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1.
JMIR Public Health Surveill ; 6(3): e19831, 2020 07 30.
Article in English | MEDLINE | ID: covidwho-1172930

ABSTRACT

Before the coronavirus disease (COVID-19), 1 in 3 women and girls, globally, were victimized by an abusive partner in intimate relationships. However, the current pandemic has amplified cases of domestic violence (DV) against women and girls, with up to thrice the prevalence in DV cases compared to the same time last year. Evidence of the adverse effects of the pandemic on DV is still emerging, even as violence prevention strategies are iteratively being refined by service providers, advocacy agencies, and survivors to meet stay-at-home mandates. Emotional and material support for survivors is a critical resource increasingly delivered using digital and technology-based modalities, which offer several advantages and challenges. This paper rapidly describes current DV mitigation approaches using digital solutions, signaling emerging best practices to support survivors, their children, and abusers during stay-at-home advisories. Some examples of technology-based strategies and solutions are presented. An immediate priority is mapping out current digital solutions in response to COVID-19-related DV and outlining issues with uptake, coverage, and meaningful use of digital solutions.


Subject(s)
Coronavirus Infections/epidemiology , Domestic Violence/prevention & control , Intimate Partner Violence/prevention & control , Pandemics , Pneumonia, Viral/epidemiology , Telemedicine/methods , Coronavirus Infections/prevention & control , Domestic Violence/statistics & numerical data , Female , Global Health/statistics & numerical data , Humans , Intimate Partner Violence/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prevalence , Social Support , Survivors/psychology
4.
CMAJ Open ; 9(2): E324-E330, 2021.
Article in English | MEDLINE | ID: covidwho-1168152

ABSTRACT

BACKGROUND: Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine-led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community. METHODS: COVIDCare@Home is a multifaceted, interprofessional team-based remote monitoring program developed at an ambulatory academic centre, the Women's College Hospital in Toronto. A descriptive analysis of the first cohort of patients admitted from Apr. 8 to May 11, 2020, was conducted. Lessons from the implementation of the program are described, focusing on measure of adoption (number of visits per patient total, with a physician or with a nurse; length of follow-up), feasibility (received an oximeter or thermometer; consultation with general internal medicine, social work or mental health, pharmacy or acute ambulatory care unit) and safety (hospitalizations, mortality and emergency department visits). RESULTS: The COVIDCare@Home program cared for a first cohort of 97 patients (median age 41 yr, 67% female) with 415 recorded virtual visits. Patients had a median time from positive testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to first appointment of 3 (interquartile range [IQR] 2-4) days, with a median virtual follow-up time of 8 (IQR 5-10) days. A total of 4 (4%) had an emergency department visit, with no patients requiring hospitalization and no deaths; 16 (16%) of patients required support with mental and social health needs. INTERPRETATION: A family medicine-led, team-based remote monitoring program can safely manage the care of outpatients diagnosed with COVID-19. Virtual care approaches, particularly those that support patients with more complex health and social needs, may be an important part of ongoing health system efforts to manage subsequent waves of COVID-19 and other diseases.


Subject(s)
Ambulatory Care/trends , Family Practice , Patient Care Team/organization & administration , Telemedicine/methods , Adult , /therapy , /methods , Canada/epidemiology , Comprehensive Health Care , Disease Transmission, Infectious/prevention & control , Family Health , Family Practice/methods , Family Practice/organization & administration , Feasibility Studies , Female , Humans , Male , Program Evaluation , Social Support
5.
MedEdPORTAL ; 17: 11106, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1154923

ABSTRACT

Introduction: During the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period. Methods: Held three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors. Results: Twenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful. Discussion: VR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.


