1
|
Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024:S0735-1097(24)07611-3. [PMID: 39320289 DOI: 10.1016/j.jacc.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
Collapse
|
2
|
Douketis JD, Spyropoulos AC. Perioperative Management of Patients Taking Direct Oral Anticoagulants: A Review. JAMA 2024; 332:825-834. [PMID: 39133476 DOI: 10.1001/jama.2024.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Importance Direct oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism. Observations For elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures). For patients undergoing minimal bleeding risk procedures, DOACs may be continued, or if there is concern about excessive bleeding, DOACs may be discontinued on the day of the procedure. Patients undergoing a low to moderate bleeding risk procedure should typically discontinue DOACs 1 day before the operation and restart DOACs 1 day after. Patients undergoing a high bleeding risk procedure should stop DOACs 2 days prior to the operation and restart DOACs 2 days after. With this perioperative DOAC management strategy, rates of thromboembolism (0.2%-0.4%) and major bleeding (1%-2%) are low and delays or cancellations of surgical and nonsurgical procedures are infrequent. Patients taking DOACs who need emergent (<6 hours after presentation) or urgent surgical procedures (6-24 hours after presentation) experience bleeding rates up to 23% and thromboembolism as high as 11%. Laboratory testing to measure preoperative DOAC levels may be useful to determine whether patients should receive a DOAC reversal agent (eg, prothrombin complex concentrates, idarucizumab, or andexanet-α) prior to an emergent or urgent procedure. Conclusions and Relevance When patients who are taking a DOAC require an elective surgical or nonsurgical procedure, standardized management protocols can be applied that do not require testing DOAC levels or heparin bridging. When patients taking a DOAC require an emergent, urgent, or semiurgent surgical procedure, anticoagulant reversal agents may be appropriate when DOAC levels are elevated or not available.
Collapse
Affiliation(s)
- James D Douketis
- Department of Medicine, St. Joseph's Healthcare Hamilton, and McMaster University, Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Alex C Spyropoulos
- Department of Medicine, Anticoagulation and Clinical Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, New York
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Institute of Health System Science at the Feinstein Institutes for Medical Research, Manhasset, New York
| |
Collapse
|
3
|
Aroca Tanarro A, Casans Francés R, Gómez-Ríos MÁ, Mendez Arias E, Otero Pérez M, Quecedo Gutierrez L, Rojas Pernia V, Abad Gurumeta A. Recommendations of the Pre-anaesthesia Teleconsultation Task Force. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00125-2. [PMID: 39243814 DOI: 10.1016/j.redare.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2024] [Accepted: 03/21/2024] [Indexed: 09/09/2024]
Abstract
The main objectives of the pre-anaesthesia consultation are to establish the patient's anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies - e-Health - has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit. The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.
Collapse
Affiliation(s)
| | - R Casans Francés
- Hospital Universitario Infanta Elena - QuironSalud. Valdemoro, Madrid, Spain.
| | - M Á Gómez-Ríos
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | | | - M Otero Pérez
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | | | | | | |
Collapse
|
4
|
Borg UR, Antunes A, Smit P, Addison PS, Montgomery D. Monitoring Respiratory Rate Continuously Without Attaching a Sensor During a Challenging Ramped Protocol. Mil Med 2024; 189:618-623. [PMID: 39160897 DOI: 10.1093/milmed/usae200] [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: 12/15/2023] [Revised: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Respiratory rate (RR) is a crucial vital sign in patient monitoring and is often the best marker of the deterioration of a sick patient. It can be used to help diagnose numerous medical conditions and has been demonstrated to be an independent predictor of patient outcomes in various critical care settings and is incorporated in many clinical early warning scores. Here, we report on the performance of depth-camera-based system for the noncontact monitoring of RR during a ramped RR protocol. The ramped breathing protocol was developed specifically to test the relatively rapid changes in rates, which include clinically important low and high ranges of RRs. MATERIALS AND METHODS We performed a series of experimental runs with healthy volunteers who were instructed to breathe over a wide range of RRs, where the rates were ramped up from 4 breaths/min to 50 breaths/min then back down to 4 breaths/min in a series of ramped steps. Depth information was acquired from the scene and used to determine a respiratory rate (RRdepth), and this was compared to capnograph or spirometer respiratory rate reference (RRref). A total of 9,482 contemporaneous data pairs (RRdepth, RRref) were collected during the study for comparison. RESULTS A Pearson correlation coefficient of 0.995 was achieved and a line of best fit given by RRdepth = 0.99 × RRref + 0.36 breaths/min. The overall root mean squared difference (RMSD) across the runs was 1.29 breaths/min with a corresponding bias of 0.16 breaths/min, respectively. The associated Bland-Altman analysis found limits of agreement of -2.45 and 2.75 breaths/min. When the data were subdivided according to low, medium, and high RRs, corresponding to ≤10, >10 to 20, and >20 breaths/min, the RMSD accuracies were found to be 0.94, 1.34, and 1.55 breaths/min, respectively. CONCLUSIONS The technology performed well, exhibiting an RMSD accuracy well within our target of 3 breaths/min, both across the whole range and across each individual subrange. In summary, our results indicate the potential viability of continuous noncontact monitoring for the determination of RR over a clinically relevant range.
