure secondary to COVID-19, who received awake prone positioning under CAPR protocol for minimal one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. 50 patients were included in the study. Primary outcomes were patient comfort, hospital stay, complications during ICU stay, 28-day mortality, and intubation rate. Statistical analysis: Data analysis was done using SPSS software. P value < 0.05 was considered statistically significant. Results: We included 50 patients between the ages of 18 and 60 years. The early APP group had lower mortality compared to the late APP group but no difference was found in intubation rate. Advanced age, intubation, longer time to initiate APP were associated with increased mortality. Conclusion: Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival.
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Background and aims: Primary Biliary Cholangitis (PBC) is a chronic, cholestatic, autoimmune liver disease, which can have a profound impact on patients’ quality of life and a significant demand for healthcare services. PBC management guidelines were published in 2017 by European Association for the Study of the Liver (EASL), which include recommendations for daily dosage (13–15 mg/kg) of licensed first-line therapy (ursodeoxycholic acid (UDCA)) and referrals for alternative treatment if UDCA response is inadequate, of which obeticholic acid (OCA) is the only licensed treatment alongside other re-purposed agents. This study explored the efficacy of patient-clinician collaborations to manage PBC in accordance with EASL guidelines from a patient perspective. Method: A closed question questionnaire was designed focussing on the application of treatments and the inclusion of patients in the management of their PBC. The questionnaire was piloted with PBC Foundation service users during a focus group testing its reliability and face validity. A convenience sample was used and participants recruited via the PBC Foundation’s app during March 2022. Intercept Pharmaceuticals provided financial support and input into the questionnaire, however the PBC Foundation has retained editorial discretion over survey outputs. Results: 172 patients completed the survey. 154 respondents (90%) take UDCA and 132 respondents (77%) received a timely UDCA prescription (0–3 months after diagnosis). 91% of UDCA patients believe they are taking the recommended dosage however only 54% of UDCA patients report taking dosage within guidelines. Of those patients who are unresponsive or intolerant to UDCA, 68% were offered alternative treatment and 57% were included in discussions about the most suitable option. 22% of all patients take 2nd line treatment (5% OCA and 17% unlicensed). 8% of all patients take no treatment for PBC management. 54% of patients had no access to face-to-face clinical appointments and 39% had appointments delayed or cancelled during the COVID pandemic. Patient comfort in raising PBC related queries ranges from 86% in face-to-face meetings, 46% on the telephone and 31% on screen-calls. Latest blood test results were discussed with 73% of patients. 50% of patients believe they understand their test results and 40% say their test results help them manage their PBC. Conclusion: Unmet PBC patient needs are evident in numerous stages of the life-long clinical journey. Data indicates substantial disparity between published PBC treatment guidelines and actual care delivered to patients, particularly relating to optimal application of PBC management therapies and patient inclusion in important discussions (test results and further treatment referrals). Unmet needs have been exacerbated during the COVID pandemic when timely appointments in patients’ preferred formats were adversely affected.
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Objectives: Investigating the impact of COVID-19 pandemic on oral health and patient attitudes towards a dental visit is essential to improving access to oral health care during the pandemic. This calls for studying the chief patient fears, preferences and future intentions related to dental visits during the COVID-19 pandemic. Methods: A web-based survey was administered to the public within the US in December 2020. The participants (N=502) answered questions about their oral health, trust level for dental offices, and chief concerns and preferences related to dental visits during the COVID-19 outbreak. We used descriptive statistics (e.g., Chi-square, Shapiro-Wilk and Kruskall-Wallis tests) to find if demographics, oral health history or social behaviors were associated with the relevant patient attitudes. Results: When queried about COVID-19's impact on oral health, 62.5% respondents reported a minimal impact, 7.2% a positive impact, and 30.3% a negative impact. There were statistically significant differences in responses based on respondents' ethnicity (N=502, P=.033) and dental visit history during the pandemic (N=502, P=.008). The public trust rating for COVID-19-related precautions was more favorable towards the medical offices than the dental offices (N=502, P<.001). The majority considered contracting COVID-19 from the other patients in the dental office waiting area (60.4%), from the dentist/hygienist/dental assistants (54.2%), and from the aerosols (50.8%) as their chief concerns. 20.1% respondents preferred no other patient, 25.1% only one more patient, and 31.1% up to three more patients in the waiting area during a dental visit. Conclusion: The reported impact of COVID-19 on self-perceived oral health was modest for most respondents. Patients' chief concerns for a dental visit include contracting COVID-19 infection from other patients, dentists, and aerosols in the operatory. It may be beneficial if dental practices avoid scheduling multiple patients in the waiting area to improve access to oral health care. © 2022 Mahmood, M.