Subject(s)
Clinical Clerkship/methods , Education, Distance/methods , Education, Medical, Undergraduate/methods , Internal Medicine/education , Teaching Rounds/methods , /epidemiology , Clinical Competence , Curriculum , Hospital Medicine/education , Hospital Medicine/trends , Humans , Personal Satisfaction , Students, Medical/psychology , Telemedicine/methods
7.
Am J Med Qual ; 36(1): 5-16, 2021.
Article in English | MEDLINE | ID: covidwho-1149968

ABSTRACT

Routine outpatient epilepsy care has shifted from in-person to telemedicine visits in response to safety concerns posed by the coronavirus disease 2019 (COVID-19) pandemic. But whether telemedicine can support and maintain standardized documentation of high-quality epilepsy care remains unknown. In response, the authors conducted a quality improvement study at a level 4 epilepsy center between January 20, 2019, and May 31, 2020. Weekly average completion proportion of standardized documentation used by a team of neurologists for adult patients for the diagnosis of epilepsy, seizure classification, and frequency were analyzed. By December 15, 2019, a 94% average weekly completion proportion of standardized epilepsy care documentation was achieved that was maintained through May 31, 2020. Moreover, during the period of predominately telemedicine encounters in response to the pandemic, the completion proportion was 90%. This study indicates that high completion of standardized documentation of seizure-related information can be sustained during telemedicine appointments for routine outpatient epilepsy care at a level 4 epilepsy center.


Subject(s)
/epidemiology , Epilepsy/therapy , Telemedicine , Adult , Female , Humans , Male , Massachusetts/epidemiology , Middle Aged , Quality of Health Care , Telemedicine/methods , Telemedicine/standards
11.
Nutrients ; 13(3)2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146555

ABSTRACT

BACKGROUND: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. METHODS: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. RESULTS: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient's treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. CONCLUSION: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.


Subject(s)
Attitude of Health Personnel , Gastrointestinal Neoplasms/therapy , Nutrition Therapy/methods , Adult , Female , Health Services Accessibility , Humans , Interviews as Topic , Male , Middle Aged , Mobile Applications , Nutrition Therapy/psychology , Telemedicine/methods , Trust
12.
World Neurosurg ; 148: 251-255, 2021 04.
Article in English | MEDLINE | ID: covidwho-1144985

ABSTRACT

The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.


Subject(s)
Biomedical Research/methods , Delivery of Health Care/methods , Neurosurgery/methods , Critical Care , Education, Distance/methods , Elective Surgical Procedures , Hospital Bed Capacity , Humans , Intensive Care Units , Neurosurgery/education , Neurosurgical Procedures , Operating Rooms , Organizational Innovation , Remote Consultation/methods , Telemedicine/methods
13.
Respir Res ; 22(1): 88, 2021 Mar 21.
Article in English | MEDLINE | ID: covidwho-1143219

ABSTRACT

BACKGROUND: Ehealth platforms, since the outbreak of COVID-19 more important than ever, can support self-management in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this observational study is to explore the impact of healthcare professional involvement on the adherence of patients to an eHealth platform. We evaluated the usage of an eHealth platform by patients who used the platform individually compared with patients in a blended setting, where healthcare professionals were involved. METHODS: In this observational cohort study, log data from September 2011 until January 2018 were extracted from the eHealth platform Curavista. Patients with COPD who completed at least one Clinical COPD Questionnaire (CCQ) were included for analyses (n = 299). In 57% (n = 171) of the patients, the eHealth platform was used in a blended setting, either in hospital (n = 128) or primary care (n = 29). To compare usage of the platform between patients who used the platform independently or with a healthcare professional, we applied propensity score matching and performed adjusted Poisson regression analysis on CCQ-submission rate. RESULTS: Using the eHealth platform in a blended setting was associated with a 3.25 higher CCQ-submission rate compared to patients using the eHealth platform independently. Within the blended setting, the CCQ-submission rate was 1.83 higher in the hospital care group than in the primary care group. CONCLUSION: It is shown that COPD patients used the platform more frequently in a blended care setting compared to patients who used the eHealth platform independently, adjusted for age, sex and disease burden. Blended care seems essential for adherence to eHealth programs in COPD, which in turn may improve self-management.


Subject(s)
/psychology , Health Personnel/psychology , Patient Acceptance of Health Care/psychology , Professional Role/psychology , Pulmonary Disease, Chronic Obstructive/psychology , Telemedicine/methods , Aged , /therapy , Cohort Studies , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Retrospective Studies
14.
BMC Ophthalmol ; 21(1): 139, 2021 Mar 20.
Article in English | MEDLINE | ID: covidwho-1143189

ABSTRACT

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.


