|
1
|
Jowell AH, Kwong AJ, Reguram R, Daugherty TJ, Kwo PY. Changes in the liver transplant evaluation process during the early COVID-19 era and the role of telehealth. World J Transplant 2025; 15:99401. [DOI: 10.5500/wjt.v15.i2.99401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 11/25/2024] [Accepted: 12/25/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disrupted healthcare and led to increased telehealth use. We explored the impact of COVID-19 on liver transplant evaluation (LTE).
AIM To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors.
METHODS This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21 (“COVID-19 era”) and the year prior (3/16/19-3/15/20, “pre-COVID-19 era”). We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration, listing, and pre-transplant mortality.
RESULTS One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort. Twenty-nine percent (58/199) of COVID-19 era initial LTE were telehealth, compared to 0% (0/178) pre-COVID-19. There were more inpatient evaluations during COVID-19 era (40% vs 28%, P < 0.01). Among outpatient encounters, telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing, pre-transplant mortality, or time to LTE and listing. Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19, driven by increased inpatient evaluations. Sociodemographic factors were not predictive of telehealth.
CONCLUSION COVID-19 demonstrates a shift to telehealth and inpatient LTE. Telehealth does not impact LTE or listing duration, likelihood of listing, or mortality, suggesting telehealth may facilitate LTE without negative outcomes.
Collapse
Affiliation(s)
- Ashley H Jowell
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States
| | - Allison J Kwong
- Department of Medicine, Stanford University, Redwood City, CA 94063, United States
| | - Reshma Reguram
- Department of Medicine, Trinity Health, Pontiac, MI 48341, United States
| | - Tami J Daugherty
- Department of Medicine, Stanford University, Redwood City, CA 94063, United States
| | - Paul Yien Kwo
- Department of Medicine, Stanford University, Redwood City, CA 94063, United States
| |
Collapse
|
|
2
|
Bloomberg L, Rubin JN. Hepatology in the Digital Era: A Review of Telehealth Care for Liver Disease. Curr Gastroenterol Rep 2025; 27:25. [PMID: 40153166 DOI: 10.1007/s11894-025-00972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2025] [Indexed: 03/30/2025]
Abstract
PURPOSE OF REVIEW Telehealth has become an integral component of healthcare delivery in the US. While telehealth has been utilized within Hepatology for decades for HCV through Project ECHO and adapted by the VA, the COVID-19 pandemic catalyzed an unprecedented expansion of telehealth. This review examines the evolution, benefits, challenges, and future implications of telehealth in Hepatology. RECENT FINDINGS Telehealth can improve access to care for underserved patient populations and provide continuity of care for chronic liver disease and liver transplant patients. Studies suggest that telehealth can deliver equivalent quality of care to in-person visits with high satisfaction rates among patients and providers. However, there are barriers to telehealth including disparities in technology access, limitations in quality of virtual encounters, and limited insurance policies. However, many questions remain. As Hepatology enters the digital era, telehealth holds promise for enhancing care delivery, but its integration must be guided by evidence-based practices.
Collapse
Affiliation(s)
- Lauren Bloomberg
- Department of Internal Medicine, Division of Gastroenterology, Loyola University Medical Center, Maywood, IL, USA
| | - Jonah N Rubin
- Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA.
- Division of Gastroenterology and Hepatology, Edward Hines Junior Veteran Affairs, Hines, IL, USA.
| |
Collapse
|
|
3
|
Wang L, Liang D, HuangFu H, Ke C, Wu S, Lai Y. Enterprise-led internet healthcare provision in China: insights from a leading platform. Front Digit Health 2025; 7:1491183. [PMID: 40099033 PMCID: PMC11911379 DOI: 10.3389/fdgth.2025.1491183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
Background China's healthcare resources are limited and unevenly distributed, with a notable urban-rural gap. Enterprise-led internet healthcare platforms have become an important solution for optimizing resource allocation, improving accessibility, and enhancing efficiency in mainland China. However, detailed analysis of their online consultation services from both healthcare provider and patient perspectives is still lacking. Objective The online consultation data of an enterprise-led internet healthcare platform was depicted and analyzed to understand the temporal trend and current situation of enterprise-led internet healthcare development in mainland China, which provided insights for the further development of internet healthcare. Methods We gathered information from an enterprise-led internet healthcare platform (i.e., Good Doctor Online) covering the period from January 2008 to December 2022, including the characteristics of doctors, healthcare institutions, and patients. Based on the above data, we sketched and analyzed the situation of online consultation services provided by the enterprise-led internet healthcare platform in mainland China. Results A total of 149,890 doctors from 7,584 healthcare institutions provided 40,462,801 online consultations from January 2008 to December 2022. Doctors and healthcare institutions providing online consultation services were primarily distributed in the economically developed eastern and southern provinces of China. Doctors with intermediate (30.15%) and senior titles (58.12%) were the main providers of online consultations and most doctors were from tertiary hospitals (88.18%). The consultation price {median [interquartile range (IQR)]} was 49.00 (15.00, 100.00) RMB. The health issues with the highest consultation frequency included upper respiratory tract infections or fever (16.19%), gynecological disorders (11.98%), and skin diseases (8.65%), with variations in gender and age. The age distribution of patients showed two peaks in age groups <5 years and 20-39 years, with the median age (IQR) 29.00 (19.00-43.00) years. Conclusions Enterprise-led internet healthcare platforms enhance access to care and reduce offline resource strain, especially during COVID-19. They mainly address non-urgent conditions but cannot fully replace in-person care. Policies should focus on increasing elderly participation, engaging senior doctors, optimizing male-oriented services, expanding access to underserved areas, standardizing pricing, and broadening insurance reimbursement coverage to improve equity and sustainability.
Collapse
Affiliation(s)
- Li Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dan Liang
- Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Hengqian HuangFu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Changwen Ke
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Guangzhou, China
| | - Shaolong Wu
- Department of Public Administration, School of Government, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Research Center of Health Informatics, Sun Yat-sen University, Guangzhou, China
- Guangdong Key Laboratory of Health Informatics, Guangzhou, China
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning, and Risk Assessment, Guangzhou, China
| |
Collapse
|
|
4
|
Al Shabeeb RQ, Lee E, El Shatanofy M, Pashai E, Benjenk I, Sherman M, Heinz E, Yamane D, Borum ML. Factors Affecting Gastroenterologists' Fear When Performing Endoscopies during the COVID Pandemic: Results of a US National Survey. South Med J 2025; 118:181-183. [PMID: 40031768 DOI: 10.14423/smj.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic affected the practice of gastroenterology. Endoscopic procedures are aerosolizing procedures that carry the risk of COVID-19 transmission. Our national survey examined factors affecting gastroenterologists' fear of contracting COVID-19 during endoscopy. METHODS An institutional review board-approved multicenter cross-sectional study used a snowball sample approach to disseminate a 42-question survey to gastroenterologists during a 3-month period in 2021, during the height of the pandemic. Physician demographics, information about personal protective equipment (PPE), negative pressure rooms, and COVID-19 vaccination status was collected. Likert scales were used to evaluate gastroenterologists' fear when performing endoscopy. Analysis was performed using Pearson's χ2, Mann-Whitney U, and Wilcoxon rank tests, with significance set at P < 0.05. RESULTS Results from 69 respondents showed that 91.3% believed that PPE was adequate, 52.2% had PPE education and training, and 47.8% reported that PPE education decreased their fear of contracting COVID-19 during endoscopy. Fear decreased from first to subsequent endoscopies (P < 0.0005) and after COVID-19 vaccination (P < 0.0005). Higher levels of fear were associated with having comorbid conditions (P = 0.048), being the primary caregiver for or living with a person 65 years old or older (P = 0.041), having had to quarantine during the pandemic (P = 0.017), having not performed a procedure because of infectious risks (P = 0.005), and living with someone with comorbid conditions (P = 0.001). CONCLUSIONS Multiple factors affect gastroenterologists' fear of contracting COVID-19 during endoscopic procedures. Lessons learned during the COVID-19 pandemic about mitigating gastroenterologists' fear are potentially applicable to future circumstances that may be associated with significant infectious concerns.