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During the COVID-19 pandemic sexual health services have adapted swiftly to ensure continued provision of essential services. To protect patients and staff, face-to-face appointments were replaced by remote telephone consultations where possible. We report our experience in a busy sexual health clinic of a novel, remote telemedicine service intended for the assessment of visible genital skin lesions. We carried out a retrospective study evaluating diagnoses and outcomes for patients assessed remotely between 03/2020 & 03/2021,01/2022 & 02/2022. Patients who reported genital lumps,where appropriate, were invited to send images for review. A total of 372 and 53 images were studied for 2020/2021 and 2022 review periods respectively. 289/372 (78%) & 47/ 53 (89%) images were of good quality, patients were able to be managed remotely (n=189, 65%) & (n=35, 74%) with a remote prescription and treatment plan for genital warts. A total of 91 patients required face-to-face review, however, only 75 patients attended in 2020/2021 review, which in 67 cases was due to poor-quality images and in 8 cases due to other service needs. See Tables1&2. While we have received a small number of patients feedback responses, the majority found the service convenient and would use it again. Our findings indicate that telemedicine has allowed us to remotely diagnose and safely manage many patients with genital dermatoses, thereby avoiding 289 and 47 faceto- face appointments for review periods respectively. Its advantages include convenience, accessibility, and patient comfort. Moving forward, telemedicine can be used as an adjunct to the existing sexual health services in the post COVID era. (Table Presented).
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Background: Explosive growth in the use of telemedicine occurred during the coronavirus disease 2019 (COVID-19) pandemic. To benefit from telemedicine, patients must have the capacity to engage with technology, for which inexperience and access may pose barriers particularly in older adults. Telemedicine also has the potential to lessen healthcare burden in this population due to frequent appointments, physical and cognitive disabilities, and reliance on caretakers. This study aimed to better understand the perspectives of older women with non-metastatic breast cancer on telemedicine, in regards to visit convenience, completeness, and interpersonal satisfaction. Methods: In this qualitative study, semi-structured interviews were conducted in a convenience sample of women age 65+, postprimary treatment for Stage I-III breast cancer, who received in-person outpatient care at NCCH (NC Cancer Hospital) before transitioning to telemedicine after March 2020. Patients were interviewed about their perceptions of telemedicine (telephone, video) as compared to in-person visits. Audio files of interviews were transcribed and reviewed to identify themes established a priori in the interview protocol. Results: 15 patients (telephone=5, video=10) were consented and interviewed (July-October 2021), mean age=74. 87% (13/15 participants) reported that they preferred a hybrid care model that included telemedicine care over in-person care alone. COVID-19, physical disability, and transportation burden were associated with telemedicine preference. Comfort with familiar patient-provider interaction and lack of physical exam were associated with in-person appointment preference. In-person appointment was favored early in the postprimary treatment phase;telemedicine was more acceptable when relationships were well-established, and patients had lower illness anxiety. All participants who had appointments via video preferred it over telephone, whereas some participants who had telephone visits wanted to use video but faced technological challenges in its use. Conclusions: Patient-clinician conversations and clinic protocols guiding decisions about the use of telemedicine should take into account newness of diagnosis, patient comfort and familiarity with the care team, travel burden, disability, and an explanation as to whether the physical exam is or is not essential.
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The Covid-19 pandemic has boosted telemedicine (TLM) for acute and chronic neurological disorders and it has demonstrated its cost/efficiency benefits. Before the Covid-19 pandemic, TLM was used mainly for the acute stroke management to deliver thrombolysis and select mechanical thrombectomy in rural and underserved areas. To the opposite, experiences for chronic neurological disorders were limited before the Covid-19 pandemic. Covid-19 pandemic suggests to re-think neurological practices. Therefore, it was observed that neurological diseases are compatible with tele-consultation, teleassistance and tele-expertise, because clinical symptoms are accessible to simple questionnaires, functional scales and expert visual observation. The new use of TLM has demonstrated its efficiency for stroke but also for chronic neurological diseases as Multiple Sclerosis, Epilepsy, Parkinson and Alzheimer diseases, Atrophic Lateral Sclerosis, Myasthenia gravis, neuromuscular diseases, post-traumatic lesions and psychiatric disorders. Moreover, TLM is safe, it allows treatments changes, it protects patient confidentially, it safeguards the privacy of participants. TLM improves quality of life, allowing to the patients to hold the tele-visit in familiar environment in a multidisciplinary approach, with a strong correlation compared with the equivalent face-to-face visit. This new medical practice provides multiple consequences: TLM training is necessary, and governments, health care systems and payers should be encouraged to continue to develop its generalization. Conclusion: TLM for acute and chronic neurological disorders presents 4 advantages: better access to care, greater convenience, enhanced patient comfort, better confidentiality. TLM must become a new normality rather than exception, while standard operating procedures and legal framework are essential.