Collapse
Affiliation(s)
- Ulf R Borg
- Medical Affairs, Medtronic Patient Monitoring, Boulder, CO 80301, USA
| | - André Antunes
- Medtronic Patient Monitoring, Technopole Centre, Edinburgh, UK
| | - Philip Smit
- Medtronic Patient Monitoring, Technopole Centre, Edinburgh, UK
| | - Paul S Addison
- Medtronic Patient Monitoring, Technopole Centre, Edinburgh, UK
| | - Dean Montgomery
- Medtronic Patient Monitoring, Technopole Centre, Edinburgh, UK
| |
Collapse
|
5
|
Le DQ, Burton BN, Tejeda CJ, Jalilian L, Kamdar N. Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis. Cureus 2024; 16:e60805. [PMID: 38910741 PMCID: PMC11189693 DOI: 10.7759/cureus.60805] [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] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion. Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%). CONCLUSIONS This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.
Collapse
Affiliation(s)
- Danny Q Le
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Brittany N Burton
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Christian J Tejeda
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Laleh Jalilian
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Nirav Kamdar
- Quality Improvement and Clinical Operations, Huntington Hospital, Pasadena, USA
| |
Collapse
|
6
|
Romero CS, Filipovic MG, Luedi MM. Beyond the Consulting Room and Telemedicine: Unveiling the Future of Anesthesiology with Virtual Preoperative Assessment. Anesthesiol Clin 2024; 42:27-32. [PMID: 38278589 DOI: 10.1016/j.anclin.2023.08.002] [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] [Indexed: 01/28/2024]
Abstract
Telemedicine has rapidly evolved, offering expanded applications including virtual consultations, remote patient education, and therapeutic options. It provides advantages such as increased accessibility, reduced travel time, and convenience. Challenges include privacy concerns, the digital divide, and the need for regulatory frameworks. Virtual preoperative assessment shows promise in safely identifying patients who do not require in-person consultations. Legal considerations and liability issues need to be addressed. While the COVID-19 pandemic has accelerated the adoption of telemedicine, it has also highlighted the need for comprehensive policies and equitable access to maximize its potential in health care delivery.
Collapse
Affiliation(s)
- Carolina S Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario De Valencia, Valencia, Spain; Research Methods Department, Universidad Europea de Valencia, Valencia, Spain
| | - Mark G Filipovic
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University, Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University, Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
7
|
Cassinello Plaza F, Hervías Sanz M, García Cebrián C, López Viñals M, Paz Aparicio A, Pellegrini M, Robles Rodríguez M, Sánchez Andrés A, Solsona Carcasona S, Suarez Castaño C, Subirana Giménez L, Torres Font J. Telemedicine pre-anesthesia evaluation in children: Experiences and recommendations. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:28-33. [PMID: 37678458 DOI: 10.1016/j.redare.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/12/2022] [Indexed: 09/09/2023]
Affiliation(s)
- F Cassinello Plaza
- Servicio de Anestesia y Reanimación, Hospital Nuestra Señora de Candelaria, Tenerife, Spain
| | - M Hervías Sanz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C García Cebrián
- Servicio de Anestesia y Reanimación, Hospital Universitario La Fe, Valencia, Spain.