Collapse
Affiliation(s)
- Reem Q Al Shabeeb
- From the Department of Medicine, INOVA-Fairfax Hospital, Falls Church, Virginia
| | - Esther Lee
- the Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC
| | - Muhammad El Shatanofy
- the Department of Otolaryngology - Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Ivy Benjenk
- the Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Marian Sherman
- the Department of Anesthesiology, Johns Hopkins Medicine at Sibley Memorial Hospital, Washington, DC
| | - Eric Heinz
- the Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | | | - Marie L Borum
- the Department of Medicine, Division of Gastroenterology and Liver Diseases, The George Washington University, Washington, DC
| |
Collapse
|
|
5
|
Galts C, Siempelkamp B, Duthie K, Wilson L, Loomes DE. Informing Modern Models of Care: A Randomized, Sequential Trial of In-Person, Telehealth, and Telephone Appointments for Patients with Inflammatory Bowel Disease. Dig Dis Sci 2025; 70:128-135. [PMID: 39614027 DOI: 10.1007/s10620-024-08750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 11/09/2024] [Indexed: 12/01/2024]
Abstract
BACKGROUND A significant shift toward virtual care has occurred for many patients with inflammatory bowel disease (IBD). To date, there are no prospective studies assessing patients visits across different styles of appointments. METHODS We randomized IBD patients' appointments to in-person, video-assisted virtual, or telephone and subsequent appointments to the alternate style of visit in a single-center study in Victoria, Canada. Participants completed surveys after each appointment. Demographic data were collected and average scores were analyzed for potential associations. RESULTS Forty-one patients were randomized to appointments, and 86 post-appointment surveys were completed, 30 in-person, 29 telephone, and 27 telehealth. The average age was 46.5 ± 18 years and 59% were female. The overall patient score (out of ten) by appointment type was 9.1 ± 1.0 for in-person, 7.8 ± 2.1 for telephone, and 8.0 ± 2.6 for telehealth without a statistically significant difference. While there was only a near statistically significant preference for in-person appointments compared with telehealth p = 0.055, it was statistically significant when comparing with phone appointments p = 0.014. The highest rated factors for preference of an in-person appointment were optimal communication and interaction with care provider (86%). For patients who preferred telehealth or telephone appointments, the highest rated factors were time and cost savings (71%, 43% and 58%, 33%, respectively). In-person appointments were associated with a significantly higher cost (p < 0.01), and longer time commitment. CONCLUSIONS Despite the increased cost and time commitment, in-person appointments were highly rated particularly in comparison to phone appointments. Based on this research, providers can be better informed on factors contributing to patients' preferred appointment style.
Collapse
Affiliation(s)
- Ciarán Galts
- Division of Gastroenterology, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 1H4, Canada.
| | - Braden Siempelkamp
- Department of Internal Medicine, University of British Columbia, Victoria, BC, Canada
| | - Kia Duthie
- Vancouver Island IBD Clinic, Victoria, BC, Canada
| | - Laura Wilson
- Vancouver Island IBD Clinic, Victoria, BC, Canada
| | - Dustin E Loomes
- Division of Gastroenterology, University of British Columbia, Victoria, BC, Canada
| |
Collapse
|
|
6
|
Kasimovskaya N, Poleshchuk I, Fomina E, Shatova E, Diatlova E, Chalova E. Development of a digital platform for nursing monitoring of patients with chronic kidney failure. Int Urol Nephrol 2025; 57:285-294. [PMID: 39180620 DOI: 10.1007/s11255-024-04186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE This study aims to develop and propose the key criteria and elements necessary to be included in digital platforms for achieving high-quality monitoring of patients with chronic kidney failure. METHODS The research was conducted from 2021 to 2023 in Moscow, Russia. A total of 75 patients comprised the experimental group (digital monitoring), while an equal number constituted the control group (standard nursing care). RESULTS Patients in the experimental group highly rated the convenience (4.6 ± 0.3) and accessibility (4.7 ± 0.4) levels of the monitoring system compared to those in the control group (convenience: 3.8 ± 0.4, accessibility: 3.9 ± 0.3). Furthermore, it was found that the level of patient satisfaction in the experimental group (4.4 ± 0.3) noticeably exceeded that in the control group (3.9 ± 0.4). The effectiveness of digital platforms is supported by data on the timeliness of detecting changes in patient's health status. In the experimental group, the response time to deteriorating health conditions decreased by 30% compared to the control group. CONCLUSION The conclusions of our study underscore the necessity of integrating digital monitoring platforms into medical practice. Monitoring utilizing digital technologies has the potential to significantly enhance patient satisfaction levels as well as promptness in responding to changes in their health status.
Collapse
Affiliation(s)
- Nataliya Kasimovskaya
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
| | - Ilia Poleshchuk
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Elena Fomina
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Eugenia Shatova
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ekaterina Diatlova
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ekaterina Chalova
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| |
Collapse
|
|
7
|
Castro L, Quera R, Núñez P, von Mühlenbrock C, San Martín P, Donoso F, Herrera K. [Evaluation of the usability of patients attended in gastrointestinal telemedicine postpandemic at University clinic]. REVISTA DE GASTROENTEROLOGIA DEL PERU : ORGANO OFICIAL DE LA SOCIEDAD DE GASTROENTEROLOGIA DEL PERU 2024; 44:265-272. [PMID: 39538395 DOI: 10.47892/rgp.2024.443.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
UNLABELLED Telemedicine has grown during the COVID-19 pandemic. Gastroenterology at Clínica Universidad de los Andes has continued it post-pandemic. Usability is the measure by which users evaluate the effectiveness, efficiency, and satisfaction in telemedicine. The usability of this type of consultation in Chile is unknown. OBJECTIVE To evaluate the level of usability among patients attended through teleconsultations in Gastroenterology at Clínica Universidad de los Andes (March-August 2023). MATERIALS AND METHODS A cross-sectional descriptive study on the level of usability using the adapted and modified Telehealth Usability Questionnaire. It consists of 12 items (score range 12-84) and comprises 2 factors: effectiveness and ease of use. Sociodemographic characteristics were also evaluated. RESULTS A total of 150 questionnaires were analyzed. A high level of usability was observed (median: 81; range 54-84), with high scores in effectiveness (median: 28; range 20-28) and ease of use (median: 53; range 30-56), without significant differences according to sex, age, educational level, geographic location, and health insurance. Of the respondents, 76.7% were aged 30 to 64 years. 36% resided in the metropolitan region, 61% were women, and 80% were from the private health system. 29% consulted for abdominal pain, 20% for inflammatory bowel disease, and 17% for abnormal liver function tests. For 53.3%, it was their first consultation, and 46.7% were in follow-up via this method. CONCLUSION In this cohort, telemedicine is perceived as an effective and easy-to-use tool, with a high level of usability regardless of the patients' sociodemographic characteristics. Therefore, in gastroenterology, telemedicine appears to be a form of healthcare accepted by patients.