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Introduction & Objectives: NMIBC surveillance incurs a heavy burden on patients and the health system. Bladder EpiCheck is a non-invasive urine test with HG sensitivity=86%, specificity=86% and HG NPV=99%[i]. The objective of the BE Home pilot is to assess the feasibility and clinical outcomes of alternating between cystoscopy/cytology and Bladder EpiCheck sent from home in NMIBC surveillance. [i] Lozano et al. EAU19 poster 709 Materials & Methods: This is a retrospective medical records analysis performed on Dec20 on all BE Home pilot patients (Figure 1a). (Figure Presented) Results: 74 kits were allocated to 61 patients from Jan19 (Figure 1b, Table 1). Of 61 tests performed, 57 had a result and 45 had ≥1 FU visit with median FU of 8.5m. Test performance, n=45: · 100% HG sensitivity (3/3 HG/MIBC, 4/4 susp. HG) · 20% LG sensitivity (0/2 LG, 1/3 susp. LG) · 88% specificity (29/33) 9% (6/67) did not perform the test, 7% (4/60) performed a cystoscopy despite a negative test result due to planning issues, thus avoiding 76% of unnecessary cystoscopies. 43% (6/14) patients were not seen within 2m of a positive test result, 3 due to patient considerations and 3 due to COVID-19 related delays. All patients maintained their pre-test surveillance frequency. (Table Presented) Conclusions: Following-up NMIBC patients with an alternating schedule of cystoscopy/ cytology & Bladder EpiCheck sent from home is feasible and effective. Thanks to Bladder EpiCheck’s high HG sensitivity and specificity and a well-planned infrastructure, all HG/MIBC were detected while avoiding 76% of unnecessary cystoscopies. Selecting patients for an immediate or delayed cystoscopy by Bladder EpiCheck allows to focus on high-risk patients while maximizing patient comfort and safety. These benefits were proven relevant in these challenging COVID-19 times in which hospital access is limited and might expose elderly patients to unnecessary risk.
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Background. Standard of care for patients receiving pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) includes HIV screening and testing for sexually transmitted infections (STIs) at all sites of potential exposure every three months. We implemented a provider and pharmacist telehealth based PrEP program as part of the HIV, Hepatitis Specialty Telehealth Access Resource (H-START) Collaborative. Due to the COVID-19 pandemic and care via telehealth, we had limited ability to collect pharyngeal or rectal swabs in clinic. We created mail-out kits including swabs and instructions for self-collection to test for rectal and pharyngeal Neisseria gonorrhea and Chlamydia trachomatis. Methods. Kits were mailed out to patients between June 2020 and May 2021. Providers first confirmed patient comfort with self-swab collection during telehealth appointments. Kits included: an instruction sheet with visual diagrams for collection, swabs with appropriate labels;and a pre-paid envelope for patients to mail swabs back to our facility for laboratory testing. Prospective data collection included the date kits were mailed out to patients, the date of kit receipt at our facility and the test result. Charts were retrospectively reviewed to determine treatment completion. Results. 54 self-swab kits were mailed to patients. 53 of the patients were male and the average age was 41.3 years old. 38 (70.3%) swabs were returned. The median time for return of swabs was 21 days (Range 2-289). Of those returned, 5 (13.1%) were positive and all 5 patients were treated for their infection. Conclusion. Mail-out STI testing was effective in identifying STIs for a telehealth PrEP program and for maintaining standard of care practice during the COVID-19 pandemic. This model may increase rates of testing compliance for care provided via telehealth and decrease rates of STI transmission and complications. Better communication around returning kits in a timely-manner and understanding reasons for non-return warrant further investigation.
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Food insecurity remains a persistent problem in the United States and affected 35.2 million Americans in 2019. In the wake of COVID-19, food insecurity has increased in many communities. Given that food insecurity exacerbates poor health or health conditions, screening of food insecurity within medical settings is frequently identified within the literature as an important first step in effectively addressing this social concern and improving the health outcomes of patients. However, health care providers often do not screen for food insecurity for a variety of reasons. In this article review, we discuss the challenges associated with incorporating food insecurity screenings within the medical model and how the COVID-19 pandemic has exacerbated these challenges. Specifically, the COVID-19 pandemic has substantially increased the delivery of health care services via telehealth, making screening for food insecurity even more difficult via remote videoconferencing. We examine the strengths and weaknesses of telehealth and their implications for food insecurity screenings. We discuss how these implications might inform future research regarding the use of telehealth as a means of screening patients for social determinants of health in the COVID-19 era. Given that the use of telehealth is not expected to back to pre-pandemic levels, it is important to understand how to best screen for social determinants of health via videoconferencing.