| | - M López Viñals
- Servicio de Anestesia y Reanimación, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Paz Aparicio
- Servicio de Anestesia y Reanimación, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Pellegrini
- Servicio de Anestesia y Reanimación, Hospital del Mar, Barcelona, Spain
| | - M Robles Rodríguez
- Servicio de Anestesia y Reanimación, Hospital Fundación Privada Asilo de Granollers, Granollers, Barcelona, Spain
| | - A Sánchez Andrés
- Servicio de Anestesia y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - S Solsona Carcasona
- Servicio de Anestesia y Reanimación, Hospital Fundación Privada Asilo de Granollers, Granollers, Barcelona, Spain
| | - C Suarez Castaño
- Servicio de Anestesia y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - L Subirana Giménez
- Servicio de Anestesia y Reanimación, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - J Torres Font
- Servicio de Anestesia y Reanimación, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
8
|
Addison PS, Cohen C, Borg UR, Antunes A, Montgomery D, Batchelder P. Accurate and continuous respiratory rate using touchless monitoring technology. Respir Med 2023; 220:107463. [PMID: 37993024 DOI: 10.1016/j.rmed.2023.107463] [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: 07/19/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Respiratory rate is a commonly used vital sign with various clinical applications. It serves as a crucial marker of acute health issues and any significant alteration in respiratory rate may be an early warning sign of major issues such as infections in the respiratory tract, respiratory failure, or cardiac arrest. Timely recognition of changes in respiratory rate enables prompt medical action, while neglecting to detect a change may lead to adverse patient outcomes. Here, we report on the performance of respiratory rate determined using a depth sensing camera system (RRdepth) which allows for continuous, non-contact 'touchless' monitoring of this important vital sign. METHODS Thirty adult volunteers undertook a range of set breathing rates to cover a target breathing range of 4-40 breaths/min. Depth information was acquired from the torso region of the subjects using an Intel D415 RealSense camera positioned above the bed. The depth information was processed to generate a respiratory signal from which RRdepth was calculated. This was compared to a manually scored capnograph reference (RRcap). RESULTS An overall RMSD accuracy of 0.77 breaths/min was achieved across the target respiratory rate range with a corresponding bias of 0.05 breaths/min. This corresponded to a line of best fit given by RRdepth = 1.01 x RRcap - 0.22 breaths/min with an associated high degree of correlation (R = 0.997). A breakdown of the performance with respect to sub-ranges corresponding to respiratory rates or ≤7, >7-10, >10-20, >20-30, >30 breaths/min all exhibited RMSD accuracies of less than 1.00 breaths/min. We also had the opportunity to test the performance of spontaneous breathing of the subjects which occurred during the study and found an overall RMSD accuracy of 1.20 breaths/min with corresponding accuracies ≤1.30 breaths/min across each of the individual sub-ranges. CONCLUSIONS We have conducted an investigative study of a prototype depth sensing camera system for the non-contact monitoring of respiratory rate. The system achieved good performance with high accuracy across a wide range of rates including both clinically important high and low rates.
Collapse
Affiliation(s)
| | | | - Ulf R Borg
- Medtronic Patient Monitoring, Boulder, CO, USA
| | | | | | | |
Collapse
|
9
|
Douketis JL, Schulman S. Potential for a Virtual Care Model in the Perioperative Management of Anticoagulant Therapy: A 5-Year Retrospective Clinic Review. TH OPEN 2023; 7:e184-e190. [PMID: 37415616 PMCID: PMC10322226 DOI: 10.1055/a-2098-6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
Background With a trend toward greater virtual care in selected clinical settings, perioperative anticoagulant management appears well suited for this care delivery model. We explored the potential for virtual care among patients who are receiving anticoagulant therapy and require perioperative management around the time of an elective surgery/procedure. Methods We undertook a retrospective review of patients who were receiving anticoagulant therapy, either a direct oral anticoagulant (DOAC) or warfarin, assessed in a perioperative anticoagulation-bridging clinic over a 5-year period from 2016 to 2020. Using prespecified criteria, we determined the proportion of patients who likely would be suitable for virtual care (receiving a DOAC or warfarin and having a minimal- or low-/moderate-bleed-risk surgery/procedure), those who likely would be suitable for in-person care (receiving warfarin and requiring heparin bridging for a mechanical heart valve), and patients who would be suitable for either care delivery model (receiving a DOAC or warfarin, but not with a mechanical heart valve, and requiring a high-bleed-risk surgery/procedure). Results During the 5-year study period, there were 4,609 patients assessed for perioperative anticoagulant management in whom the most widely used anticoagulants were warfarin (37%), apixaban (30%), and rivaroxaban (24%). Within each year assessed, 4 to 20% of all patients were undergoing a minimal-bleed-risk procedure, 76 to 82% were undergoing a low-/moderate-bleed-risk surgery/procedure, and 10 to 39% were undergoing a high-bleed-risk surgery/procedure. The proportion of patients considered suitable for virtual, in-person, or either virtual or in-person management was 79.6, 7.1, and 13.3%, respectively. Conclusion In patients who were assessed in a perioperative anticoagulation clinic, there was a high proportion of patients in whom a virtual care model might be suitable.
