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1.
Circ Arrhythm Electrophysiol ; 13(7): e009007, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-669270
3.
Cleve Clin J Med ; 87(8): 461-468, 2020 07 31.
Artículo en Inglés | MEDLINE | ID: covidwho-721560

RESUMEN

Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19- associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients, with more aggressive prophylaxis and screening recommended for patients with D-dimer levels above 3.0 µg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.


Asunto(s)
Anticoagulantes/farmacología , Betacoronavirus , Trastornos de la Coagulación Sanguínea , Infecciones por Coronavirus , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral , Betacoronavirus/patogenicidad , Betacoronavirus/fisiología , Coagulación Sanguínea/efectos de los fármacos , Coagulación Sanguínea/fisiología , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/terapia , Pruebas de Coagulación Sanguínea/métodos , Quimioprevención/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Humanos , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Trombosis/etiología , Trombosis/prevención & control
4.
JACC Cardiovasc Interv ; 13(16): 1945-1948, 2020 08 24.
Artículo en Inglés | MEDLINE | ID: covidwho-714612

RESUMEN

Teleproctoring can be used successfully in performing challenging and innovative structural heart interventions using sophisticated technology that allows real-time bidirectional audiovisual communication with digital transmission of live videos and direct observation of the operative field by a remote proctor. The authors share an illustrative case that was performed amid the coronavirus disease-2019 global pandemic that led to travel restrictions to limit spread of the virus. Teleproctoring has future implications beyond the current global health crisis to facilitate rapid dissemination and exchange of knowledge for ultimately helping patients around the globe.


Asunto(s)
Betacoronavirus , Procedimientos Quirúrgicos Cardíacos/métodos , Infecciones por Coronavirus/complicaciones , Cardiopatías/cirugía , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral/complicaciones , Telemedicina/métodos , Infecciones por Coronavirus/epidemiología , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Humanos , Neumonía Viral/epidemiología
7.
Recenti Prog Med ; 111(7): 404-410, 2020.
Artículo en Italiano | MEDLINE | ID: covidwho-643888

RESUMEN

Lockdown and self-isolation are to date the only solution to limit the spread of recent outbreak of coronavirus disease (CoViD-19), highlighting the great advantage of home dialysis in a patient otherwise forced to travel from / to the dialysis center to receive this "life-saving" treatment. Indeed, to prevent spreading of CoViD-19 infection among extremely fragile dialysis patients, as well as among dialysis workers, hemodialysis (HD) centers are adopting specific procedures ("dedicated" dialysis facilities, portable osmosis, etc.) with a great economic and organizational commitment. Peritoneal dialysis (PD) represents a type of home dialysis therapy not yet adequately implemented to date, in spite of safe and simple practice, as well as similar dialytic efficiency vs in-center hemodialysis. Remote patient monitoring (RPM) systems have been developed in automated PD (APD) cyclers in order to improve the acceptance of this dialysis method, to increase the compliance to the prescribed therapy and to control treatment adequacy. In this review we assess the potential advantages of RPM in APD, that are the chance for patients to acquire greater independence and safety in the home treatment, to allow better access to care for residents in remote areas, faster resolution of problems, reduction in hospitalizations and mortality rates, as well as time and cost saving for both the patient and the staff. The use of medical devices (sphygmomanometer, glucometer, balance, etc.), connected by wireless to the clinician's portal, might also allow a wider diffusion of incremental dialysis, an integrated therapy that combines conservative management of ESKD patients with a soft dialysis based on the residual kidney function and symptomatology, with potential prognosis and economic benefits. Although the majority of the studies are small and observational, a wider use of RPM systems is desirable to broaden the spread of home dialysis, as we learnt from Coronavirus pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Hemodiálisis en el Domicilio , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral , Automatización , Infecciones por Coronavirus/prevención & control , Ahorro de Costo , Susceptibilidad a Enfermedades , Accesibilidad a los Servicios de Salud , Hemodiálisis en el Domicilio/economía , Hemodiálisis en el Domicilio/métodos , Humanos , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Monitoreo Fisiológico/instrumentación , Pandemias/prevención & control , Cooperación del Paciente , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/métodos , Neumonía Viral/prevención & control , Medicina de Precisión , Aislamiento Social , Telemedicina
8.
Recenti Prog Med ; 111(7): 393-397, 2020.
Artículo en Italiano | MEDLINE | ID: covidwho-643106

