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2.
J Med Internet Res ; 22(10): e22068, 2020 10 08.
Article in English | MEDLINE | ID: covidwho-863364

ABSTRACT

BACKGROUND: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients' understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). OBJECTIVE: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. METHODS: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. RESULTS: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. CONCLUSIONS: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed.


Subject(s)
Coronavirus Infections/epidemiology , Internet , Kidney Transplantation , Knowledge , Living Donors/education , Patient Education as Topic , Pneumonia, Viral/epidemiology , Telemedicine , Betacoronavirus , Humans , Pandemics , Patient Education as Topic/standards , Patient Education as Topic/statistics & numerical data , Search Engine , Uncertainty
3.
J Med Internet Res ; 22(10): e22523, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-862684

ABSTRACT

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.


Subject(s)
Ambulatory Care Facilities/organization & administration , Coronavirus Infections/epidemiology , Outpatients , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Betacoronavirus , Communication , Coronavirus Infections/psychology , Delivery of Health Care/organization & administration , Health Resources , Humans , Pandemics , Pneumonia, Viral/psychology , Texas/epidemiology
4.
J Med Internet Res ; 22(9): e21561, 2020 09 30.
Article in English | MEDLINE | ID: covidwho-862666

ABSTRACT

BACKGROUND: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. OBJECTIVE: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans' willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. RESULTS: Participants' mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. CONCLUSIONS: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Rural Health/statistics & numerical data , Telemedicine , Veterans/psychology , Veterans/statistics & numerical data , Videoconferencing , Aged , Appointments and Schedules , Arkansas/epidemiology , Caregivers , Cross-Sectional Studies , Delivery of Health Care , Electronic Mail , Female , Humans , Male , Middle Aged , Pandemics
5.
J Pediatr Urol ; 16(3): 290, 2020 06.
Article in English | MEDLINE | ID: covidwho-846667

Subject(s)
Telemedicine , Urology , Child , Humans
6.
Acta Biomed ; 91(3): ahead of print, 2020 07 28.
Article in English | MEDLINE | ID: covidwho-843626

ABSTRACT

During the COVID-19 pandemic, surgical elective procedures were stopped in our plastic surgery unit. Limitations for consultations and for follow-up of previous surgical procedures were imposed in order to minimize the risk of contagion in waiting rooms and outpatient clinics. We have identified telemedicine as an alternative way to follow patients during the lockdown. Nevertheless, we have experienced different difficulties. We have not had the possibility to use a secure teleconferencing software. In our unit we had not technological devices. Surgeons in our department were not able to use remote video technology for patient management. Guidelines for an appropriate selection of patients which could be served via telemedicine had to be created. Telemedicine must be regulated by healthcare organizations for legal, ethical, medico-legal and risk management aspects. Even if we have experienced an important need to use telematic solutions during the COVID-19 lockdown, liability and risk management issues has greatly limited this possibility in our unit. The need of telemedicine in the time of COVID-19 pandemic has encouraged us to implement future virtual encounters in order to reduce unnecessary in-person visits by taking into consideration all legal, ethical and medico-legal aspects.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Pneumonia, Viral/epidemiology , Reconstructive Surgical Procedures/methods , Risk Management/methods , Surgery, Plastic/organization & administration , Telemedicine/methods , Coronavirus Infections/transmission , Humans , Pandemics , Pneumonia, Viral/transmission
7.
Br J Community Nurs ; 25(10): 480-488, 2020 Oct 02.
Article in English | MEDLINE | ID: covidwho-841751

ABSTRACT

People with chronic pain faced potential treatment disruption during the COVID-19 pandemic in Singapore, as the focus of healthcare shifted. A model of rapid integration of a pain centre with community healthcare teams was implemented to care for vulnerable older patients with chronic pain and multiple comorbidities. Telemedicine and home visits by community nurses were used, with risk-mitigation measures, ensuring comprehensive assessment and treatment compliance. Medications from pain physicians were delivered at home through a hospital pharmacy. A secure national electronic health records system used by all teams ensured seamless access and documentation. Potential emergency department visits, admissions and delayed discharges were thus avoided. Integration of community teams with chronic pain management services can be recommended to ensure pandemic preparedness.