Collapse
Affiliation(s)
- Lorena Castro
- Universidad de los Andes, Centro Enfermedades Digestivas, Clínica Universidad de los Andes, Santiago, Chile
| | - Rodrigo Quera
- Universidad de los Andes, Centro Enfermedades Digestivas, Clínica Universidad de los Andes, Santiago, Chile
| | - Paulina Núñez
- Universidad de los Andes, Centro Enfermedades Digestivas, Clínica Universidad de los Andes, Santiago, Chile; Programa de Enfermedad Inflamatoria Intestinal, Hospital San Juan de Dios, Santiago, Chile; Facultad Medicina Occidente, Universidad de Chile, Santiago, Chile
| | - Christian von Mühlenbrock
- Universidad de los Andes, Centro Enfermedades Digestivas, Clínica Universidad de los Andes, Santiago, Chile
| | - Pamela San Martín
- DIDeP, área de Investigación, Clínica Universidad de los Andes, Santiago, Chile; IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Universidad de los Andes, Santiago, Chile; Centro de Investigación e Innovación Biomédica, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Felipe Donoso
- Universidad de los Andes, Centro Enfermedades Digestivas, Clínica Universidad de los Andes, Santiago, Chile
| | - Karin Herrera
- DIDeP, área de Investigación, Clínica Universidad de los Andes, Santiago, Chile; Programa de Nutrición y Ciencia de los Alimentos, Universidad de Granada, Granada, España
| |
Collapse
|
|
8
|
Odebunmi OO, Hughes TD, Waters AR, Urick BY, Herron C, Wangen M, Rohweder C, Ferrari RM, Marciniak MW, Wheeler SB, Brenner AT, Shah PD. Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey. J Med Internet Res 2024; 26:e50205. [PMID: 38780994 PMCID: PMC11157176 DOI: 10.2196/50205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 02/16/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this. OBJECTIVE This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. METHODS We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. RESULTS Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. CONCLUSIONS Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable.
Collapse
Affiliation(s)
- Olufeyisayo O Odebunmi
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Tamera D Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Austin R Waters
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Benjamin Y Urick
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
- Prime Therapeutics, Eagan, MN, United States
| | - Caroline Herron
- Syracuse Veterans Affairs Medical Center, Syracuse, NY, United States
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Department of Maternal and Child Health, University of North Carolina, Chapel Hill, NC, United States
| | - Macary W Marciniak
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| |
Collapse
|
|
9
|
Carter D, Rosen A, Applebaum JR, Southern WN, Crossman DJ, Shelton RC, Auerbach A, Schnipper JL, Adelman JS. National Survey of Patient Safety Experiences in Hospital Medicine During the COVID-19 Pandemic. Jt Comm J Qual Patient Saf 2024; 50:260-268. [PMID: 38087723 DOI: 10.1016/j.jcjq.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals were caring for increasing numbers of patients with a novel and highly contagious respiratory illness, forcing adaptations in care delivery. The objective of this study was to understand the impact of these adaptations on patient safety in hospital medicine. METHODS The authors conducted a nationwide survey to understand patient safety challenges experienced by hospital medicine clinicians during the COVID-19 pandemic. The survey was distributed to members of the Society of Hospital Medicine via an e-mail listserv. It consisted of closed- and open-ended questions to elicit respondents' experience in five domains: error reporting and communication, staffing, equipment, personal protective equipment (PPE) and isolation practices, and infrastructure. Quantitative questions were reported as counts and percentages; qualitative responses were coded and analyzed for relevant themes. RESULTS Of 196 total responses, 167 respondents (85.2%) were attending physicians and 85 (43.8%) practiced at teaching hospitals. Safety concerns commonly identified included nursing shortages (71.0%), limiting patient interactions to conserve PPE (61.9%), and feeling that one was practicing in a more hazardous environment (61.4%). In free-text responses, clinicians described poor outcomes and patient decompensation due to provider and equipment shortages, as well as communication lapses and diagnostic errors resulting from decreased patient contact and the need to follow isolation protocols. CONCLUSION Efforts made to accommodate shortages in staff and equipment, adapt to limited PPE, and enforce isolation policies had unintended consequences that affected patient safety and created a more hazardous environment characterized by less efficient care, respiratory decompensations, diagnostic errors, and poor communication with patients.
Collapse
|
|
10
|
Wu X, Kuang Y, Guo Y, Wu J, Xiao L. Internet hospital response to the COVID-19 pandemic in a tertiary hospital in China: Perspectives based on a mixed-methods. Digit Health 2024; 10:20552076241228418. [PMID: 38303968 PMCID: PMC10832419 DOI: 10.1177/20552076241228418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Objective This study aimed to summarize the characteristics of the Internet hospital services of the Seventh Affiliated Hospital of Sun Yat-sen University (SAHSYSU), describe diagnosis and treatment patterns in each department, determine SAHSYSU Internet hospital's role in pandemic control, and explore development strategies in non-pandemic situations. Methods Mixed-methods was used in this study. Qualitative organizational behavior analysis was conducted on hospital meeting records and semi-structured interview records to determine the research analysis indicators. We quantitatively analyzed online consultation record data of SAHSYSU Internet hospital from January to December 2020, and conduct classification analysis on departmental case studies using K-means clustering algorithm. Results 29,944 patient data items were retrieved. Internet hospital services synchronized with COVID-19 pandemic development in China and Guangdong province. The service volume peaked during the period of January to March, which coincided with the height of the pandemic. Out of the total visits, 58.90% were conducted during office hours while 41.10% were conducted during non-office hours. The majority of the patients came from Guangdong (19.67%) and Hubei (9.09%) provinces. The cluster analysis identified three clusters, each with different change rates and magnitudes of change for various departments. Conclusion Internet hospitals complemented conventional medical services, providing crucial medical care during the COVID-19 pandemic. Internet hospitals are the future trend of medical services and should be improved based on each department's treatment characteristics.
Collapse
Affiliation(s)
- Xiaolong Wu
- Business School, Sun Yat-sen University, Shenzhen, China
| | - Yulin Kuang
- Business School, Sun Yat-sen University, Shenzhen, China
| | - Yonglin Guo
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Ji Wu
- School of Business, Sun Yat-sen University, Guangzhou, China
| | - Li Xiao
- Office of the SYSU CPC Committee, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
|
11
|
Aldzhyan V, Tamamian C, Tabibian JH. Leveraging telemedicine in gastroenterology and hepatology: a narrative review. Mhealth 2023; 9:36. [PMID: 38023778 PMCID: PMC10643195 DOI: 10.21037/mhealth-23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objective Over the years, telemedicine has played a prominent role in delivering healthcare to patients. Due to its flexibility and many benefits, telemedicine confers physicians the ability to guide and promote medical care remotely. The advent of the coronavirus disease 2019 (COVID-19) pandemic has changed the landscape of medicine and has accelerated the usage of digital and remote healthcare systems for clinical care. Herein, we provide an overview of telemedicine, its applications in managing inflammatory bowel disease (IBD), celiac disease (CD), and liver diseases, its advantages and limitations, and its use in educating the next generation of gastroenterologists. Methods We conducted a review of scientific articles published in PubMed and Google Scholar. Articles were selected based on the search terms included in the search strategy summary. The language of the articles was restricted to English only. Key Content and Findings We report that telemedicine has the potential to streamline and improve patient care in gastroenterology (GI) and hepatology while also limiting health care expenses. Additionally, we noted the importance of tele-education for training the next generation of physicians who intend on practicing in rural settings. Furthermore, we identified barriers to telemedicine care that exacerbate health inequities and potential solutions to achieving digital health equity. Lastly, we briefly discuss the role of artificial intelligence (AI) in remote patient monitoring. Conclusions Although telemedicine has existed for many decades, over the past decade there have been many advancements in telemedicine applications in GI and hepatology. Despite its broad benefits, further research needs to be done to alleviate barriers to telemedicine care.