Collapse
Affiliation(s)
- James Luke Douketis
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
10
|
Huang WN, Xin X, Rao V, Wong TH, Chow P, Tan HK. Battling against the great disruption to surgical care in a pandemic: experiences of 11 South and Southeast Asian countries. BMJ Open 2023; 13:e060770. [PMID: 37037622 PMCID: PMC10111189 DOI: 10.1136/bmjopen-2022-060770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES The majority of the cancelled elective surgeries caused by the COVID-19 pandemic globally were estimated to occur in low- and middle-income countries (LMICs), where surgical services had long been in short supply even before the pandemic. Therefore, minimising disruption to existing surgical care in LMICs is of crucial importance during a pandemic. This study aimed to explore contributory factors to the continuity of surgical care in LMICs in the face of a pandemic. DESIGN Semistructured interviews were conducted over zoom with surgical leaders of 25 tertiary hospitals from 11 LMICs in South and Southeast Asia in September to October 2020. Key themes were subsequently identified from the interview transcripts using the Braun and Clarke's method of thematic analysis. RESULTS The COVID-19 pandemic affected all surgical services of participating institutions to varying degrees. Overall, elective surgeries suffered the gravest disruption, followed by outpatient surgical care, and finally emergency surgeries. Keeping healthcare workers safe and striving for continuity of essential surgical care emerged as notable response strategies observed across all participating institutions. CONCLUSION This study suggested that four factors are important for the resilience of surgical care against COVID-19: adequate COVID-19 testing capacity and effective institutional infection control measures, designated COVID-19 treatment facilities, whole-system approach to balancing pandemic response and meeting essential surgical needs, and active community engagement. These findings can inform healthcare institutions in other countries, especially LMICs, in their effort to tread a fine line between preserving healthcare capacity for pandemic response and protecting surgical services against pandemic disruption.
Collapse
Affiliation(s)
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Vijaya Rao
- SingHealth International Collaboration Office, Singapore Health Service, Singapore
- SingHeath Duke-NUS Global Health Institute, Singapore
| | - Ting Hway Wong
- Duke-NUS Graduate Medical School, Singapore
- SingHeath Duke-NUS Global Health Institute, Singapore
| | - Pierce Chow
- SingHeath Duke-NUS Global Health Institute, Singapore
- Department of Hepato-pancreato-biliary and Transplant surgery, National Cancer Center Singapore and Singapore General Hospital, Singapore
- Surgery Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
| | - Hiang Khoon Tan
- SingHealth International Collaboration Office, Singapore Health Service, Singapore
- SingHeath Duke-NUS Global Health Institute, Singapore
- Surgery Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, Singapore
| |
Collapse
|
11
|
Song B, Zhou M, Zhu J. Necessity and Importance of Developing AI in Anesthesia from the Perspective of Clinical Safety and Information Security. Med Sci Monit 2023; 29:e938835. [PMID: 36810475 PMCID: PMC9969716 DOI: 10.12659/msm.938835] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
The rapid development of artificial intelligence (AI) technology is due to the significant progress in big data, databases, algorithms, and computing power, and medical research is a vital application direction of AI. The integrated development of AI and medicine has improved medical technology, and the efficiency of medical services and equipment has enabled doctors to better serve patients. The tasks and characteristics of the anesthesia discipline also make AI necessary for its development, and AI has also been initially applied in different fields of anesthesia. Our review aims to clarify the current situation and challenges of AI application in anesthesiology to provide clinical references and guide the future development of AI in anesthesiology. This review summarizes progress in the application of AI in perioperative risk assessment and prediction, deep monitoring and regulation of anesthesia, essential anesthesia skills operation, automatic drug administration systems, and teaching and training in anesthesia. Also discussed herein are the accompanying risks and challenges of applying AI in anesthesia: patient privacy and information security, data sources, and ethical issues, lack of capital and talent, and the "black box" phenomenon.
