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1.
Int J Eat Disord ; 53(7): 1142-1154, 2020 07.
Article in English | MEDLINE | ID: covidwho-680160

ABSTRACT

The necessity to employ distance-based methods to deliver on-going eating disorder care due to the novel coronavirus (COVID-19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family-based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing.


Subject(s)
Anorexia Nervosa/therapy , Bulimia Nervosa/therapy , Coronavirus Infections/prevention & control , Family Therapy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/methods , Adolescent , Betacoronavirus , Child , Female , Humans , Videoconferencing
2.
J Med Internet Res ; 22(7): e19514, 2020 07 02.
Article in English | MEDLINE | ID: covidwho-669450

ABSTRACT

BACKGROUND: Most patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. However, the condition of some of these patients becomes severe or critical as the disease progresses. OBJECTIVE: The aim of this study was to evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 who are home-quarantined and shortages in the medical workforce. METHODS: A telemedicine system was developed to continuously monitor the progression of home-quarantined patients with COVID-19. The system was built based on a popular social media smartphone app called WeChat; the app was used to establish two-way communication between a multidisciplinary team consisting of 7 medical workers and 188 home-quarantined individuals (including 74 confirmed patients with COVID-19). The system helped patients self-assess their conditions and update the multidisciplinary team through a telemedicine form stored on a cloud service, based on which the multidisciplinary team made treatment decisions. We evaluated this telemedicine system via a single-center retrospective study conducted at Tongji Hospital in Wuhan, China, in January 2020. RESULTS: Among 188 individuals using the telemedicine system, 114 (60.6%) were not infected with COVID-19 and were dismissed. Of the 74 confirmed patients with COVID-19, 26 (35%) recovered during the study period and voluntarily stopped using the system. The remaining 48/76 confirmed patients with COVID-19 (63%) used the system until the end of the study, including 6 patients whose conditions progressed to severe or critical. These 6 patients were admitted to hospital and were stabilized (one received extracorporeal membrane oxygenation support for 17 days). All 74 patients with COVID-19 eventually recovered. Through a comparison of the monitored symptoms between hospitalized and nonhospitalized patients, we found prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic of need for hospitalization. CONCLUSIONS: By continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home. The system uses a set of scales for quarantine management assessment that enables patients to self-assess their conditions. The results are useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions. The system requires few staff to manage a large cohort of patients. In addition, the system can solicit help from recovered but self-quarantined medical workers to alleviate shortages in the medical workforce and free healthy medical workers to fight COVID-19 on the front line. Thus, it optimizes the usage of local medical resources and prevents cross-infections among medical workers and patients.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Disease Progression , Housing , Monitoring, Physiologic , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Quarantine , Telemedicine/methods , Adult , Aged , Betacoronavirus , Coronavirus Infections/physiopathology , Female , Health Personnel/statistics & numerical data , Hospitalization , Humans , Male , Middle Aged , Pandemics , Patient Admission , Physicians/statistics & numerical data , Pneumonia, Viral/physiopathology , Quarantine/methods , Retrospective Studies
3.
Eur J Endocrinol ; 183(2): G67-G77, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-665892

ABSTRACT

The COVID-19 pandemic is a major international emergency leading to unprecedented medical, economic and societal challenges. Countries around the globe are facing challenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabetes suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient services need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes presenting with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term harm caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-related complications. Outpatient management need to be reorganised to maintain remote advice and support services, focusing on proactive care for the highest risk, and using telehealth and digital services for consultations, self-management and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapidly with guidance on care management, but the pandemic has created a tension around prioritisation of communicable vs non-communicable disease. Resulting challenges in clinical decision-making are compounded by a reduced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising preventable morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the current focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Therapies, Investigational/trends , Coronavirus Infections/diagnosis , Diabetes Mellitus/diagnosis , Endocrinology/methods , Endocrinology/trends , Humans , Pandemics , Pneumonia, Viral/diagnosis , Telemedicine/methods , Telemedicine/trends , Therapies, Investigational/methods , United Kingdom/epidemiology
4.
BMJ Open Diabetes Res Care ; 8(1)2020 07.
Article in English | MEDLINE | ID: covidwho-657120

ABSTRACT

The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Delivery of Health Care/standards , Diabetes Mellitus/therapy , Disease Outbreaks/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/methods , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Diabetes Mellitus/virology , Humans , Infection Control/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Public Health
5.
Eur J Endocrinol ; 183(2): G79-G88, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-656176

ABSTRACT

In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Neuroendocrine Tumors/therapy , Pneumonia, Viral/therapy , Telemedicine/trends , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endocrinology/methods , Endocrinology/trends , Humans , Neoplasm Grading/methods , Neoplasm Grading/trends , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Telemedicine/methods
6.
Ann Fam Med ; 18(4): 349-354, 2020 07.
Article in English | MEDLINE | ID: covidwho-653930

ABSTRACT

During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors' primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences-complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.