Collapse
Affiliation(s)
- Vahagn Aldzhyan
- Department of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carine Tamamian
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - James H. Tabibian
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Gastroenterology, Adventist Health Glendale Medical Center, Glendale, CA, USA
| |
Collapse
|
|
12
|
Peng YL, Chang CH, Wei SC, Huang TY, Tai WC, Hsu WH, Wu DC, Yen HH, Tai CM, Chang CW, Lin WC, Wang HY, Lin CC, Kuo CJ, Chiu CT, Lin CP, Lee HC, Wu JF, Chung CS. Impact of the COVID-19 pandemic on inflammatory bowel disease care in Taiwan: A multicenter study. J Formos Med Assoc 2023; 122:1042-1049. [PMID: 37019722 PMCID: PMC10040350 DOI: 10.1016/j.jfma.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a great impact on healthcare system and patients. This study aimed to evaluate the effect of the COVID-19 pandemic on the perceptions of patients with inflammatory bowel disease (IBD). METHODS This prospective multicenter study was conducted between July 2021 and December 2021. Patients with IBD answered a structured questionnaire, and their degree of anxiety was assessed using a visual analogue scale (VAS) before and after reading educational materials. RESULTS A total of 225 (47.67%) patients with Crohn's disease, 244 (51.69%) with ulcerative colitis and 3 (0.64%) with indeterminate colitis were enrolled. Common concerns were adverse events from vaccination (20.34%), and higher risks of developing severe COVID-19 (19.28%) and COVID-19 infection (16.31%) than the general population. Medications deemed by the patients to increase the risk of COVID-19 were immunomodulators (16.10%), anti-tumor necrosis factor-α antagonists (9.96%), and corticosteroids (9.32%). Thirty-five (7.42%) patients self-discontinued IBD medication, of whom 12 (34.28%) had worse symptoms. Older age (>50 years) (OR 1.10, 95% CI 1.01-1.19, p = 0.03), IBD-related complications (OR 1.16, 95% CI 1.04-1.28, p = 0.01), education status below senior high school (OR 1.22, 95% CI 1.08-1.37, p = 0.001), and residing in north-central Taiwan (OR 1.21, 95% CI 1.10-1.34, p < 0.001) were associated with more anxiety. None of the enrolled patients contracted COVID-19. The anxiety VAS score (mean ± SD) improved after reading the educational materials (3.84 ± 2.33 vs. 2.81 ± 1.96, p < 0.001). CONCLUSION The medical behavior of IBD patients was influenced by the COVID-19 pandemic, and their anxiety could be mitigated after education.
Collapse
Affiliation(s)
- Yen-Ling Peng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Hsin Chang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, IBD Center, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Shu-Chen Wei
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Yu Huang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chen Tai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsu-Heng Yen
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chi-Ming Tai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chen-Wang Chang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Chen Lin
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Horng-Yuan Wang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chun-Chi Lin
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jung Kuo
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Cheng-Tang Chiu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Pin Lin
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsi-Chang Lee
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Jia-Feng Wu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taipei, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
|
13
|
Makhani S, Morales J, Whitson MJ. The new normal: a review of the impact of COVID-19 on gastroenterology fellowship training. Therap Adv Gastroenterol 2023; 16:17562848231201848. [PMID: 37779860 PMCID: PMC10540587 DOI: 10.1177/17562848231201848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
The COVID-19 pandemic had a significant impact on medical education and gastroenterology fellowship training. As a result of the pandemic, a trainee's physical safety, mental health and wellness, clinical and procedural training, and educational opportunities were all potentially altered. Changes necessitated at the start of the pandemic were different than those needed further along in the pandemic course. Fellowship programs were required to modify policies and adapt to changes rapidly to advocate for their trainees and ensure quality education. Much of COVID-19's initial impact on education - decreased endoscopic procedures and the loss of educational conferences - has largely returned to pre-pandemic form. However, other changes made during the pandemic have persisted and likely will continue in the future. This includes a virtual interview format for fellowship matches, a virtual option for many national conferences, and an expansion of simulation training. This article reviews the impact that COVID-19 had on medical education with a specific focus on gastroenterology fellowship. The paper highlights the initial impact of COVID-19, the lingering effects, and discusses the areas needed for further research to best understand the total impact COVID-19 had on our trainees' education.
Collapse
Affiliation(s)
- Salima Makhani
- Division of Gastroenterology, Department of Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Manhassett, NY, USA
| | - Jaclyn Morales
- Division of Gastroenterology, Department of Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Manhassett, NY, USA
| | - Matthew J. Whitson
- Division of Gastroenterology, Department of Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, 600 Northern Boulevard, Suite 111, Manhassett, NY 11021, USA
| |
Collapse
|
|
14
|
Dowthwaite L, Cruz GR, Pena AR, Pepper C, Jäger N, Barnard P, Hughes AM, Nair RD, Crepaz-Keay D, Cobb S, Lang A, Benford S. Examining the Use of Autonomous Systems for Home Health Support Using a Smart Mirror. Healthcare (Basel) 2023; 11:2608. [PMID: 37830645 PMCID: PMC10572232 DOI: 10.3390/healthcare11192608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
The home is becoming a key location for healthcare delivery, including the use of technology driven by autonomous systems (AS) to monitor and support healthcare plans. Using the example of a smart mirror, this paper describes the outcomes of focus groups with people with multiple sclerosis (MS; n = 6) and people who have had a stroke (n = 15) to understand their attitudes towards the use of AS for healthcare in the home. Qualitative data were analysed using a thematic analysis. The results indicate that the use of such technology depends on the level of adaptability and responsiveness to users' specific circumstances, including their relationships with the healthcare system. A smart mirror would need to support manual entry, responsive goal setting, the effective aggregation of data sources and integration with other technology, have a range of input methods, be supportive rather than prescriptive in messaging, and give the user full control of their data. The barriers to its adoption include a perceived lack of portability and practicality, a lack of accessibility and inclusivity, a sense of redundancy, feeling overwhelmed by multiple technological devices, and a lack of trust in data sharing. These results inform the development and deployment of future health technologies based on the lived experiences of people with health conditions who require ongoing care.
Collapse
Affiliation(s)
- Liz Dowthwaite
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Gisela Reyes Cruz
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Ana Rita Pena
- Horizon Centre for Doctoral Training, University of Nottingham, Nottingham NG8 1BB, UK; (A.R.P.); (C.P.)
| | - Cecily Pepper
- Horizon Centre for Doctoral Training, University of Nottingham, Nottingham NG8 1BB, UK; (A.R.P.); (C.P.)
| | - Nils Jäger
- Department of Architecture and Built Environment, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Pepita Barnard
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK;
| | - Roshan das Nair
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK;
- Health Division, Stiftelsen for Industriell og Teknisk Forskning (SINTEF), 0314 Oslo, Norway
| | | | - Sue Cobb
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.)
| | - Alexandra Lang
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.)
| | - Steve Benford
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| |
Collapse
|
|
15
|
Wang M, Shui AM, Barry F, Verna E, Kent D, Yao F, Seetharaman S, Berry K, Grubbs RK, George G, Huang CY, Duarte-Rojo A, Lai JC. The tele-liver frailty index (TeLeFI): development of a novel frailty tool in patients with cirrhosis via telemedicine. Am J Transplant 2023; 23:966-975. [PMID: 37061188 PMCID: PMC10330470 DOI: 10.1016/j.ajt.2023.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
Frailty is a critical determinant of outcomes in cirrhosis patients. The increasing use of telemedicine has created an unmet need for virtual frailty assessment. We aimed to develop a telemedicine-enabled frailty tool (tele-liver frailty index). Adults with cirrhosis in the liver transplant setting underwent ambulatory frailty testing with the liver frailty index (LFI) in-person, then virtual administration of (1) validated surveys (eg, SARC-F and Duke Activity Status Index [DASI]), (2) chair stands, and (3) balance. Two models were selected and internally validated for predicting LFI ≥4.4 using: (1) Bayesian information criterion (BIC), (2) C-statistics, and (3) ease of use. Of 145 patients, the median (interquartile range) LFI was 3.7 (3.3-4.2); 15% were frail. Frail (vs not frail) patients reported significantly greater impairment on all virtually assessed instruments. We selected 2 parsimonious models: (1) DASI + chair/bed transfer (SARC-F) (BIC 255, C-statistics 0.78), and (2) DASI + chair/bed transfer (SARC-F) + virtually assessed chair stands (BIC 244, C-statistics 0.79). Both models had high C-statistics (0.76-0.78) for predicting frailty. In conclusion, the tele-liver frailty index is a novel tool to screen frailty in liver transplant patients via telemedicine pragmatically and may be used to identify patients who require in-person frailty assessment, more frequent follow-up, or frailty intervention.