Collapse
Affiliation(s)
- Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Ming Zhou
- Department of Information, Beijing University of Technology, Beijing, China (mainland)
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| |
Collapse
|
12
|
Sirisegaram L, Owodunni OP, Ehrlich A, Qin CX, Bettick D, Gearhart SL. Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older. BMC Geriatr 2023; 23:15. [PMID: 36631769 PMCID: PMC9832416 DOI: 10.1186/s12877-022-03623-1] [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: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. OBJECTIVE We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. METHODS This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS. RESULTS Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI. CONCLUSION This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care.
Collapse
Affiliation(s)
- Luxey Sirisegaram
- grid.21107.350000 0001 2171 9311The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.39381.300000 0004 1936 8884Schulich School of Medicine, University of Western Ontario, London, ON Canada
| | - Oluwafemi P. Owodunni
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - April Ehrlich
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Caroline Xu Qin
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Dianne Bettick
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Susan L. Gearhart
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.411940.90000 0004 0442 9875Department of Surgery, Johns Hopkins Bayview Medical Center, A Building, 4940 Eastern Avenue, Baltimore, MD 21286 USA
| |
Collapse
|
13
|
Romero CS, Doll D, Kleiman AM, Luedi MM. Editorial: Self-care in healthcare workers for sustainable healthcare systems. Front Med (Lausanne) 2023; 10:1190049. [PMID: 37144040 PMCID: PMC10151777 DOI: 10.3389/fmed.2023.1190049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Carolina S. Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario de Valencia, Valencia, Spain
- *Correspondence: Carolina S. Romero
| | - Dietrich Doll
- Department of Procto-Surgery, St. Marienhospital Vechta, Vechta, Germany
| | - Amanda M. Kleiman
- Department of Anaesthesiology, University of Virginia, Charlottesville, VA, United States
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
14
|
YILDIZ T, AVCU C. The Effect of the COVID-19 Pandemic on the Surgery Process. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1135188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
With this review, it was aimed to discuss the effect of the COVID-19 pandemic on the process before, during and after surgery. Studies that were accessed using the keywords “COVID-19”, “perioperative” and “surgery” in Pubmed and Science Direct and Turkish databases were discussed. The measures taken with the declaration of the pandemic also affected surgical practices, and postponing elective cases other
than emergency and cancer surgery was one of the common measures implemented in many countries. In addition to all these measures and recommendations, the fact that the operating room environment has some unique risk factors draws attention to the process before, during and after the surgery. Guidelines for the measures to be taken in the national and international arena are published in order to plan the workforce of health professionals and to use limited health care resources effectively, as well as to prevent the spread of COVID-19. These measures and recommendations are shaped according to the statistical fluctuation in the number of infected cases and health care resources in countries, and policies and procedures regarding the preoperative, intraoperative and postoperative period are updated. It is extremely important to follow the current literature in order to protect both patients and healthcare professionals involved in the surgical process and to prevent cross-contamination against the COVID-19 virus.
Collapse
|
15
|
Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments. J Am Acad Orthop Surg 2022; 30:1131-1139. [PMID: 36400060 DOI: 10.5435/jaaos-d-22-00456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery. METHODS A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05. RESULTS A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036). DISCUSSION Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.