Subject(s)
Chronic Pain/therapy , Community Health Nursing , Coronavirus Infections , House Calls , Pain Clinics , Pain Management , Pandemics , Pneumonia, Viral , Telemedicine , Betacoronavirus , Cooperative Behavior , Delivery of Health Care , Female , Humans , Male , Middle Aged , Patient Care Team , Referral and Consultation , Singapore , Workflow
9.
J Med Internet Res ; 22(8): e21265, 2020 08 21.
Article in English | MEDLINE | ID: covidwho-836109

ABSTRACT

BACKGROUND: To avoid misuse of personal protective equipment (PPE), ensure health care workers' safety, and avoid shortages, effective communication of up-to-date infection control guidelines is essential. As prehospital teams are particularly at risk of contamination given their challenging work environment, a specific gamified electronic learning (e-learning) module targeting this audience might provide significant advantages as it requires neither the presence of learners nor the repetitive use of equipment for demonstration. OBJECTIVE: The aim of this study was to evaluate whether a gamified e-learning module could improve the rate of adequate PPE choice by prehospital personnel in the context of the coronavirus disease (COVID-19) pandemic. METHODS: This was an individual-level randomized, controlled, quadruple-blind (investigators, participants, outcome assessors, and data analysts) closed web-based trial. All emergency prehospital personnel working in Geneva, Switzerland, were eligible for inclusion, and were invited to participate by email in April 2020. Participants were informed that the study aim was to assess their knowledge regarding PPE, and that they would be presented with both the guidelines and the e-learning module, though they were unaware that there were two different study paths. All participants first answered a preintervention quiz designed to establish their profile and baseline knowledge. The control group then accessed the guidelines before answering a second set of questions, and were then granted access to the e-learning module. The e-learning group was shown the e-learning module right after the guidelines and before answering the second set of questions. RESULTS: Of the 291 randomized participants, 176 (60.5%) completed the trial. There was no significant difference in baseline knowledge between groups. Though the baseline proportion of adequate PPE choice was high (75%, IQR 50%-75%), participants' description of the donning sequence was in most cases incorrect. After either intervention, adequate choice of PPE increased significantly in both groups (P<.001). Though the median of the difference in the proportion of correct answers was slightly higher in the e-learning group (17%, IQR 8%-33% versus 8%, IQR 8%-33%), the difference was not statistically significant (P=.27). Confidence in the ability to use PPE was maintained in the e-learning group (P=.27) but significantly decreased in the control group (P=.04). CONCLUSIONS: Among prehospital personnel with an already relatively high knowledge of and experience with PPE use, both web-based study paths increased the rate of adequate choice of PPE. There was no major added value of the gamified e-learning module apart from preserving participants' confidence in their ability to correctly use PPE.


Subject(s)
Coronavirus Infections/prevention & control , Health Personnel/standards , Infection Control/methods , Pandemics/prevention & control , Personal Protective Equipment/trends , Pneumonia, Viral/prevention & control , Telemedicine/methods , Betacoronavirus , Coronavirus Infections/radiotherapy , Female , Humans , Male , Pneumonia, Viral/radiotherapy
10.
World J Gastroenterol ; 26(36): 5387-5394, 2020 Sep 28.
Article in English | MEDLINE | ID: covidwho-835896

ABSTRACT

The current coronavirus pandemic is imposing unpreceded challenges to the practice of pediatric gastroenterology. These are highlighted in their impact on performing aerosol-generating endoscopy procedures and the need to accommodate longer room turnaround time for disinfection, ensuring appropriate and consistent safety measures for patients, staff and providers, and emphasizing the importance for screening patients for active coronavirus disease (COVID) infection before endoscopy when possible. Pediatric patients are less likely to exhibit severe COVID-related symptoms so survey-based screening would not be a sensitive measure to identify patients with active infections. To address the restrictions of patients coming for face to face clinic encounters, there has been rapid expansion of telehealth services in a very short time period with several difficulties encountered. To survive these challenges, pediatric gastroenterology practices need to adapt and accept flexibility in clinical operations with ongoing commitment to safety for patients and healthcare workers.