Collapse
Affiliation(s)
- Melinda Wang
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Amy M Shui
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Fawzy Barry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Dorothea Kent
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Frederick Yao
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Srilakshmi Seetharaman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Kacey Berry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Rachel K Grubbs
- Division Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Geena George
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Andres Duarte-Rojo
- Division Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
| |
Collapse
|
|
16
|
Perisetti A, Desai M, Bourke MJ, Penman I, Repici A, Reddy DN, Tajiri H, Rex DK, Hassan C, Sharma P. Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature. Gut 2023; 72:493-500. [PMID: 36522150 DOI: 10.1136/gutjnl-2022-328369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Greenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity. DESIGN The GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded. RESULTS Our search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions. CONCLUSIONS Recognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.
Collapse
Affiliation(s)
- Abhilash Perisetti
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Madhav Desai
- Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ian Penman
- Gastroenterology and Hepatology, Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Alessandro Repici
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Duvvur Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Hisao Tajiri
- Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Douglas K Rex
- Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Cesare Hassan
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Missouri, USA
| |
Collapse
|
|
17
|
Güney Coşkun M, Kolay E, Basaranoglu M. Telenutrition for the management of inflammatory bowel disease: Benefits, limits, and future perspectives. World J Clin Cases 2023; 11:308-315. [PMID: 36686349 PMCID: PMC9850965 DOI: 10.12998/wjcc.v11.i2.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) require lifelong and personalized care by a multidisciplinary healthcare team. However, the traditional medical model is not ideal for patients who require continuous close monitoring and whose symptoms may dramatically worsen between regularly scheduled visits. Additionally, close dietary follow-up and monitoring of IBD in a traditional setting are challenging because of the disease complexity, high pressure on outpatient clinics with a small number of IBD specialist dietitians, and rising incidence. Given the significant burden of IBD, there is a need to develop effective dietary management strategies. The coronavirus disease 2019 pandemic caused an unprecedented shift from in-person care to delivering health care via technological remote devices. Traditional nutrition therapy and consultation can be provided by telenutrition through remote electronic communication applications that could greatly benefit patient care. Telenutrition might be useful, safe, and cost-effective compared with standard care. It is likely that virtual care for chronic diseases including IBD will continue in some form into the future. This review article summarizes the evidence about telenutrition applications in the management of IBD patients, and we gave an overview of the acceptance and impact of these interventions on health outcomes.
Collapse
Affiliation(s)
- Merve Güney Coşkun
- Department of Nutrition and Dietetics, Istanbul Medipol University, Faculty of Health Sciences, Istanbul 34810, Turkey
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Ezgi Kolay
- Dietitian, Independent Researcher, Istanbul 34000, Turkey
| | - Metin Basaranoglu
- Department of Gastroenterology, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| |
Collapse
|
|
18
|
Olufunlayo TF, Ojo OO, Ozoh OB, Agabi OP, Opara CR, Taiwo FT, Fasanmade OA, Okubadejo NU. Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria. Digit Health 2023; 9:20552076221150072. [PMID: 36636728 PMCID: PMC9829877 DOI: 10.1177/20552076221150072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction and objective Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery. Methods We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization's tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05. Results The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p = 0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness - 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues - 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues. Conclusions The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behoves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic.
Collapse
Affiliation(s)
- Tolulope F Olufunlayo
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria,Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oluwadamilola O Ojo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria,Oluwadamilola O Ojo, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria; Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Osigwe P Agabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chuks R Opara
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Funmilola T Taiwo
- Department of Medicine, University College Hospital, Ibadan, Oyo, Nigeria
| | - Olufemi A Fasanmade
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Njideka U Okubadejo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| |
Collapse
|
|
19
|
Theocharidou E, Adebayo D. Challenges in liver transplantation in the context of a major pandemic. World J Transplant 2022; 12:347-358. [PMID: 36437846 PMCID: PMC9693897 DOI: 10.5500/wjt.v12.i11.347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/27/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has led to a temporary suspension of liver transplant activity across the world and the remodeling of care for patients on the waiting list and transplant recipients with the increasing use of remote consultations. Emerging evidence shows that patients with more advanced liver disease are at increased risk of severe COVID-19 and death, whereas transplant recipients have similar risk with the general population which is mainly driven by age and metabolic comorbidities. Tacrolimus immunosuppression might have a protective role in the post-transplant population. Vaccines that have become rapidly available seem to be safe in liver patients, but the antibody response in transplant patients is likely suboptimal. Most transplant centers were gradually able to resume activity soon after the onset of the pandemic and after modifying their pathways to optimize safety for patients and workforce. Preliminary evidence regarding utilizing grafts from positive donors and/or transplanting recently recovered or infected recipients under certain circumstances is encouraging and may allow offering life-saving transplant to patients at the greatest need. This review summarizes the currently available data on liver transplantation in the context of a major pandemic and discusses areas of uncertainty and future challenges. Lessons learnt from the COVID-19 pandemic might provide invaluable guidance for future pandemics.
Collapse
Affiliation(s)
- Eleni Theocharidou
- 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Danielle Adebayo
- Department of Gastroenterology and Hepatology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, United Kingdom
| |
Collapse
|
|
20
|
Kim HJ, Tomaszewski M, Zhao B, Lam E, Enns R, Bressler B, Moosavi S. Impact of Telehealth on Medication Adherence in Chronic Gastrointestinal Diseases. J Can Assoc Gastroenterol 2022; 5:203-207. [PMID: 36193346 PMCID: PMC9384003 DOI: 10.1093/jcag/gwac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background With the COVID-19 pandemic, the demand and availability of telehealth in outpatient care has had exponential growth. Although use of telehealth has been studied and validated for various medical specialties, relatively few studies have looked at its role in gastroenterology. Aim To assess effectiveness of telehealth medicine in gastroenterology by comparing medication adherence rate for patients seen with telehealth and traditional in-person appointment for various gastrointestinal conditions. Methods Retrospective chart review of patients seen in outpatient gastroenterology clinic was performed to identify patients who were given prescription to fill either through telehealth or in-person appointment. By using provincial pharmacy database, we determined the prescription fill rate. Results A total of 206 patients were identified who were provided new prescriptions or prescription renewal at their gastroenterology clinic visit. One hundred and three patients were seen through in-person visit during pre-pandemic period, and 103 patients were seen through telehealth appointment during COVID-19 pandemic. The mean age of patients was 49.2 years (55% female). On average, patients had 4.7 previous visits with their gastroenterologists before their visit. IBD management was the most common reason for visits (37.9% and 46.6% in telehealth and in-person groups, respectively). Prescription fill rate for patients seen through telehealth was 92.2% compared to 81.6% for the in-person group (OR: 2.69, 95% CI: 1.12-6.45; P = 0.023). Conclusions Medication adherence rate for telehealth visits was higher than for in-patient visits. These findings suggest that telehealth can be an effective method of care delivery, especially for patients with chronic gastrointestinal conditions like IBD.
Collapse
Affiliation(s)
- Hyun Jae Kim
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel Tomaszewski
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Billy Zhao
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Lam
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarvee Moosavi
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
|
21
|
Fung BM, Markarian E, Serper M, Tabibian JH. Current Applications of Telemedicine in Gastroenterology. Am J Gastroenterol 2022; 117:1072-1079. [PMID: 35385404 DOI: 10.14309/ajg.0000000000001761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 12/11/2022]
Abstract
Telemedicine generally refers to the use of technology to communicate with patients and provide health care from a distance. Advances in technology, specifically computers, cellphones, and other mobile devices, have facilitated healthcare providers' growing ability to virtually monitor and mentor patients. There has been a progressive expansion in the use of telemedicine in the field of gastroenterology (GI), which has been accelerated by the COVID-19 pandemic. In this review, we discuss telemedicine-its history, various forms, and limitations-and its current applications in GI. Specifically, we focus on telemedicine in GI practice in general and specific applications, including the management of inflammatory bowel disease, celiac disease, and colorectal cancer surveillance and its use as an aid in endoscopic procedures.