RESUMEN

The CoViD-19 pandemic has provided the opportunity for the health care's digital revolution with the unprecedented accelerated expansion of telehealth, telemedicine and other digital health tools. Several tools have been developed and launched at national and international level to face the emergency, including tools to perform online triage, symptoms checking, video visits and remote monitoring, and to conduct local and national epidemiological surveillance studies. Artificial intelligence-based tools have also been developed to diagnose cases of CoViD-19 or to identify patients at risk. Most of these technologies have been endorsed by medical societies such as the American Medical Association and the American Academy of Family Physicians which launched specific guidelines about their use. The growth in telemedicine services and in digital health technologies could not have occurred without important telehealth regulatory changes that have occurred in some countries aimed at promoting their use to face the CoViD-19 emergency, such as the deregulation of the use of video conferencing and video chat systems to carry out video visits, and the payment parity between telehealth and in clinic care. In order to decide whether to continue using these tools even after the pandemic is over, it could be useful to perform validation and efficacy studies of these tools to study their implications on the doctor-patient relationship, to understand if the new features can be integrated with the other technological tools already in use, and if they can improve clinical practice and quality of care.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Informática Médica , Pandemias , Neumonía Viral , Inteligencia Artificial , Informática Aplicada a la Salud de los Consumidores , Prescripción Electrónica , Necesidades y Demandas de Servicios de Salud , Humanos , Italia , Monitoreo Fisiológico/métodos , Relaciones Médico-Paciente , Vigilancia de la Población/métodos , Guías de Práctica Clínica como Asunto , Telemedicina , Telemetría , Triaje/métodos , Comunicación por Videocoferencia
9.
J Biomed Inform ; 108: 103483, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-621696

RESUMEN

Monitoring patients through robotics telehealth systems is an interesting scenario where patients' conditions, and their environment, are dynamic and unknown variables. We propose to improve telehealth systems' features to include the ability to serve patients with their needs, operating as human caregivers. The objective is to support the independent living of patients at home without losing the opportunity to monitor their health status. Application scenarios are several, and they spread from simple clinical assisting scenarios to an emergency one. For instance, in the case of a nursing home, the system would support in continuously monitoring the elderly patients. In contrast, in the case of an epidemic diffusion, such as COVID-19 pandemic, the system may help in all the early triage phases, significantly reducing the risk of contagion. However, the system has to let medical assistants perform actions remotely such as changing therapies or interacting with patients that need support. The paper proposes and describes a multi-agent architecture for intelligent medical care. We propose to use the beliefs-desires-intentions agent architecture, part of it is devised to be deployed in a robot. The result is an intelligent system that may allow robots the ability to select the most useful plan for unhandled situations and to communicate the choice to the physician for his validation and permission.


Asunto(s)
Monitoreo Fisiológico/instrumentación , Robótica/tendencias , Anciano , Inteligencia Artificial , Sistemas de Computación , Infecciones por Coronavirus/terapia , Medicina de Emergencia/instrumentación , Geriatría/instrumentación , Humanos , Infectología/instrumentación , Informática Médica , Modelos Teóricos , Monitoreo Fisiológico/métodos , Casas de Salud , Pandemias , Neumonía Viral/terapia , Riesgo , Telemedicina/instrumentación , Telemedicina/métodos
11.
Emerg Med Pract ; 22(7): 1-20, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-607852

RESUMEN

There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. An update on managing COVID-19-associated acute respiratory distress syndrome is also included.


Asunto(s)
Lesión Pulmonar Aguda/prevención & control , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital/organización & administración , Monitoreo Fisiológico/métodos , Neumonía Viral/terapia , Respiración Artificial/instrumentación , Síndrome de Dificultad Respiratoria del Adulto/terapia , Lesión Pulmonar Aguda/etiología , Adulto , Infecciones por Coronavirus/epidemiología , Seguridad de Equipos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Respiración Artificial/efectos adversos , Síndrome de Dificultad Respiratoria del Adulto/virología , Medición de Riesgo , Resultado del Tratamiento , Ventiladores Mecánicos
12.
Am J Perinatol ; 37(10): 1066-1069, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-601347

RESUMEN

We describe our experience with three pregnant women with novel coronavirus disease 2019 (COVID-19) who required mechanical ventilation. Recent data suggest a mortality of 88% in nonpregnant patients with COVID-19 who require intubation and mechanical ventilation. The three women we report were intubated and mechanically ventilated during pregnancy due to respiratory failure and pneumonia resulting from COVID-19. After several days of ventilation, all three were successfully weaned off mechanical ventilation and extubated, and are continuing their pregnancies with no demonstrable adverse effects. Our experience suggests that the mortality in pregnant women with COVID-19 requiring mechanical ventilation is not necessarily as high as in nonpregnant patients with COVID-19. KEY POINTS: · Coronavirus disease 2019 (COVID-19) is now a pandemic.. · COVID-19 may cause pneumonia or respiratory failure in pregnant women.. · Approximately 5% of women with COVID-19 will develop severe or critical disease.. · Mechanical ventilation in pregnant women may not necessarily result in high mortality rates..