Subject(s)
Coronavirus Infections/prevention & control , Delivery of Health Care/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Primary Health Care/methods , Telemedicine/methods , Betacoronavirus , Humans , Quarantine , United States/epidemiology
7.
Harm Reduct J ; 17(1): 49, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-653240

ABSTRACT

BACKGROUND: Health services globally are struggling to manage the impact of COVID-19. The existing global disease burden related to opioid use is significant. Particularly challenging groups include older drug users who are more vulnerable to the effects of COVID-19. Increasing access to safe and effective opioid agonist treatment (OAT) and other harm reduction services during this pandemic is critical to reduce risk. In response to COVID-19, healthcare is increasingly being delivered by telephone and video consultation, and this report describes the development of a national model of remote care to eliminate waiting lists and increase access to OAT in Ireland. PURPOSE AND FINDINGS: The purpose of this initiative is to provide easy access to OAT by developing a model of remote assessment and ongoing care and eliminate existing national waiting lists. The Irish College of General Practitioners in conjunction with the National Health Service Executive office for Social Inclusion agreed a set of protocols to enable a system of remote consultation but still delivering OAT locally to people who use drugs. This model was targeted at OAT services with existing waiting lists due to a shortage of specialist medical staff. The model involves an initial telephone assessment with COVID-risk triage, a single-patient visit to local services to provide a point of care drug screen and complete necessary documentation and remote video assessment and ongoing management by a GP addiction specialist. A secure national electronic health link system allows for the safe and timely delivery of scripts to a designated local community pharmacy. CONCLUSION: The development of a remote model of healthcare delivery allows for the reduction in transmission risks associated with COVID-19, increases access to OAT, reduces waiting times and minimises barriers to services. An evaluation of this model is ongoing and will be reported once completed. Fast adaptation of OAT delivery is critical to ensure access to and continuity of service delivery and minimise risk to our staff, patients and community. Innovative models of remote healthcare delivery adapted during the COVID-19 crisis may inform and have important benefits to our health system into the future.


Subject(s)
Analgesics, Opioid/therapeutic use , Coronavirus Infections , Delivery of Health Care/organization & administration , Health Services Accessibility , Opiate Substitution Treatment/methods , Opioid-Related Disorders/drug therapy , Pandemics , Pneumonia, Viral , Telemedicine/methods , Betacoronavirus , Humans , Ireland
8.
Oncology (Williston Park) ; 34(7): 244, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-648039

ABSTRACT

Now that the world has been dealing with the coronavirus disease 2019 (COVID-19) pandemic for several months, we have learned so much. Some of the modifications we have made have been "good" and will hopefully help oncology care, education, and research going forward. Here are some of the issues and changes that the pandemic engendered.


Subject(s)
Organizational Innovation , Telemedicine/methods , Betacoronavirus , Biomedical Research , Clinical Trials as Topic/methods , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Humans , Medical Oncology/methods , Medical Oncology/organization & administration , Medical Oncology/trends , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Telecommunications/trends
9.
Oncology (Williston Park) ; 34(7): 280-282, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-648006

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world in the past several months. No effective treatment for COVID-19 has been established. High transmissibility and considerable mortality rates have forced many national governments to implement quarantine measures. Many patients with cancer rely on clinical trials to receive their oncologic care, but the routine conduct of clinical trials has substantially changed because of the COVID-19 pandemic. The oncology research community should implement formal policies based on the guidance given from regulatory agencies, with the goal of minimizing the risks of COVID-19 infection while maintaining appropriate oncologic treatments for patients during this pandemic.