Collapse
|
16
|
Demissie WR, Mulatu B, Siraj A, Hajikassim A, Kejela E, Muluken Z, Mekonin GT, Biratu M, Birhanu M, Dadi N, Kelbesa M, Belay A, Dukessa A. Pattern of Perioperative Surgical Patient Care, Equipment Handling and Operating Room Management During COVID-19 Pandemic at Jimma Medical Center. J Multidiscip Healthc 2022; 15:2527-2537. [PMID: 36352855 PMCID: PMC9639398 DOI: 10.2147/jmdh.s372428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background The nature of COVID-19 transmission creates significant risks in surgical departments owing to the close contact of medical staff with patients, the limited physical environment of the operating room and recovery room, the possibility of shared surgical equipment and challenges in the delivery of surgical care in all surgical departments. Globally, studies have reported that the effects of the pandemic on surgical departments are profound, potentially long-lasting and extensive. To manage these effects, different local guidelines and recommendations have been developed, with potential differences in their effectiveness and implementation. Therefore, harmonized and effective national/international guidelines for specific surgical departments during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The pattern of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC), Ethiopia, has not been explored yet. The present study aimed to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC. Methods A cross-sectional study was conducted to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC, using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently). A total of 90 respondents [35 patients (five patients from each of seven surgical departments) and 55 healthcare providers (six professionals from each of nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire via direct observation and face-to-face interviews with patients undergoing surgery, healthcare providers and hospital administrators, against the standard surgical patient care guidelines. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData (v4.3.1) and exported to SPSS (v22) for analysis. The mean score of practice was compared among different disciplines by applying the unpaired t-test. The findings of the study were reported using tables and narration. A p-value of less than 0.05 was declared as statistically significant. Results Despite the surgical care practice having changed during the COVID-19 pandemic in all service domains, it is not implemented consistently among different surgical departments owing to different barriers (lack of training on the updated guidelines and financial constraints). The majority of surgical staff were implementing the use of preventive measures against COVID-19, while they were practiced less among patients. The guidelines for surgical practice during the preoperative phase were well applied, especially screening patients by different methods and the application of telemedicine to reduce physical contacts. But, against guidelines, elective patients were planned and underwent surgery, especially in the general surgery department. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. The extent of practice for anesthesia care, operating room management and postoperative care in the recovery room also changed, and the guidelines were sometimes applied. Conclusion and Recommendations Although perioperative surgical care practice differed before and during the pandemic, the standard guidelines were inconsistently implemented among surgical departments. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. Thus, the authors developed safe surgical care guidelines throughout the different domains (infection prevention and PPE use; preoperative care, intraoperative care, operating room management, anesthesia care, equipment handling process and postoperative care) for all disciplines and shared them with all staff. We recommend that all surgical staff should access these guidelines and strictly adhere to them for surgical service during the pandemic.
Collapse
Affiliation(s)
- Wondu Reta Demissie
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia
| | - Bilisuma Mulatu
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Ahmed Siraj
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Edosa Kejela
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Zemenu Muluken
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Melka Biratu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Mitiku Birhanu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Negashu Dadi
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Megersa Kelbesa
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Admasu Belay
- School of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Dukessa
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia
| |
Collapse
|
17
|
Douketis JD, Spyropoulos AC, Murad MH, Arcelus JI, Dager WE, Dunn AS, Fargo RA, Levy JH, Samama CM, Shah SH, Sherwood MW, Tafur AJ, Tang LV, Moores LK. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest 2022; 162:e207-e243. [PMID: 35964704 DOI: 10.1016/j.chest.2022.07.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The American College of Chest Physicians Clinical Practice Guideline on the Perioperative Management of Antithrombotic Therapy addresses 43 Patients-Interventions-Comparators-Outcomes (PICO) questions related to the perioperative management of patients who are receiving long-term oral anticoagulant or antiplatelet therapy and require an elective surgery/procedure. This guideline is separated into four broad categories, encompassing the management of patients who are receiving: (1) a vitamin K antagonist (VKA), mainly warfarin; (2) if receiving a VKA, the use of perioperative heparin bridging, typically with a low-molecular-weight heparin; (3) a direct oral anticoagulant (DOAC); and (4) an antiplatelet drug. METHODS Strong or conditional practice recommendations are generated based on high, moderate, low, and very low certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for clinical practice guidelines. RESULTS A multidisciplinary panel generated 44 guideline recommendations for the perioperative management of VKAs, heparin bridging, DOACs, and antiplatelet drugs, of which two are strong recommendations: (1) against the use of heparin bridging in patients with atrial fibrillation; and (2) continuation of VKA therapy in patients having a pacemaker or internal cardiac defibrillator implantation. There are separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and GI (endoscopic) procedures. CONCLUSIONS Substantial new evidence has emerged since the 2012 iteration of these guidelines, especially to inform best practices for the perioperative management of patients who are receiving a VKA and may require heparin bridging, for the perioperative management of patients who are receiving a DOAC, and for patients who are receiving one or more antiplatelet drugs. Despite this new knowledge, uncertainty remains as to best practices for the majority of perioperative management questions.
