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3.
Eur J Endocrinol ; 185(2): C1-C7, 2021 Jul 05.
Article in English | MEDLINE | ID: covidwho-1298092

ABSTRACT

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Endocrinologists/organization & administration , Endocrinology/organization & administration , COVID-19/complications , COVID-19/prevention & control , Community Networks/organization & administration , Community Networks/trends , Delivery of Health Care/history , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Endocrine System Diseases/diagnosis , Endocrine System Diseases/epidemiology , Endocrine System Diseases/etiology , Endocrine System Diseases/therapy , Endocrinologists/history , Endocrinologists/trends , Endocrinology/history , Endocrinology/trends , Europe/epidemiology , History, 21st Century , Humans , Pandemics , Phenotype , Physician's Role , Practice Patterns, Physicians'/history , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/trends , Societies, Medical/history , Societies, Medical/organization & administration , Societies, Medical/trends , Telemedicine/history , Telemedicine/organization & administration , Telemedicine/trends
4.
Eur J Endocrinol ; 185(2): C1-C7, 2021 Jul 05.
Article in English | MEDLINE | ID: covidwho-1270953

ABSTRACT

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Endocrinologists/organization & administration , Endocrinology/organization & administration , COVID-19/complications , COVID-19/prevention & control , Community Networks/organization & administration , Community Networks/trends , Delivery of Health Care/history , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Endocrine System Diseases/diagnosis , Endocrine System Diseases/epidemiology , Endocrine System Diseases/etiology , Endocrine System Diseases/therapy , Endocrinologists/history , Endocrinologists/trends , Endocrinology/history , Endocrinology/trends , Europe/epidemiology , History, 21st Century , Humans , Pandemics , Phenotype , Physician's Role , Practice Patterns, Physicians'/history , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/trends , Societies, Medical/history , Societies, Medical/organization & administration , Societies, Medical/trends , Telemedicine/history , Telemedicine/organization & administration , Telemedicine/trends
5.
Fertil Steril ; 116(3): 872-881, 2021 09.
Article in English | MEDLINE | ID: covidwho-1233425

ABSTRACT

OBJECTIVE: To evaluate the experience and perceptions of reproductive endocrinology and infertility fellowship applicants and program directors (PDs) regarding the current and future use of web-based interviews (WBIs). DESIGN: Cross-sectional study. SETTING: Nationwide cohort. PATIENT(S): Reproductive endocrinology and infertility fellowship applicants and PDs participating in the 2020 application cycle. INTERVENTION(S): Anonymous survey sent to applicants and PDs. MAIN OUTCOME MEASURE(S): Descriptive study evaluating the experience and satisfaction of applicants and PDs with WBIs. RESULT(S): Forty-six percent of applicants and eligible PDs responded to our survey. Most applicants and PDs responded that WBIs were adequate for conveying a sense of a program's strengths, faculty, diversity, clinical training, and research opportunities, but less than half responded that WBIs were adequate in providing a sense of the program's clinical site and facilities. After WBIs, both applicants (73%) and PDs (86%) were able to rank with confidence. The cost of WBIs was significantly lower for both applicants (median: $100) and programs (median: $100) than the costs previously reported for in-person interviews. The applicants interviewed at more programs than they would have if the interviews were on-site, and Zoom was the highest rated platform used. Most applicants and PDs responded that WBIs were an adequate substitute, and that they should continue after the coronavirus disease 2019 pandemic. Furthermore, most of the PDs were planning to continue to use WBIs in some capacity. CONCLUSION(S): Both applicants and PDs had favorable experiences with and perceptions of WBIs, and most endorse the continued use of this interview modality. The findings of this study can help guide and optimize future WBI practices.


Subject(s)
Endocrinology/organization & administration , Fellowships and Scholarships/organization & administration , Interviews as Topic/methods , Physicians/psychology , Reproductive Medicine/organization & administration , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Endocrinology/education , Endocrinology/methods , Fellowships and Scholarships/methods , Female , Humans , Infertility/therapy , Internet , Internship and Residency/methods , Internship and Residency/organization & administration , Interpersonal Relations , Interviews as Topic/statistics & numerical data , Job Application , Male , Middle Aged , Pandemics , Perception , Personal Satisfaction , Physicians/statistics & numerical data , Reproductive Medicine/education , Reproductive Medicine/methods , SARS-CoV-2 , Students, Medical/psychology , Students, Medical/statistics & numerical data , Surveys and Questionnaires
7.
J Diabetes Sci Technol ; 15(5): 986-992, 2021 09.
Article in English | MEDLINE | ID: covidwho-1133531

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. METHODS: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. RESULTS: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. CONCLUSIONS: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Diabetes Mellitus/therapy , Healthcare Disparities , Telemedicine , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , California/epidemiology , Child , Child, Preschool , Communicable Disease Control/methods , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Endocrinology/methods , Endocrinology/organization & administration , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Infant , Male , Middle Aged , Pandemics , Primary Health Care/organization & administration , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quarantine , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Young Adult
8.
Pituitary ; 24(2): 143-145, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1074463