Subject(s)
Clinical Trials as Topic/organization & administration , Coronavirus Infections , Medical Oncology , Neoplasms/therapy , Pandemics , Pneumonia, Viral , Telemedicine , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Infection Control , Medical Oncology/methods , Medical Oncology/trends , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Quarantine , Telemedicine/methods , Telemedicine/trends
10.
Recenti Prog Med ; 111(7): 402-403, 2020.
Article in Italian | MEDLINE | ID: covidwho-644446

ABSTRACT

The CoViD-19 pandemic has changed the concept of clinic and doctor-patient relationship. Due to the risk of mutual contagion, patients in many cases were managed without direct physical contact. This resulted in a forced acceleration towards e-health and remote consultation. The onset of a new professional figure is ever closer, the virtualist, the doctor who can treat patients without direct physical contact. For this reason, new skills and organizational methods are needed to create a care approach capable of integrating technology opportunities with the traditional clinical method.


Subject(s)
Betacoronavirus , Coronavirus Infections , Medicine , Pandemics , Physician-Patient Relations , Pneumonia, Viral , Telemedicine/trends , Virtual Reality , Coronavirus Infections/prevention & control , Health Services Accessibility , Humans , Internet , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/prevention & control , Social Determinants of Health , Social Isolation , Telemedicine/methods , User-Computer Interface
11.
Recenti Prog Med ; 111(7): 454-460, 2020.
Article in Italian | MEDLINE | ID: covidwho-644272

ABSTRACT

The lockdown of Italy, the re-orientation of many hospital departments into CoViD-19 patient care wards, the need to prevent the general practitioners from being infected has been arising the need of access to medical care in patients isolated at their homes. The specialists of the De Martinis Telemedicine Panel, addressing e-health issues, have been responding to the requests of general practitioners in 14 municipalities of Marche region, by implementing the televideoconsultation to 98 patients, 68 of whom with, certain, probable or supposed to be CoViD-19 infection. The patients were managed from remote until the symptoms were over. Sixty-five patients adhere the televideoconsultation completely and were cured, also with home oxygen therapy and other treatments additional to the standard anti-inflammatory and antibiotic drugs. However, they got stuck to full isolation while making use of no external human resources for health and relying entirely on the electronic prescription of their general practitioner and the help of the cohabiting family members. Two patients abandoned, including one owing to the lack of support from the cohabiting family member, and addressed themselves to the hospital care. However, they required no mechanical ventilation and were discharged being recovered within shortly. One over 90 years' old patient was hospitalised in agreement with the general practitioner for management problems. The results are discussed in relationship to the procedures put in practice, to the perspectives in the use of clinical televideoconsultation in the Italian health system, mainly in support to the primary health care, and to the limitations due to the poor development of other e-health tools such as the citizen's electronic health record.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , General Practice/methods , Home Care Services/organization & administration , Pandemics , Pneumonia, Viral/therapy , Telemedicine/methods , Videoconferencing , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Combined Modality Therapy , Comorbidity , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Electronic Health Records , Electronic Prescribing , Female , Humans , Italy , Male , Middle Aged , Oxygen Inhalation Therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Young Adult
12.
Recenti Prog Med ; 111(7): 411-414, 2020.
Article in Italian | MEDLINE | ID: covidwho-644269

ABSTRACT

CoViD-19 is a disease caused by the novel coronavirus (SARS-CoV-2), originated from China in December 2019. In March 2020, CoViD-19 was declared a pandemic, having spread all over the word. The psychological impact of CoViD-19 disease must be recognized alongside the physical symptoms for all those affected. Furhermore quarantine for coronavirus has serious psychological side effects, such as depression and anxiety that are more likely to occur and worsen. Furhermore quarantine reduces the availability of psychiatric and psychological interventions. The evidence base for telepsychiatry is growing in adults and adolescents. A growing body of literature suggests that use of telepsychiatry to provide mental health services has the potential to remove geographic barriers between patients and providers and improves quality care. It has increased the volume of patients that physicians can reach and diagnose, as well as allowing them to treat patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral/psychology , Psychiatry/methods , Stress, Psychological/etiology , Telemedicine/methods , Adolescent , Adult , Aged , Anxiety/etiology , Attitude of Health Personnel , Attitude to Death , Caregivers/psychology , Child , Comorbidity , Coronavirus Infections/epidemiology , Depression/etiology , Health Personnel/psychology , Health Services Accessibility , Humans , Mental Disorders/epidemiology , Mental Disorders/therapy , Pneumonia, Viral/epidemiology , Psychiatry/organization & administration , Psychology, Adolescent , Psychology, Child , Quarantine/psychology
13.
Eur Psychiatry ; 63(1): e61, 2020 05 22.
Article in English | MEDLINE | ID: covidwho-641759