Collapse
Affiliation(s)
- James D Douketis
- Department of Medicine, St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada.
| | - Alex C Spyropoulos
- Department of Medicine, Northwell Health at Lenox Hill Hospital, New York, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Institute of Health Systems Science at The Feinstein Institutes for Medical Research, Manhasset, NY
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN
| | - Juan I Arcelus
- Department of Surgery, Facultad de Medicina, University of Granada, Granada, Spain
| | - William E Dager
- Department of Pharmacy, University of California-Davis, Sacramento, CA
| | - Andrew S Dunn
- Division of Hospital Medicine, Department of Medicine, Mt. Sinai Health System, New York, NY
| | - Ramiz A Fargo
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA; Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, NC
| | - C Marc Samama
- Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP, Centre-Université Paris-Cité-Cochin Hospital, Paris, France
| | - Sahrish H Shah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN
| | | | - Alfonso J Tafur
- Department of Medicine, Cardiovascular, NorthShore University HealthSystem, Evanston, IL
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China
| | - Lisa K Moores
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
18
|
Contributing Factors to Operating Room Delays Identified from an Electronic Health Record: A Retrospective Study. Anesthesiol Res Pract 2022; 2022:8635454. [PMID: 36147900 PMCID: PMC9489409 DOI: 10.1155/2022/8635454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022] Open
Abstract
The operating room (OR) is considered a major cost center and revenue generator for hospitals. Multiple factors contribute to OR delays and impact patient safety, patient satisfaction scores, and hospital financial performance. Reducing OR delays allows better utilization of OR resources and staffing and improves patient satisfaction while decreasing operating costs. Accurate scheduling can be the basis to achieve these goals. The objective of this initial study was to identify factors not normally documented in the electronic health record (EHR) that may contribute to or be indicators of OR delays. Materials and Methods. A retrospective data analysis was performed analyzing 67,812 OR cases from 12 surgical specialties at a small university medical center from 2010 through the first quarter of 2017. Data from the hospital's EHR were exported and subjected to statistical analysis using Statistical Analysis System (SAS) software (SAS Institute, Cary, NC). Results. Statistical analysis of the extracted EHR data revealed factors that were associated with OR delays including, surgical specialty, preoperative assessment testing, patient body mass index, American Society of Anesthesiologists (ASA) physical status classification, daily procedure count, and calendar year. Conclusions. Delays hurt OR efficiency on many levels. Identifying those factors may reduce delays and better accommodate the needs of surgeons, staff, and patients thereby leading to improved patient's outcomes and patient satisfaction. Reducing delays can decrease operating costs and improve the financial position of the operating theater as well as that of the hospital. Anesthesiology teams can play a key role in identifying factors that cause delays and implementing mitigating efficiencies.
Collapse
|
19
|
Hasoon J, Urits I, Viswanath O, Kaye AD. Pain Management and Telemedicine: A Look at the COVID Experience and Beyond. Health Psychol Res 2022; 10:38012. [PMID: 36071858 PMCID: PMC9441022 DOI: 10.52965/001c.38012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
COVID-19 caused a drastic change in clinical medicine around the globe. In the United States, telemedicine was rapidly adopted on a wide scale to minimize direct patient interaction and to reduce the spread of the COVID-19 virus. Telemedicine also went hand in hand with the rapid movement of working remotely. This has provided several challenges to chronic pain management clinics along with other subspecialties. Telemedicine has also opened opportunities for providing valuable care for patients with significant barriers to healthcare professionals. Given the benefits and downfalls of telemedicine, it is ultimately up to the provider who has an established patient-physician relationship and best understands the patient's limitations and healthcare needs who can best determine which patient population telemedicine is appropriate for and how frequently it can be utilized for each individual patient.