Collapse
Affiliation(s)
- Brian M Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Banner-University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Eric Markarian
- Academy of Science and Medicine, Crescenta Valley High School, Los Angeles, California, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
|
22
|
Cvietusa PJ, Goodrich GK, Steiner JF, Shoup JA, King DK, Ritzwoller DP, Shetterly SM, Bender BG. Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1569-1576. [PMID: 35263682 PMCID: PMC8898589 DOI: 10.1016/j.jaip.2022.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma. OBJECTIVE This retrospective cohort study assessed changes from in-person to virtual care during the pandemic. In patients with persistent asthma, compared with the same period before the pandemic. METHODS Kaiser Permanente Colorado members aged 18 to 99 years with persistent asthma were evaluated during two periods (March to October 2019 and March to October 2020). Comparison of asthma exacerbations (hospitalizations, emergency department visits, and courses of oral prednisone) and asthma medication metrics were evaluated between the two periods and by type of care received during the pandemic (no care, virtual care only, in-person care only, or a mix of virtual and in-person care). Population characteristics by type of care received during the pandemic were also evaluated. RESULTS Among 7,805 adults with persistent asthma, those who used more virtual care or sought no care during the pandemic were younger and had fewer comorbidities, mental health diagnoses, or financial barriers. Exacerbations decreased (0.264 to 0.214; P <.001) as did courses of prednisone (0.213 to 0.169). Asthma medication adherence (0.53 to 0.54; P <.001) and the asthma medication ratio, a quality-of-care metric (0.755 to 0.762; P = .019), increased slightly. Patients receiving a mix of in-person and virtual care had the highest rate of exacerbations (0.83) and a lower asthma medication ratio (0.74) despite having the highest adherence (.57). CONCLUSIONS Despite an increase in virtual care, asthma exacerbations decreased except among individuals who received both in-person and virtual care, likely because they had more severe disease.
Collapse
Affiliation(s)
- Peter J Cvietusa
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo; Department of Asthma, Allergy, and Immunology, Permanente Medical Group, Denver, Colo.
| | - Glenn K Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Diane K King
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska
| | | | - Susan M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Bruce G Bender
- Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colo
| |
Collapse
|
|
23
|
Russo MW, Kwok R, Serper M, Ufere N, Hameed B, Chu J, Goacher E, Lingerfelt J, Terrault N, Reddy KR. Impact of the Corona Virus Disease 2019 Pandemic on Hepatology Practice and Provider Burnout. Hepatol Commun 2022; 6:1236-1247. [PMID: 34783189 PMCID: PMC8652849 DOI: 10.1002/hep4.1870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 01/16/2023] Open
Abstract
The corona virus disease 2019 (COVID-19) pandemic has had a wide-ranging impact on the clinical practice of medicine and emotional well-being of providers. Our aim was to determine the impact of the COVID-19 pandemic on practice and burnout among hepatology providers. From February to March 2021, we conducted an electronic survey of American Association for the Study of Liver Diseases (AASLD) members who were hepatologists, gastroenterologists, and advanced practice providers (APPs). The survey included 26 questions on clinical practice and emotional well-being derived from validated instruments. A total of 230 eligible members completed the survey as follows: 107 (47%) were adult transplant hepatologists, 43 (19%) were adult general hepatologists, 14 (6%) were adult gastroenterologists, 11 (5%) were pediatric hepatologists, 45 (19%) were APPs, and 9 (4%) were other providers. We found that 69 (30%) experienced a reduction in compensation, 92 (40%) experienced a reduction in staff, and 9 (4%) closed their practice; 100 (43%) respondents reported experiencing burnout. In univariate analysis, burnout was more frequently reported in those ≤55 years old (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.2), women (OR, 2.2; 95% CI, 1.3-3.7), nontransplant hepatology (OR, 2.0; 95% CI, 1.1-3.3), APPs (OR, 2.7; 95% CI, 1.4-5.1), and those less than 10 years in practice (OR, 1.9; 95% CI, 1.1-3.3). In multivariable analysis, only age ≤55 years was associated with burnout (OR, 2.3; 95% CI, 1.1-4.8). The most common ways the respondents suggested the AASLD could help was through virtual platforms for networking, mentoring, and coping with the changes in practice due to the COVID-19 pandemic. Conclusion: The COVID-19 pandemic has had a substantial impact on the clinical practice of hepatology as well as burnout and emotional well-being. Women, APPs, and early and mid-career clinicians more frequently reported burnout. Identified strategies to cope with burnout include virtual platforms to facilitate networking and mentoring.
Collapse
Affiliation(s)
- Mark W Russo
- Division of HepatologyAtrium Health Wake Forest School of MedicineCharlotteNCUSA
| | - Ryan Kwok
- Uniformed Services UniversityBethesdaMDUSA.,Madigan Army Medical CenterTacomaWAUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Nneka Ufere
- Division of GastroenterologyDepartment of MedicineMassachusetts General Hospital BostonMAUSA
| | - Bilal Hameed
- Division of Gastroenterology and HepatologyUniversity of California San Francisco School of MedicineSan FranciscoCAUSA
| | - Jaime Chu
- Division of Pediatric HepatologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Elizabeth Goacher
- Division of GastroenterologyDuke University School of MedicineDurhamNCUSA
| | - John Lingerfelt
- American Association for the Study of Liver DiseasesAlexandriaVAUSA
| | - Norah Terrault
- Division of Gastroenterology and LiverKeck Medicine at University of Southern CaliforniaLos AngelesCAUSA
| | - K Rajender Reddy
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| |
Collapse
|
|
24
|
French experience with telemedicine in inflammatory bowel disease: a patients and physicians survey. Eur J Gastroenterol Hepatol 2022; 34:398-404. [PMID: 34860706 DOI: 10.1097/meg.0000000000002319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS The use of telemedicine dramatically increased during the COVID-19 pandemic. We collected patients and physicians experience on telemedicine in the field of inflammatory bowel disease (IBD). METHODS We conducted a nationwide survey between September 2020 and January 2021. A self-administered questionnaire was sent to participants through mailing lists of the national patients' association and IBD expert groups. RESULTS Overall, 300 patients and 110 gastroenterologists filled out the survey. On a 10 points scale of satisfaction with telemedicine, 60% of patients noted a score ≥8 and 52.7% of physicians ≥7. Patients and gastroenterologists felt that the duration of teleconsultations appeared to be shorter than in-person visits in 57.5 and 55.1% of cases, respectively. All participants agreed that telemedicine is appropriate in dedicated situations and not for flare-up consultations. For 55.1% of patients, quality of care was the same via telemedicine, whereas 51.4% of gastroenterologists believed they managed less well their patients. Lack of clinical examination being pointed out as the main limitation of telemedicine. Three-quarters of patients and gastroenterologists would agree to use telemedicine more often in the future. CONCLUSION Patients and gastroenterologists were satisfied with telemedicine and would be willing to use it in the future. However, telemedicine does not replace in-person visits and should be discussed on a case-by-case basis.