Subject(s)
Coronavirus Infections , Gastroenterology/methods , Infection Control/methods , Pandemics , Patient Safety , Pediatrics/methods , Pneumonia, Viral , Betacoronavirus , Humans , Telemedicine/trends
12.
Telemed J E Health ; 26(6): 725-733, 2020 06.
Article in English | MEDLINE | ID: covidwho-830465

ABSTRACT

Background: Most secondary transmission of COVID-19 is occurring in a hospital setting. To decrease person-to-person contact, health care providers have built many isolation wards. However, out-of-hospital professionals cannot access patient information, which has greatly reduced the efficiency of treatment; it is inconvenient for health care professionals to issue a case discussion with professionals from other wards. This article mainly introduces a mobile telehealth system (MTS) applied to facilitate patient information presentation and case discussion. Materials and Methods: The MTS searches patient information, which is stored in hospital intranet, and uses five modules to display patient information. By a request/response module and a real-time interaction module, we successfully conducted case discussions. In addition, we took measures in three areas to prevent patient information leakage. Results: The system uses mobile collaboration technology to present patient information and support case discussion. MTS was officially launched for 37 days, during which it has been used 3,061 times. Conclusions: The building of the MTS not only provides convenience and benefit for health care professionals, but also reduces person-to-person contact.


Subject(s)
Betacoronavirus , Cell Phone , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Electronic Health Records , Information Storage and Retrieval/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Telemedicine/methods , Humans , Pandemics
14.
Circulation ; 141(21): e823-e831, 2020 05 26.
Article in English | MEDLINE | ID: covidwho-827449

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.


Subject(s)
Arrhythmias, Cardiac/etiology , Betacoronavirus , Coronavirus Infections/epidemiology , Electrocardiography , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , American Heart Association , Arrhythmias, Cardiac/therapy , Cardiology , Cardiopulmonary Resuscitation , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Societies, Medical , Telemedicine , Triage , United States
15.
Sensors (Basel) ; 20(9)2020 Apr 27.
Article in English | MEDLINE | ID: covidwho-827037

ABSTRACT

Non-invasive remote health monitoring plays a vital role in epidemiological situations such as SARS outbreak (2003), MERS (2015) and the recently ongoing outbreak of COVID-19 because it is extremely risky to get close to the patient due to the spread of contagious infections. Non-invasive monitoring is also extremely necessary in situations where it is difficult to use complicated wired connections, such as ECG monitoring for infants, burn victims or during rescue missions when people are buried during building collapses/earthquakes. Due to the unique characteristics such as higher penetration capabilities, extremely precise ranging, low power requirement, low cost, simple hardware and robustness to multipath interferences, Impulse Radio Ultra Wideband (IR-UWB) technology is appropriate for non-invasive medical applications. IR-UWB sensors detect the macro as well as micro movement inside the human body due to its fine range resolution. The two vital signs, i.e., respiration rate and heart rate, can be measured by IR-UWB radar by measuring the change in the magnitude of signal due to displacement caused by human lungs, heart during respiration and heart beating. This paper reviews recent advances in IR- UWB radar sensor design for healthcare, such as vital signs measurements of a stationary human, vitals of a non-stationary human, vital signs of people in a vehicle, through the wall vitals measurement, neonate's health monitoring, fall detection, sleep monitoring and medical imaging. Although we have covered many topics related to health monitoring using IR-UWB, this paper is mainly focused on signal processing techniques for measurement of vital signs, i.e., respiration and heart rate monitoring.