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Introduction & Objective: Due to the COVID-19 global pandemic, in July 2020 we developed a same day discharge (SDD) protocol for robotic assisted laparoscopic prostatectomy (RALP) that balanced safety concerns with benefits of early discharge. In this study we present our experience and protocol. Methods: We performed a prospective analysis of patients undergoing RALP who were selected for SDD in a high-volume prostate cancer referral center. The criteria for discharge included uncomplicated surgery, stable postoperative hemoglobin, ambulation, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family comfort with SDD. We excluded patients older than 70 years, having concomitant general surgery operations, significant comorbidities (e.g. cardiopulmonary disease), and challenging procedures (e.g. salvage procedure, large prostates). We analyzed patient demographics, clinicopathologic factors, and operative outcomes and evaluated rates of SDD and factors associated with SDD failure (SDF). Results: From July 13, 2020 to January 1, 2021, 101 patients undergoing RALP were selected for SDD. Eighty patients (79%) met criteria , 73 (72%) were successful SDD, and 28 (28%) were SDF. All the SDF were discharged on postoperative day 1. Preoperative demographics were similar between the two groups with a median age of 63 (57-67) years and median BMI of 27 (25-30) kg/m2. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) vs 103 (91-111) minutes for SDD and SDF respectively (P = 0.51). The readmission in the SDD group was due to dizziness from hematoma and ileus from urine leak in the SDF cohort (P = 0.69). Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%) and drowsiness (7%), followed by patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). Conclusions: SDD for patients undergoing RALP can be safely incorporated into a clinical care pathway without increasing readmission rates. Coordinated care with anesthesia and nursing teams is an integral part of developing a SDD program, as is preoperative counseling to manage expectations. Future aims will be to investigate anesthesia factors leading to nausea and to expand selection to more patients.
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OBJECTIVE: This study assessed oxygen saturation variation and comfort in adult surgical patients wearing masks in PACU during the COVID-19 epidemic. DESIGN: Retrospective observation was applied in this study. METHODS: One hundred thirty-seven patients wearing no medical masks (Group A, aged from 20 to 87) and 136 patients wearing medical masks (Group B, aged from 18 to 91) were selected in this retrospective study after extubation in PACU. After extubation their pulse oxygen saturation, noninvasive mean blood pressure and heart rate were recorded at two different time points (treated with 40% O2 oxygen therapy for 10 minutes and breathing room air for 10 minutes). The comfort, arterial blood gas data, complications and duration of patients were also reviewed in PACU. FINDINGS: There were no significant differences in the pulse oxygen saturation between the two groups after inhaling 40% O2 or air. Compared with Group A, patients in Group B have lower comfort (6 [4-7] vs 7 [6-8]; P < .001), with shortened duration after extubation in PACU (50 [45-55] vs 56 [48-60]; P < .001). No significant differences were found in heart rate, noninvasive mean blood pressure, arterial blood gas data and complications. And no hypoxemia and respiratory adverse events happened in two groups. CONCLUSIONS: Wearing medical masks does not reduce oxygen saturation in adult surgical patients during recovery from general anesthesia. The discomfort caused by masks is the concern in PACU.
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COVID-19 , Adult , Airway Extubation , Anesthesia, General , Humans , Retrospective StudiesABSTRACT
The COVID-19 pandemic has driven rapid, widespread adoption of telemedicine. The distribution of clinicians, long travel distances, and disability all limit access to care, especially for persons with Parkinson's disease. Telemedicine is not a panacea for all of these challenges but does offer advantages. These advantages can be summarized as the 5 C's: accessible care, increased convenience, enhanced comfort, greater confidentiality to patients and families, and now reduced risk of contagion. Telemedicine also has its limitations, including the inability to perform parts of the physical examination and inequitable access to the Internet and related technologies. Future models will deliver care to patients from a diverse set of specialties. These will include mental health specialists, physiotherapists, neurosurgeons, speech-language therapists, dieticians, social workers, and exercise coaches. Along with these new care models, digital therapeutics, defined as treatments delivered through software programs, are emerging. Telemedicine is now being introduced as a bridge to restart clinical trials and will increasingly become a normal part of future research studies. From this pandemic will be a wealth of new telemedicine approaches which will fundamentally change and improve care as well as research for individuals with Parkinson's disease.