Collapse
|
|
25
|
Telemedicine Is an Effective Tool to Monitor Disease Activity in IBD Patients in the COVID-19 Era: A Single Centre Experience Based on Objective Data. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: The COVID-19 outbreak has led IBD clinics to adopt a remote monitoring approach in order to guarantee an adequate follow-up of patients with inflammatory bowel disease (IBD) and ensure the rules of social distancing. Aim: The aim of the study was to perform a survey on IBD patients who underwent remote monitoring in our tertiary referral center, to assess adherence, patients’ perceptions and satisfaction, and finally their opinions for future monitoring. Furthermore, we evaluated changes in disease activity and Quality of Life (QoL) using validated questionnaires. Methods: Consecutive patients with IBD scheduled for follow-up visits were switched to remote monitoring through e-mail from March 2020 to February 2021. Patients were asked to complete a questionnaire focusing on the following elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. Results: Four hundred and twenty four Caucasian patients completed the survey. 233 (55.1%) were male, 220 (52.0%) had Crohn’s Disease (CD). Median baseline Mayo Score and Harvey Bradshaw Index were 3 and 4, respectively. 9 (2.1%) patients were referred to the emergency department because of disease flares. 410 (96.9%) patients were satisfied with telemedicine, and 320 (76.5%) patients reported that they would maintain this approach also after COVID-19 pandemic. Overall, on univariate logistic regression analysis, none of the variables were related to patients’ satisfaction or to an improved QoL. The presence of ulcerative colitis was associated with the need for treatment change. Conclusions: Our results suggest that a telemedicine approach is well accepted by patients with IBD and could represent an effective tool in monitoring disease activity. Further controlled studies are warranted to properly assess if telemedicine can replace face-to-face consultations in IBD.
Collapse
|
|
26
|
Nishath T, Wright K, Burke CR, Teng X, Cotter N, Yi JA, Drudi LM. Implementation of telemedicine in the care of patients with aortic dissection. Semin Vasc Surg 2022; 35:43-50. [PMID: 35501040 DOI: 10.1053/j.semvascsurg.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/18/2023]
Abstract
Telemedicine uses telephone-based or any form of digital communication for remote clinical services. It has been a field of interest for the last century, with broader implementation of telemedicine technologies during the last 25 years. The COVID-19 pandemic was an impetus for the adoption of these technologies globally across all health care services, including patient care, surgical practice, and workflow. As part of the patient engagement work in the Aortic Dissection Collaborative, this topic was identified as an important patient-centered research topic. Telemedicine has been adopted increasingly in vascular surgery; however, there is little evidence on appropriate use of these technologies pertaining to treating patients with aortic dissection or aortopathy in general. This landscape review summarizes the uses of telemedicine applications pre and post pandemic in medicine and vascular surgery, with a particular focus on uses in aortopathy. Using common resource databases, we identified articles related to the history of telemedicine, its current utilization, and application to vascular surgery and/or aortopathy. We briefly review the history of telemedicine and illustrate a range of applications in medicine before the pandemic, along with its rapid uptake globally during the COVID-19 pandemic. The enablers and barriers to using telemedicine are explored, although as a whole there is satisfaction with its integration among patients and providers. To address these, we offer recommendations to address future research as it pertains to telemedicine technologies in aortic dissection.
Collapse
Affiliation(s)
- Thamanna Nishath
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Katie Wright
- The VEDS Movement, Division of the Marfan Foundation, Port Washington, NY; Aortic Dissection Collaborative
| | - Christopher R Burke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Xiaoyi Teng
- Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Jeniann A Yi
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, Canada; Carrefour de l'Innovation, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | |
Collapse
|
|
27
|
Riemann JF, Teufel A. Digital Communication Strategies in Visceral Medicine. Visc Med 2021; 37:455-457. [PMID: 35087895 PMCID: PMC8740225 DOI: 10.1159/000518878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jürgen F. Riemann
- Department of Medicine C, LebensBlicke Foundation, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
|
28
|
Kraszewski S, Szczurek W, Szymczak J, Reguła M, Neubauer K. Machine Learning Prediction Model for Inflammatory Bowel Disease Based on Laboratory Markers. Working Model in a Discovery Cohort Study. J Clin Med 2021; 10:jcm10204745. [PMID: 34682868 PMCID: PMC8539616 DOI: 10.3390/jcm10204745] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, incurable disease involving the gastrointestinal tract. It is characterized by complex, unclear pathogenesis, increased prevalence worldwide, and a wide spectrum of extraintestinal manifestations and comorbidities. Recognition of IBD remains challenging and delays in disease diagnosis still poses a significant clinical problem as it negatively impacts disease outcome. The main diagnostic tool in IBD continues to be invasive endoscopy. We aimed to create an IBD machine learning prediction model based on routinely performed blood, urine, and fecal tests. Based on historical patients’ data (702 medical records: 319 records from 180 patients with ulcerative colitis (UC) and 383 records from 192 patients with Crohn’s disease (CD)), and using a few simple machine learning classificators, we optimized necessary hyperparameters in order to get reliable few-features prediction models separately for CD and UC. Most robust classificators belonging to the random forest family obtained 97% and 91% mean average precision for CD and UC, respectively. For comparison, the commonly used one-parameter approach based on the C-reactive protein (CRP) level demonstrated only 81% and 61% average precision for CD and UC, respectively. Results of our study suggest that machine learning prediction models based on basic blood, urine, and fecal markers may with high accuracy support the diagnosis of IBD. However, the test requires validation in a prospective cohort.
Collapse
Affiliation(s)
- Sebastian Kraszewski
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Pl. Grunwaldzki 13, 50-377 Wroclaw, Poland
- Correspondence: (S.K.); (K.N.)
| | - Witold Szczurek
- Doctoral School, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland;
| | - Julia Szymczak
- Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland; (J.S.); (M.R.)
| | - Monika Reguła
- Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland; (J.S.); (M.R.)
| | - Katarzyna Neubauer
- Divison of Dietetics, Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
- Correspondence: (S.K.); (K.N.)
| |
Collapse
|
|
29
|
Revés JB, Frias-Gomes C, Morão B, Nascimento C, Palmela C, Fidalgo C, Roque Ramos L, Sampaio A, Glória L, Cravo M, Torres J. Inflammatory Bowel Disease Patients' Perspectives during COVID-19 Pandemic: Results from a Portuguese Survey. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 5:1-9. [PMID: 34934777 PMCID: PMC8678223 DOI: 10.1159/000518945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022]
Abstract
Introduction Patients with inflammatory bowel disease (IBD) do not seem to be at increased risk of infection by SARS-CoV-2, but there is a concern whether immunosuppressive therapy may be associated with more severe disease. Several clinical practice recommendations have been published to help guide IBD care during the COVID-19 pandemic. Nonetheless, few studies have addressed patients' perspectives and fears. We aimed to evaluate Portuguese IBD patients' perspectives on the clinical management of their disease during the SARS-CoV-2 pandemic as well as the impact on their professional life. Methods An anonymous electronic survey was created using REDCap and was distributed by the Portuguese Association of Inflammatory Bowel Disease (APDI) between May and August 2020. Patients' perspectives on immunosuppressive therapy, disease management, interaction with gastroenterology departments, and the impact of the pandemic in their professional life were assessed. Patients' proposals to improve medical care were also evaluated. Descriptive analysis and logistic regression were performed. Results A total of 137 participants answered the survey (79.6% females, mean age 41.7 ± 12.1 years). Although having IBD and receiving treatment with immunosuppressors (thiopurines, steroids, or biologics) were considered promotors of anxiety, most patients (85.4%) agreed that disease remission was a priority and only a minority of patients interrupted their treatment during the pandemic. In multivariate analysis, active disease, biologic treatment, and use of corticosteroids in the last 3 months were perceived by the patients as high-risk features for increased risk of SARS-Cov-2 infection and more severe disease. Fifty-nine patients (44%) believed that their follow-up was influenced by the pandemic and only 58.8% felt that they had the opportunity to discuss their therapeutic options with their doctor. Sixty-three patients (46.0%) were working from home during the pandemic, although this decision was related to IBD and immunosuppressive therapy in only 36.5 and 39.7% of the cases, respectively. Areas where care could have been improved during the pandemic were identified by patients, namely enhancement of the communication with IBD professionals, conciliation of telemedicine with face-to-face appointments, and facilitation of the interaction between patients and employers. Conclusion Most patients agreed that maintaining IBD remission is crucial, and only a minority of the patients stopped their treatment as per their own initiative. IBD status only had a small influence on patients' professional activity during the COVID-19 outbreak, with most changes being related to the pandemic itself.