Subject(s)
Heart Rate , Monitoring, Physiologic/methods , Radar , Respiratory Rate , Signal Processing, Computer-Assisted , Telemedicine , Coronavirus Infections/diagnosis , Humans , Models, Theoretical , Monitoring, Physiologic/instrumentation , Pandemics , Pneumonia, Viral/diagnosis , Radio Waves
18.
J Am Med Inform Assoc ; 27(9): 1456-1461, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-817427

ABSTRACT

The COVID-19 pandemic has led to the rapid expansion of telehealth services as healthcare organizations aim to mitigate community transmission while providing safe patient care. As technology adoption rapidly increases, operational telehealth teams must maintain awareness of critical information, such as patient volumes and wait times, patient and provider experience, and telehealth platform performance. Using a model of situation awareness as a conceptual foundation and a user-centered design approach we describe our process for rapidly developing and disseminating dashboard visualizations to support telehealth operations. We used a 5-step process to gain domain knowledge, identify user needs, identify data sources, design and develop visualizations, and iteratively refine these visualizations. Through this process we identified 3 distinct stakeholder groups and designed and developed visualization dashboards to meet their needs. Feedback from users demonstrated the dashboard's support situation awareness and informed important operational decisions. Lessons learned are shared to provide other organizations with insights from our process.


Subject(s)
Coronavirus Infections , Data Display , Data Visualization , Pandemics , Pneumonia, Viral , Telemedicine , Betacoronavirus , Humans , Mid-Atlantic Region , Multi-Institutional Systems , Organizational Case Studies , User-Computer Interface
19.
RMD Open ; 6(3)2020 10.
Article in English | MEDLINE | ID: covidwho-814261

ABSTRACT

OBJECTIVE: There is emerging evidence that COVID-19 disproportionately affects people from racial/ethnic minority and low socioeconomic status (SES) groups. Many physicians across the globe are changing practice patterns in response to the COVID-19 pandemic. We sought to examine the practice changes among rheumatologists and what they perceive the impact to be on their most vulnerable patients. METHODS: We administered an online survey to a convenience sample of rheumatologists worldwide during the initial height of the pandemic (between 8 April and 4 May 2020) via social media and group emails. We surveyed rheumatologists about their opinions regarding patients from low SES and racial/ethnic minority groups in the context of the COVID-19 pandemic. Mainly, what their specific concerns were, including the challenges of medication access; and about specific social factors (health literacy, poverty, food insecurity, access to telehealth video) that may be complicating the management of rheumatologic conditions during this time. RESULTS: 548 rheumatologists responded from 64 countries and shared concerns of food insecurity, low health literacy, poverty and factors that preclude social distancing such as working and dense housing conditions among their patients. Although 82% of rheumatologists had switched to telehealth video, 17% of respondents estimated that about a quarter of their patients did not have access to telehealth video, especially those from below the poverty line. The majority of respondents believed these vulnerable patients, from racial/ethnic minorities and from low SES groups, would do worse, in terms of morbidity and mortality, during the pandemic. CONCLUSION: In this sample of rheumatologists from 64 countries, there is a clear shift in practice to telehealth video consultations and widespread concern for socially and economically vulnerable patients with rheumatic disease.


Subject(s)
Autoimmune Diseases/ethnology , Betacoronavirus , Continental Population Groups , Coronavirus Infections/epidemiology , Ethnic Groups , Minority Groups , Pneumonia, Viral/epidemiology , Poverty , Rheumatic Diseases/ethnology , Autoimmune Diseases/mortality , Coronavirus Infections/mortality , Coronavirus Infections/virology , Food Supply/economics , Health Literacy , Housing , Humans , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Rheumatic Diseases/mortality , Rheumatologists , Surveys and Questionnaires , Telemedicine
20.
BMJ Case Rep ; 13(10)2020 Oct 04.
Article in English | MEDLINE | ID: covidwho-814254

ABSTRACT

This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/methods , Angiography, Digital Subtraction/methods , Humans , Intracranial Aneurysm/diagnostic imaging
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