ABSTRACT

The current pandemic has forced many people into self-isolation and to practice social distancing. When people are physically isolated and distant from each other, technology may play a fundamental role by enabling social connection and reducing feelings of loneliness caused by this prolonged social isolation. In response to the COVID-19 pandemic, many mental health services worldwide have had to shift their routine face-to-face outpatient appointments to remote telepsychiatry encounters. The increased pressure on mental health services highlights the importance of community-led health-promotion interventions, which can contribute to preventing mental illness or their relapses, and to reduce the burden on health services. Patients with psychosis are particularly socially isolated, have sedentary lifestyles, and commonly face stigma and discrimination from the general population. At the same time, patients with psychosis value technology, are interested in, use and own smart-phones to digitally connect, and are satisfied with their use. Thus, among psychosocial interventions, a helpful resource may be "Phone Pal," a complex intervention which facilitates remote communication between volunteers and socially isolated patients with psychosis through different smart-phone tools. While "Phone Pal" has been originally developed for people with psychosis, it may also be useful to the wider population, helping to overcome the social isolation caused by physical distancing, particularly in these times of widespread isolation. "Phone Pal" may be a potential public health resource for society, providing important support to those that may need it the most, and possibly benefit most from it.


Subject(s)
Coronavirus Infections/epidemiology , Loneliness/psychology , Mental Health Services , Pneumonia, Viral/epidemiology , Psychotic Disorders/psychology , Smartphone , Social Isolation/psychology , Telemedicine/methods , Communication , Delivery of Health Care , Humans , Pandemics , Social Stigma , Telemedicine/instrumentation
14.
Neurol India ; 68(3): 555-559, 2020.
Article in English | MEDLINE | ID: covidwho-640415

ABSTRACT

Background: The COVID-19 pandemic has within months turned the world upside down. With personal distancing and shortage of personal protective equipment, face-to-face health care encounters are increasingly becoming problematic. Neurological manifestations are also being observed in clinical presentations. Objective: Worldwide most countries, the World Health Organization (WHO) and Centre for Disease Control (USA) have recommended use of Telemedicine during the current pandemic.With acute shortage of neurologists and neurosurgeons and their lopsided distribution, it becomes more difficult to provide neurological care to those who need it the most, particularly with travel restrictions. The author has since 2002 been advocating use of Telemedicine in Neurosciences. Materials and Methods: This article reviews the increasing deployment of Telemedicine in neurological practice in the last few years, particularly the radical exponential use in the last few months due to COVID-19. Conclusions: With possible reduction in face-to-face consultations, remote evaluation may become mainstream. Webinars will play an increasing role. CME's and resident training will become more and more digital. The world will never be the same again. It is imperative that we accept and start deploying the "New Normal".


Subject(s)
Coronavirus Infections/epidemiology , Neurology/methods , Pneumonia, Viral/epidemiology , Telemedicine/methods , Betacoronavirus , Humans , Mobile Applications , Neurology/education , Pandemics , Telephone , Telerehabilitation , Videoconferencing
15.
Int J Environ Res Public Health ; 17(13)2020 07 06.
Article in English | MEDLINE | ID: covidwho-639067

ABSTRACT

The COVID-19 pandemic forced physicians to quickly adapt and find ways to provide their usual offline services by using online tools. We aimed to understand how physicians adapted to the sudden need for telehealth and if their perception of telehealth changed due to their experience during the COVID-19 pandemic. We conducted an exploratory sequential mixed-methods study. We interviewed five Lebanese physicians and thematically analyzed the interviews. We developed a questionnaire based on the analysis results and administered it online to physicians in Lebanon. In total, 140 responses were collected. We found that, during the COVID-19 pandemic, physicians engaged in more telehealth activities in the realms of telemedicine, public awareness, continuing medical education, research, administration, and teaching. They also expanded their repertoire of information-technology tools. Our results also show that there was a significant shift in the physicians' perceptions, indicating greater openness and willingness to adopt telehealth services. However, a significant amount of skepticism and uncertainty regarding telemedicine remains, especially concerning its efficiency, safety, and the adequacy of existing regulations. Based on our findings, we offer recommendations for health IT policy makers, developers, and researchers, to sustain the continuity of telehealth activities beyond the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Pandemics , Physicians/psychology , Pneumonia, Viral , Telemedicine/statistics & numerical data , Attitude of Health Personnel , Betacoronavirus , Education, Medical, Continuing , Humans , Lebanon , Surveys and Questionnaires , Telemedicine/methods
16.
Obesity (Silver Spring) ; 28(7): 1184-1186, 2020 07.
Article in English | MEDLINE | ID: covidwho-638210

ABSTRACT

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.