Collapse
Affiliation(s)
- Joana Branco Revés
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Frias-Gomes
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Bárbara Morão
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Nascimento
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carolina Palmela
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Fidalgo
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lídia Roque Ramos
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ana Sampaio
- Associação Portuguesa da Doença Inflamatória do Intestino (APDI), Matosinhos, Portugal
| | - Luísa Glória
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marília Cravo
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Torres
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
|
30
|
Stephenson R, Walsh AR, Chavanduka TMD, Sallabank G, Horvath KJ, Castel AD, Bonar EE, Hightow-Weidman L, Bauermeister JA, Sullivan PS. Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic. PLoS One 2021; 16:e0249740. [PMID: 34506488 PMCID: PMC8432816 DOI: 10.1371/journal.pone.0249740] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. METHODS We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). RESULTS There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0-14.33 per 10,000 youth aged 13-24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county's available LGBTQ+ youth-friendly HIV service providers and their HIV burden. CONCLUSIONS As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth.
Collapse
Affiliation(s)
- Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Alison R. Walsh
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Tanaka M. D. Chavanduka
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Erin E. Bonar
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jose A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| |
Collapse
|
|
31
|
Magro F, Nuzzo A, Abreu C, Libânio D, Rodriguez‐Lago I, Pawlak K, Hollenbach M, Brouwer WP, Siau K. COVID-19 in gastroenterology: Where are we now? Current evidence on the impact of COVID-19 in gastroenterology. United European Gastroenterol J 2021; 9:750-765. [PMID: 34190413 PMCID: PMC8435247 DOI: 10.1002/ueg2.12115] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created unprecedented challenges in all fields of society with social, economic, and health-related consequences worldwide. In this context, gastroenterology patients and healthcare systems and professionals have seen their routines changed and were forced to adapt, adopting measures to minimize the risk of infection while guaranteeing continuous medical care to chronic patients. OBJECTIVE At this point, it is important to evaluate the impact of the pandemic on this field to further improve the quality of the services provided in this context. METHODS/RESULTS/CONCLUSION We performed a literature review that summarizes the main aspects to consider in gastroenterology, during the pandemic crisis, and includes a deep discussion on the main changes affecting gastroenterology patients and healthcare systems, anticipating the pandemic recovery scenario with future practices and policies.
Collapse
Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and TherapeuticsUniversity of PortoPortoPortugal
- Department of GastroenterologyCentro Hospitalar São JoãoPortoPortugal
- Unit of Clinical PharmacologyCentro Hospitalar São JoãoPortoPortugal
| | - Alexandre Nuzzo
- Department of Gastroenterology, IBD & Intestinal FailureAPHP Beaujon HospitalUniversity of ParisClichyFrance
| | - Cândida Abreu
- Infectious Diseases ServiceCentro Hospitalar São JoãoPortoPortugal
- Department of MedicineGrupo de I&D em Nefrologia e Doenças InfeciosasInstituto de Inovação e Investigação em Saúde (I3s)Instituto Nacional de Engenharia Biomédica (INEB)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Diogo Libânio
- Gastroenterology DepartmentPortuguese Oncology Institute of PortoPortoPortugal
- MEDCIDS ‐ Department of Community Medicine, Health Information and DecisionFaculty of MedicineUniversity of PortoPortoPortugal
| | - Iago Rodriguez‐Lago
- Gastroenterology DepartmentIBD UnitHospital de GaldakaoBiocruces Bizkaia Health Research Institute and School of MedicineUniversity of DeustoGaldakaoSpain
| | - Katarzyna Pawlak
- Department of GastroenterologyEndoscopy UnitHospital of the Ministry of Interior and AdministrationSzczecinPoland
| | - Marcus Hollenbach
- Medical Department IIDivision of GastroenterologyUniversity of Leipzig Medical CenterLeipzigGermany
| | - Willem P. Brouwer
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Keith Siau
- Department of GastroenterologyDudley Group Hospitals NHS Foundation TrustDudleyUK
| |
Collapse
|
|
32
|
Seixas AA, Olaye IM, Wall SP, Dunn P. Optimizing Healthcare Through Digital Health and Wellness Solutions to Meet the Needs of Patients With Chronic Disease During the COVID-19 Era. Front Public Health 2021; 9:667654. [PMID: 34322469 PMCID: PMC8311288 DOI: 10.3389/fpubh.2021.667654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic exposed and exacerbated longstanding inefficiencies and deficiencies in chronic disease management and treatment in the United States, such as a fragmented healthcare experience and system, narrowly focused services, limited resources beyond office visits, expensive yet low quality care, and poor access to comprehensive prevention and non-pharmacological resources. It is feared that the addition of COVID-19 survivors to the pool of chronic disease patients will burden an already precarious healthcare system struggling to meet the needs of chronic disease patients. Digital health and telemedicine solutions, which exploded during the pandemic, may address many inefficiencies and deficiencies in chronic disease management, such as increasing access to care. However, these solutions are not panaceas as they are replete with several limitations, such as low uptake, poor engagement, and low long-term use. To fully optimize digital health and telemedicine solutions, we argue for the gamification of digital health and telemedicine solutions through a pantheoretical framework-one that uses personalized, contextualized, and behavioral science algorithms, data, evidence, and theories to ground treatments.
Collapse
Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Iredia M. Olaye
- Department of Medicine Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY, United States
| | - Stephen P. Wall
- Department of Emergency Medicine, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Pat Dunn
- American Heart Association, Center for Health Technology and Innovation, New York, NY, United States
| |
Collapse
|
|
33
|
COVID-19 and beyond: development of a comprehensive telemedical diagnostic framework. Int J Comput Assist Radiol Surg 2021; 16:1403-1412. [PMID: 34091871 PMCID: PMC8179836 DOI: 10.1007/s11548-021-02424-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
Purpose During the COVID-19 pandemic, a threatening bottleneck of medical staff arose due to a shortage of trained caregivers, who became infected while working with infectious patients. While telemedicine is rapidly evolving in the fields of teleconsultation and telesurgery, proper telediagnostic systems are not yet available, although the demand for contactless patient–doctor interaction is increasing. Methods In this project, the current limitations were addressed by developing a comprehensive telediagnostic system. Therefore, medical examinations have been assessed in collaboration with medical experts. Subsequently, a framework was developed, satisfying the relevant constraints of medical-, technical-, and hygienic- aspects in order to transform in-person examinations into a contactless procedure. Diagnostic steps were classified into three groups: assisted procedures carried out by the patient, teleoperated examination methods, and adoptions of conventional methods. Results The Telemedical Diagnostic Framework was implemented, resulting in a functional proof of concept, where potentially infectious patients could undergo a full medical examination. The system comprises, e.g., a naso-pharyngeal swab, an inspection of the oral cavity, auscultation, percussion, and palpation, based on robotic end-effectors. The physician is thereby connected using a newly developed user-interface and a lead robot, with force feedback control, that enables precise movements with the follower robot on the patient’s side. Conclusion Our concept proves the feasibility of a fully telediagnostic system, that consolidates available technology and new developments to an efficient solution enabling safe patient-doctor interaction. Besides infectious situations, this solution can also be applied to remote areas.
Collapse
|
|
34
|
Evaluating IBD Patient-Initiated Electronic Communication During the SARS-CoV-2 Pandemic: A Single-Center Study. Dig Dis Sci 2021; 66:2468-2469. [PMID: 34021426 PMCID: PMC8139372 DOI: 10.1007/s10620-021-06977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 12/09/2022]
|