Effective prevention and management of COVID-19 in outpatient hemodialysis patients.

The authors introduce a mobile phone app that may effectively prevent and manage coronavirus disease 2019 (COVID-19) in outpatient hemodialysis patients in Sichuan Province, China.

Equitable psychiatry, telehealth, and the COVID-19 pandemic: Analysis of national data.

Background: At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia. Methods: The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage. Results: There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments. Conclusion: Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry.

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

INTRODUCTION: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. MATERIALS AND METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient). CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. LEVEL OF EVIDENCE: 3.

[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. METHODS: Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. RESULTS: Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. CONCLUSION: Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.

Application of telemedicine in the COVID-19 epidemic: An analysis of Gansu Province in China.

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.

The management of COVID-19 cases through telemedicine in Brazil.

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.

Asthma patients experience increased symptoms of anxiety, depression and fear during the COVID-19 pandemic.

Population studies showed a decrease in psychological wellbeing during the COVID-19 pandemic. Asthma is associated with a negative effect on anxiety and depression, which might worsen during the COVID-19 lockdown. The aim of the study was to compare fear, anxiety and depression between asthma patients and patients wit hout asthma pre-COVID-19 and during COVID-19 pandemic.This study compares fear, anxiety and depression in asthma patients and controls between pre-COVID-19 and during COVID-19 lockdown with a cross-sectional online survey. Participants were invited to fill out several questionnaires pertaining to fear, anxiety, depression, asthma control and quality of life.Asthma patients (N = 37) displayed, during the course of the pandemic, a clinically relevant increase in anxiety (3.32 ± 2.95 vs. 6.68 ± 3.78; p < 0.001) and depression (1.30 ± 1.15 vs. 3.65 ± 3.31; p < 0.001), according to the hospital anxiety and depression levels (HADS) compared to pre-COVID-19 assessment. This was not seen in controls. Also, asthma patients displayed more anxiety about acquiring COVID-19 disease compared to controls ((5.11 ± 1.99 vs. 3.50 ± 2.79), p = 0.006).Patients with asthma experienced an increase in anxiety and depression levels and were more afraid of acquiring COVID-19 disease compared to controls. Also, patients with asthma were more likely to avoid healthcare facilities due to fear of acquiring COVID-19 disease compared to controls. Therefore, we advise health care workers to address these possible negative effects on mental health by phone or e-consults.

The Colorectal Telephone Clinic: a new normal post-COVID-19?

INTRODUCTION: In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS: We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS: Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS: While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.

Perception of virtual clinics among Saudi adults with type 1 diabetes during the COVID-19 pandemic.

BACKGROUND AND AIMS: We aimed to assess patient perception toward the rapid implementation of virtual phone clinics among Saudi adult patients with type 1 diabetes mellitus (T1DM) during the coronavirus disease (COVID-19) pandemic. METHODS: This cross-sectional, web-based study included Saudi adult patients with T1DM who attended at least one virtual phone visit with the diabetes clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between August 1 and December 31, 2020. Patients anonymously answered a Google form-created Arabic questionnaire. Information about patient characteristics, outcome, and perception of the virtual phone visit were obtained. Data were presented using descriptive statistics, chi-square, one-way ANOVA, independent t-, and Welch's t-tests. RESULTS: The questionnaire was sent to 281 patients, of whom 201 completed it. 59.2% patients were satisfied with their overall virtual phone clinic experience, and 75.6% preferred to continue attending the virtual phone clinics in the future. The average perception value of patients toward virtual phone clinics was 67.76 ± 19.9, suggesting good perception among the majority. Negative or neutral views of current health, asking to be physically seen, and missing a virtual appointment were associated with significantly lower average patient perception value (p < 0.001). CONCLUSIONS: Most Saudi patients with T1DM have adapted to virtual phone consultations, exhibiting good satisfaction and perception, and high preference to continue using this system in the future. The utilization of the service to assist patients with diabetes is highly encouraged, especially during the COVID-19 pandemic. Strategies need to be developed to further enhance the patient experience.

Managing high frequency users of an electronic consultation system in primary care: a quality improvement project.

The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called 'Dr iQ'. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan-Do-Study-Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.

The Impact of COVID-19 on Teledermatology: A Review.

The accelerated implementation and use of teledermatology during the coronavirus disease 2019 pandemic has met with successes and challenges. This review explores how telemedicine was used in dermatology before the pandemic, the regulatory adaptions made in response to the pandemic, and the effectiveness of the rapid implementation of teledermatology during the coronavirus disease 2019 pandemic, and, finally, how teledermatology has expanded in response to the pandemic. This review examines lessons learned and how teledermatology's reliance on digital technologies might paradoxically exacerbate health care disparities, and finally, considers the future outlook.

The result of the use of remote consultation in orthopaedic and trauma surgery during the COVID-19 pandemic.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients.The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5619 patients were made with a lack of response of 19%The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department.Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement.Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually.Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria.El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes.Son objetivos operativos; proponer un plan de consultas, conocer como limita la asistencia a las consultas, definir qué patologías se benefician mas con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5619 consultas con una falta de respuesta telefónica del 19%.El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo mas probable la respuesta telefónica para las consulta de unidad, OR = 0.60 o de traumatología general, OR = 0.67 y menos para los derivados desde urgencias.El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0.34, control postoperatorio, OR = 0.49, y unidades, OR = 0.40, cumplieron mejor este requisito.De los pacientes restantes, las consultas de traumatología general, OR = 0.50, y las derivadas a unidades, OR = 0.54, fueron las que se mas se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que mas precisan de ser realizadas de forma presencial.

Telephone consultation service in orthopedics during COVID-19 pandemic.

BACKGROUND AND AIM: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. MATERIAL AND METHOD: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. RESULTS: A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. CONCLUSIONS: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19 la actividad de los servicios quirúrgicos se ha visto obligada a adaptarse y transformarse. La telemedicina se está implantando como nunca antes en esta nueva situación en la que los pacientes están confinados y los profesionales sanitarios presentan riesgo de infectarseEl objetivo es mostrar que una reestructuración combinada telemática y presencial de las visitas permite asegurar la asistencia médica, garantizando la protección del personal sanitario y de los pacientes. MATERIAL Y MÉTODO: Estudio descriptivo observacional sobre el seguimiento de pacientes durante la Pandemia COVID combinando la consulta telefónica con la presencial. RESULTADOS: Se realizaron un total de 5031 llamadas telefónicas diferenciando entre Derivaciones, Visitas de atención primaria especializada y Consulta externa hospitalaria.Se registraron como efectivas, tributarias de visita presencial y no se logra contacto telefónico. Y las dividimos en 2 grupos resueltas y no resueltas.Del total de visitas no presenciales telefónicas fueron efectivas un 53%. CONCLUSIONES: La medicina telemática es una opción factible en un servicio de traumatología y de manera adecuada será una opción interesante de mantener tras la pandemia.Futuras líneas de investigación deberían ser abiertas para mejorar la capacidad de resolución de este sistema, analizar su relación coste-efectividad y subsanar los conflictos legales que pudieran existir.