Subject(s)
Academic Medical Centers/trends , Ambulatory Care/trends , Eye Diseases/diagnosis , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmology/trends , Practice Patterns, Physicians'/trends , /transmission , Communicable Disease Control , Humans , International Classification of Diseases , Ophthalmology/methods , Practice Guidelines as Topic , Retrospective Studies , Telemedicine/methods , United States
15.
Am J Speech Lang Pathol ; 30(2): 740-747, 2021 03 26.
Article in English | MEDLINE | ID: covidwho-1139763

ABSTRACT

Purpose Youth with cochlear implants (CIs) are at risk for delays in verbal short-term memory (STM)/working memory (WM), which adversely affect language, neurocognitive, and behavioral outcomes. Assessment of verbal STM/WM is critical for identifying and addressing these delays, but standard assessment procedures require face-to-face (FTF) administration. The purpose of this study was to determine the feasibility and validity of remote testing methods (teleassessment) of verbal STM/WM in youth with CIs as a method of addressing COVID-19-related restrictions on FTF test administration. Method Tests of verbal STM/WM for nonwords, digit spans, letter-number sequences, sentences, and stories were individually administered by speech-language pathologists over a teleassessment platform to 28 youth (aged 9-22 years) with CIs and 36 same-aged normal-hearing peers. Examiners, parents, and participants completed quality and satisfaction ratings with the teleassessment procedure. Teleassessment scores were compared to results of tests obtained at FTF visits an average of 1.6 years earlier. Results Quality and satisfaction ratings for teleassessment were high and in almost all cases did not differ between the CI and normal-hearing samples. Youth with CIs scored lower than normal-hearing peers on measures of verbal STM/WM, and scores for digit span and letter-number sequencing did not differbetween teleassessment and FTF methods. Correlations across teleassessment and FTF visits were strong for digit span, letter-number sequencing, and sentence memory, but were more modest for nonword repetition. Conclusion With some caveats, teleassessment of verbal STM/WM was feasible and valid for youth with CIs.


Subject(s)
Cochlear Implants/psychology , Memory, Short-Term , Speech Perception , Speech-Language Pathology/methods , Telemedicine/methods , Adolescent , Case-Control Studies , Child , Cochlear Implants/adverse effects , Feasibility Studies , Female , Humans , Male , Pandemics
20.
Am J Speech Lang Pathol ; 30(2): 503-516, 2021 03 26.
Article in English | MEDLINE | ID: covidwho-1125414

ABSTRACT

Purpose COVID-19 has shifted models of health care delivery, requiring the rapid adoption of telehealth, despite limited evidence and few resources to guide speech-language pathologists. Management of dysarthria presents specific challenges in the telehealth modality. Evaluations of dysarthria typically rely heavily on perceptual judgments, which are difficult to obtain via telehealth given a variety of technological factors such as inconsistencies in mouth-to-microphone distance, changes to acoustic properties based on device settings, and possible interruptions in connection that may cause video freezing. These factors limit the validity, reliability, and clinicians' certainty of perceptual speech ratings via telehealth. Thus, objective measures to supplement the assessment of dysarthria are essential. Method This tutorial outlines how to obtain objective measures in real time and from recordings of motor speech evaluations to support traditional perceptual ratings in telehealth evaluations of dysarthria. Objective measures include pause patterns, utterance length, speech rate, diadochokinetic rates, and overall speech severity. We demonstrate, through clinical case vignettes, how these measures were completed following three clinical telehealth evaluations of dysarthria conducted via Zoom during the COVID-19 pandemic. This tutorial describes how each of these objective measures were utilized, in combination with subjective perceptual analysis, to determine deviant speech characteristics and their etiology, develop a patient-specific treatment plan, and track change over time. Conclusion Utilizing objective measures as an adjunct to perceptual ratings for telehealth dysarthria evaluations is feasible under real-world pandemic conditions and can be used to enhance the quality and utility of these evaluations.


Subject(s)
Dysarthria/therapy , Speech-Language Pathology/methods , Telemedicine/methods , /epidemiology , Humans , Pandemics , Speech Intelligibility , Telemedicine/standards
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