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Embarazo de Alto Riesgo , Insuficiencia Respiratoria/terapia , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital , Femenino , Edad Gestacional , Humanos , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral/terapia , Embarazo , Respiración Artificial/métodos , Insuficiencia Respiratoria/etiología , Medición de Riesgo , Muestreo
14.
J Med Internet Res ; 22(6): e19091, 2020 06 19.
Artículo en Inglés | MEDLINE | ID: covidwho-620537

RESUMEN

BACKGROUND: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. OBJECTIVE: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. METHODS: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. RESULTS: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. CONCLUSIONS: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. TRIAL REGISTRATION: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Cuidados Críticos/métodos , Encuestas de Atención de la Salud , Unidades de Cuidados Intensivos , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral , Adulto , Inteligencia Artificial , Cuidados Críticos/normas , Femenino , Alemania , Hospitales Universitarios , Humanos , Masculino , Monitoreo Fisiológico/normas , Enfermeras y Enfermeros , Médicos , Investigación Cualitativa
15.
Artif Organs ; 44(8): 873-876, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-401294

RESUMEN

Coronavirus disease 2019 (COVID-19) is a pandemic touching thousands of people all around the world. Patients supported with left ventricular assist devices (LVADs) are affected by long-standing cardiovascular diseases and subjected to variations of the normal cardiovascular physiology, thus requiring an even closer monitoring during the COVID-19 outbreak. Nevertheless, the COVID-19 pandemic led to a drastic reduction in routine clinical activities and a consequent risk of looser connections between LVAD patients and their referring center. Potential deleterious effects of such a situation can be a delayed recognition of LVAD-related complications, misdiagnosis of COVID-19, and impaired social and psychological well-being for patients and families. As one of the largest LVAD programs worldwide, we designed a sustainable and enforceable telemonitoring algorithm which can be easily adapted to every LVAD center so as to maintain optimal quality of care for LVAD patients during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Insuficiencia Cardíaca/terapia , Corazón Auxiliar/estadística & datos numéricos , Control de Infecciones/organización & administración , Evaluación de Resultado en la Atención de Salud , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/organización & administración , Infecciones por Coronavirus/prevención & control , Femenino , Salud Global , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Evaluación de Programas y Proyectos de Salud
18.
Cleve Clin J Med ; 87(8): 461-468, 2020 07 31.
Artículo en Inglés | MEDLINE | ID: covidwho-266450

RESUMEN

Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19- associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients, with more aggressive prophylaxis and screening recommended for patients with D-dimer levels above 3.0 µg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.


Asunto(s)
Anticoagulantes/farmacología , Betacoronavirus , Trastornos de la Coagulación Sanguínea , Infecciones por Coronavirus , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Monitoreo Fisiológico/métodos , Pandemias , Neumonía Viral , Betacoronavirus/patogenicidad , Betacoronavirus/fisiología , Coagulación Sanguínea/efectos de los fármacos , Coagulación Sanguínea/fisiología , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/terapia , Pruebas de Coagulación Sanguínea/métodos , Quimioprevención/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Humanos , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Trombosis/etiología , Trombosis/prevención & control
19.
Clin Med (Lond) ; 20(4): e62-e65, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-245760

RESUMEN

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a highly contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pneumonia and acute respiratory distress syndrome (ARDS) are the most common severe complications. There is growing evidence regarding the imaging findings of COVID-19 in chest X-rays and computed tomography (CT); however, their availability to clinical staff in this pandemic outbreak might be compromised. At this moment, the role of lung ultrasound (LUS) has yet to be explored. The purpose of this case report is to describe the natural course of the disease in mild infection managed at home. CASE REPORT: We report a 35-year-old man with recently diagnosed COVID-19 infection. Clinical examination was unremarkable. The diagnosis of mild disease was made clinically which was later reaffirmed by LUS after identifying a bilateral small pleural effusion and a thickened pleural line. During follow up, subpleural consolidations appeared before symptoms slightly aggravated (cough, tiredness and fever). The patient's condition improved after adjustment of therapy at home. CONCLUSION: LUS is an excellent tool in the characterisation of COVID-19 infection and is more available than CT or X-ray. We emphasise the utility and the opportunity that LUS presents in some clinical scenarios, like this COVID-19 pandemic, and how it may serve as a monitoring and therapy guide.


Asunto(s)
Infecciones por Coronavirus , Servicios de Atención de Salud a Domicilio/organización & administración , Pulmón/diagnóstico por imagen , Pandemias , Derrame Pleural , Neumonía Viral , Sistemas de Atención de Punto , Ultrasonografía/métodos , Adulto , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Monitoreo Fisiológico/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Resultado del Tratamiento
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