Subject(s)
Coronavirus Infections/prevention & control , Obesity Management/methods , Obesity/therapy , Pandemics/prevention & control , Pediatrics/methods , Pneumonia, Viral/prevention & control , Telemedicine/methods , Betacoronavirus , Child , Coronavirus Infections/ethnology , Coronavirus Infections/virology , Female , Humans , Male , Minority Health , New York City/epidemiology , Obesity/ethnology , Obesity/virology , Pneumonia, Viral/ethnology , Pneumonia, Viral/virology , Poverty/ethnology , Risk Factors , Vulnerable Populations
17.
JCO Glob Oncol ; 6: 1046-1051, 2020 07.
Article in English | MEDLINE | ID: covidwho-638037

ABSTRACT

PURPOSE: Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic. METHODS: Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences. RESULTS: Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time. CONCLUSION: Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.


Subject(s)
Ambulatory Care/methods , Coronavirus Infections/epidemiology , Medical Oncology/methods , Pandemics , Patient Satisfaction , Pneumonia, Viral/epidemiology , Sarcoma/therapy , Telemedicine/methods , Workload , Adult , Aged , Aged, 80 and over , Betacoronavirus , Delivery of Health Care/methods , Female , Gastrointestinal Neoplasms/therapy , Gastrointestinal Stromal Tumors/therapy , Humans , Male , Middle Aged , Retrospective Studies , Soft Tissue Neoplasms/therapy , Travel , United Kingdom/epidemiology , Young Adult
18.
J Alzheimers Dis ; 76(1): 33-40, 2020.
Article in English | MEDLINE | ID: covidwho-630183

ABSTRACT

BACKGROUND: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. OBJECTIVE: To share our experience in adapting our model of care to the new situation to ensure continuity of care. METHODS: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. RESULTS: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. DISCUSSION: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Dementia/therapy , Holistic Health , Patient-Centered Care/methods , Pneumonia, Viral/therapy , Telemedicine/methods , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Dementia/epidemiology , Dementia/psychology , Female , Follow-Up Studies , Holistic Health/trends , Humans , Male , Pandemics , Patient-Centered Care/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Spain/epidemiology , Telemedicine/trends
20.
Diabetes Technol Ther ; 22(6): 449-453, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-628147

ABSTRACT

Background: The Stay at Home order in Colorado and The Stay Safe at Home order in California during COVID-19 pandemic have forced a majority of the endocrinologists/diabetologists to adapt to providing diabetes care remotely through telehealth. This may provide increased access to diabetes health care in certain settings. However, health care disparities continue to challenge availability of diabetes technologies for underprivileged communities. We report our experience with two patients providing diabetes care effectively and preventing hospital admissions by using telehealth. Methods: Two adult patients with type 1 diabetes (T1D): one new onset and the other one with established T1D are presented where telehealth facilitated by Clarity Software and the "Share" feature with the use of Dexcom G6 continuous glucose monitoring (CGM) for management of diabetic ketosis and hyperglycemia. Results: Both patients were managed effectively virtually despite higher risk of diabetic ketoacidosis (DKA). Shared glucose data through CGM facilitated frequent insulin dose adjustments, increased fluid and carbohydrate intake, and prevented hospital admissions in both cases. In the case of new onset patient with T1D, most of the education was done remotely by certified diabetes care and education specialists. Conclusion: Acute diabetes complication like DKA increases morbidity and mortality in addition to adding cost to the health care system. The current pandemic of COVID-19 has allowed newer ways (with the help of newer technologies) to manage high-risk patients with T1D and DKA through telehealth and may result in lasting benefits to people with T1D.


Subject(s)
Blood Glucose Self-Monitoring/methods , Coronavirus Infections/prevention & control , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/methods , Adult , Betacoronavirus , California/epidemiology , Colorado/epidemiology , Coronavirus Infections/complications , Diabetic Ketoacidosis/prevention & control , Female , Hospitalization , Humans , Hypoglycemic Agents/administration & dosage , Male , Pneumonia, Viral/complications , Young Adult
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