ABSTRACT

PURPOSE: Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid replacement in patients with adrenal insufficiency. The Pituitary Society surveyed its membership to understand planned approaches to glucocorticoid management in patients with adrenal insufficiency who will receive a COVID-19 vaccine. METHODS: Members were asked to complete up to 3 questions regarding their planned approach for use of glucocorticoid replacement in patients with proven adrenal insufficiency. RESULTS: Surveys were sent to 273 members and 103 responded. Thirty-six percent plan to recommend that patients automatically increase glucocorticoid dosage with administration of the first vaccine injection. Of these, 84% plan to increase glucocorticoid dose on the day of vaccination, and 49% plan to increase glucocorticoid dose prior to vaccination. Of the 64% who do not plan to recommend automatic glucocorticoid dose increase with vaccine administration, 88% plan to increase the dose if the patient develops a fever, and 47% plan to increase the dose if myalgias and arthralgias occur. CONCLUSIONS: Most clinicians plan to maintain the current glucocorticoid dose with vaccine administration. The vast majority plan and to increase glucocorticoid dose in case of fever, and just under half in case of arthralgias and myalgias. These survey results offer suggested management guidance for glucocorticoid management in patients with adrenal insufficiency.


Subject(s)
Adrenal Insufficiency/drug therapy , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Glucocorticoids/therapeutic use , Adrenal Insufficiency/epidemiology , Adrenal Insufficiency/pathology , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/adverse effects , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Endocrinology/organization & administration , Endocrinology/standards , Humans , Hypothalamo-Hypophyseal System/drug effects , Pandemics , Pituitary Diseases/therapy , Pituitary-Adrenal System/drug effects , Practice Patterns, Physicians'/standards , SARS-CoV-2/immunology , Societies, Medical , Surveys and Questionnaires
9.
J Endocrinol Invest ; 44(8): 1689-1698, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-996502

ABSTRACT

CONTEXT: The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit. OBJECTIVE: We have developed and applied an emergency plan, tailored for Outpatients with endocrine diseases. DESIGN: Cross-sectional study from March to May 2020. SETTING: Referral University-Hospital center. PATIENTS: 1262 patients in 8 weeks. INTERVENTIONS: The emergency plan is based upon the endocrine triage, the stay-safe procedures and the tele-Endo. During endocrine triage every patient was contacted by phone to assess health status and define if the visit will be performed face-to-face (F2F) or by tele-Medicine (tele-Endo). In case of F2F, targeted stay-safe procedures have been adopted. Tele-Endo, performed by phone and email, is dedicated to COVID-19-infected patients, to elderly or frail people, or to those with a stable disease. MAIN OUTCOME MEASURE: To assess efficacy of the emergency plan to continue the follow-up of Outpatients. RESULTS: The number of visits cancelled after endocrine triage (9%) is lower than that cancelled independently by the patients (37%, p < 0.001); the latter reduced from 47 to 19% during the weeks of lockdown (p = 0.032). 86% of patients contacted by endocrine-triage received a clinical response (F2F and tele-Endo visits). F2F visit was offered especially to young patients; tele-Endo was applied to 63% of geriatric patients (p < 0.001), visits' outcome was similar between young and aged patients. CONCLUSIONS: The emergency plan respects the WHO recommendations to limit viral spread and is useful to continue follow-up for outpatients with endocrine diseases.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Endocrinology , Referral and Consultation , Telemedicine , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Cross-Sectional Studies , Disease Outbreaks , Endocrinology/methods , Endocrinology/organization & administration , Endocrinology/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Middle Aged , Outpatients/statistics & numerical data , Pandemics , Quarantine/methods , Quarantine/organization & administration , Quarantine/statistics & numerical data , Referral and Consultation/organization & administration , Referral and Consultation/statistics & numerical data , SARS-CoV-2/physiology , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Triage/methods , Triage/organization & administration , Triage/statistics & numerical data
10.
Am J Med Genet A ; 185(1): 68-72, 2021 01.
Article in English | MEDLINE | ID: covidwho-855991

ABSTRACT

The national importance of telemedicine for safe and effective patient care has been highlighted by the current COVID-19 pandemic. Prior to the 2020 pandemic the Division of Genetics and Metabolism piloted a telemedicine program focused on initial and follow-up visits in the patients' home. The goals were to increase access to care, decrease missed work, improve scheduling, and avoid the transport and exposure of medically fragile patients. Visits were conducted by physician medical geneticists, genetic counselors, and biochemical dietitians, together and separately. This allowed the program to develop detailed standard operating procedures. At the onset of the COVID-19 pandemic, this pilot-program was deployed by the full team of 22 providers in one business day. Two physicians remained on-site for patients requiring in-person evaluations. This model optimized patient safety and workforce preservation while providing full access to patients during a pandemic. We provide initial data on visit numbers, types of diagnoses, and no-show rates. Experience in this implementation before and during the pandemic has confirmed the effectiveness and value of telemedicine for a highly complex medical population. This program is a model that can and will be continued well-beyond the current crisis.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Endocrinology/organization & administration , Genetics, Medical/organization & administration , Models, Organizational , Pandemics , Telemedicine/organization & administration , Adolescent , Adult , Child , Child, Preschool , Delivery of Health Care/methods , Delivery of Health Care/standards , Endocrinology/education , Female , Genetic Counseling/methods , Genetic Counseling/organization & administration , Genetic Counseling/standards , Genetic Diseases, Inborn/epidemiology , Genetic Diseases, Inborn/therapy , Genetic Testing/methods , Genetic Testing/standards , Genetics, Medical/education , Humans , Implementation Science , Infant , Infant, Newborn , Internship and Residency/methods , Internship and Residency/organization & administration , Internship and Residency/standards , Male , Metabolic Diseases/epidemiology , Metabolic Diseases/therapy , Middle Aged , Patient Safety , Pilot Projects , Program Evaluation , Telemedicine/methods , Young Adult
11.
Diabetes Res Clin Pract ; 168: 108372, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-764465

ABSTRACT

AIMS: Our study aimed to review the impact of COVID-19 pandemia in children and adolescents with type 1 diabetes mellitus, to analyze the clinical characteristics of the infection and to propose clinical practice recommendations from the Italian Society for Pediatric Endocrinology and Diabetology (ISPED). METHODS: A literature search was carried out in the guideline databases, Medline and Embase and in Diabetes Societies websites until May 21st, 2020 for guidelines and recommendations on type 1 diabetes mellitus management during COVID-19 pandemic. RESULTS: COVID-19 infection in pediatric patients seems to be clinically less severe than in adults; children have so far accounted for 1-5% of diagnosed cases, with a median age of 6.7 years (1 day-15 years) and better prognosis. Clinical manifestations include mild, moderate, severe disease up to critical illness. There is currently no evidence suggesting a higher risk of COVID-19 infection in children with diabetes than unaffected peers. Besides general recommendations for pediatric patients, ISPED has proposed specific measures for patients with diabetes. CONCLUSION: COVID-19 outbreak modified type 1 diabetes management, and telemedicine has been demonstrating to be an effective new tool for patients care. Moreover psychological aspects deserve attention and future researchs are mandatory.


Subject(s)
Coronavirus Infections/epidemiology , Diabetes Mellitus, Type 1/therapy , Endocrinology/standards , Pneumonia, Viral/epidemiology , Telemedicine/standards , Adolescent , Age of Onset , Betacoronavirus , COVID-19 , Child , Child, Preschool , Diabetes Mellitus, Type 1/epidemiology , Endocrinology/organization & administration , Female , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Pandemics , SARS-CoV-2 , Societies, Medical , Telemedicine/organization & administration
12.
J Diabetes Sci Technol ; 15(2): 329-338, 2021 03.
Article in English | MEDLINE | ID: covidwho-695185

ABSTRACT

BACKGROUND: The importance of telemedicine in diabetes care became more evident during the coronavirus disease 2019 (COVID-19) pandemic as many people with diabetes, especially those in areas without well-established telemedicine, lost access to their health care providers (HCPs) during this pandemic. SUBJECTS AND METHODS: We describe a simplified protocol of a Diabetes Telemedicine Clinic that utilizes technological tools readily available to most people with diabetes and clinics around the world. We report the satisfaction of 145 patients and 14 HCPs who participated in the virtual clinic and 210 patients who attended the virtual educational sessions about "Diabetes and Ramadan." RESULTS: The majority of patients agreed or strongly agreed that the use of telemedicine was essential in maintaining a good glucose control during the pandemic (97%) and they would use the clinic again in the future (86%). A similar high satisfaction was reported by patients who attended the "Diabetes and Ramadan" virtual educational session and 88% of them recommended continuing this activity as a virtual session every year. Majority of the HCPs (93%) thought the clinic protocol was simple and did not require a dedicated orientation session prior to implementing. CONCLUSIONS: The simplicity of our Diabetes Telemedicine Clinic protocol and the high satisfaction reported by patients and HCPs make it a suitable model to be adopted by clinics, especially during pandemics or disasters in resource-limited settings. This clinic model can be quickly implemented and does not require technological tools other than those widely available to most people with diabetes, nowadays. We were able to successfully reduce the number of patients, HCPs, and staff physically present in the clinics during the COVID-19 pandemic without negatively impacting the patients' nor the HCPs' satisfaction with the visits.


Subject(s)
Ambulatory Care Facilities/organization & administration , COVID-19/epidemiology , Diabetes Mellitus/therapy , Endocrinology/organization & administration , Telemedicine/organization & administration , Appointments and Schedules , Electronic Health Records , Humans , Job Satisfaction , Pandemics , Patient Satisfaction , Saudi Arabia/epidemiology
14.
Diabetes Metab Syndr ; 14(5): 767-771, 2020.
Article in English | MEDLINE | ID: covidwho-526669

ABSTRACT

BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic. METHODS: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin D″", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND". RESULTS: We have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing's syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics. CONCLUSIONS: Considering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Endocrine System Diseases/therapy , Endocrinology/methods , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/complications , Endocrine System Diseases/complications , Endocrine System Diseases/epidemiology , Endocrinology/organization & administration , Endocrinology/trends , Humans , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2
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