Collapse
Affiliation(s)
- Jamal Hasoon
- Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School
| | - Ivan Urits
- Department of Anesthesia and Pain Medicine, Louisiana State University Health Sciences Center
| | - Omar Viswanath
- Department of Anesthesia and Pain Medicine, Louisiana State University Health Sciences Center
| | - Alan D Kaye
- Department of Anesthesia and Pain Medicine, Louisiana State University Health Sciences Center
| |
Collapse
|
20
|
Filipovic MG, Huber M, Luedi MM. Electronic screening - of anesthesiologists and algorithms. J Clin Anesth 2022; 82:110951. [PMID: 35988433 DOI: 10.1016/j.jclinane.2022.110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Mark G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
21
|
Knaus ME, Kersey K, Ahmad H, Weaver L, Thomas JL, Metzger GA, Wood RJ, Gasior AC. Both sides of the screen: Provider and patient perspective on telemedicine in pediatric surgery. J Pediatr Surg 2022; 57:1614-1621. [PMID: 35430030 PMCID: PMC8949635 DOI: 10.1016/j.jpedsurg.2022.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND There has been increased telemedicine use secondary to the COVID-19 pandemic. The objective of this study was to assess patient/parent satisfaction with their telemedicine experience, gauge provider perspective on telemedicine for the management of pediatric colorectal disease and evaluate the quality of telemedicine care being provided. METHODS A cross sectional study was performed at a single institution from March 2020-February 2021. Patients who completed a patient/parent telemedicine survey after a telemedicine appointment and nurse practitioners/surgeons who completed a provider telemedicine survey were included. Patient and provider characteristics and responses were analyzed using descriptive statistics. Differences between the levels of provider confidence to provide telemedicine care were analyzed using Pearson's chi-square test. RESULTS 118 patients/parents completed the survey. The median age of patients was 7 years. Most patients were male (59%) and White (73%). The most common diagnosis was anorectal malformation (49%). 71% of parents felt the telemedicine visit was as effective or better than an in-person visit and over 70% said they prefer a telemedicine visit to an in-person visit. Ten surgeons and 8 nurse practitioners completed the provider survey. 28% had previous telemedicine experience and 94% planned to continue offering telemedicine appointments. Providers felt significantly more confident performing clinical duties via video telemedicine compared to telephone telemedicine. CONCLUSIONS Telemedicine is a useful adjunct or alternative in pediatric surgery for complex patients who require multidisciplinary care. Providers show confidence with the use of video telemedicine and parents show high satisfaction, with the majority preferring telemedicine visits over in-person visits. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Maria E. Knaus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States,Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Kelly Kersey
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Laura Weaver
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Jessica L. Thomas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Gregory A. Metzger
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Richard J. Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Alessandra C. Gasior
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States,Department of Colon and Rectal Surgery, The Ohio State University, Columbus, OH, United States,Corresponding author at: Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| |
Collapse
|
22
|
Alghamdi NS, Alghamdi SM. The Role of Digital Technology in Curbing COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148287. [PMID: 35886139 PMCID: PMC9320375 DOI: 10.3390/ijerph19148287] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023]
Abstract
Introduction: Using digital technology to provide support, medical consultations, healthcare services, and to track the spread of the coronavirus has been identified as an important solution to curb the transmission of the virus. This research paper aims to (1) summarize the digital technologies used during the COVID-19 pandemic to mitigate the transmission of the COVID-19; (2) establish the extent to which digital technology applications have facilitated mitigation of the spread of COVID-19; and (3) explore the facilitators and barriers that impact the usability of digital technologies throughout the pandemic. Methods: A rapid electronic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted of available records up to June 2022 on the medical databases PubMed, Ovid, Embase, CINHAIL, the Cochrane Library, Web of Science, and Google Scholar. Results: An increasing number and variety of digital health applications have been available throughout the pandemic, such as telehealth, smartphone mobile health apps, machine learning, and artificial intelligence. Each technology has played a particular role in curbing COVID-19 transmission. Different users have gained benefits from using digital technology during the COVID-19 pandemic and different determinants have contributed to accelerating the wheel of digital technology implementation during the pandemic. Conclusion: Digital health during the COVID-19 pandemic has evolved very rapidly, with different applications and roles aimed at curbing the pandemic.
Collapse
Affiliation(s)
| | - Saeed M. Alghamdi
- National Heart and Lung Institution, Imperial College London, London SW3 6LY, UK
- Respiratory Care Program, Clinical Technology Department, College of Applied Medical Science, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Correspondence:
| |
Collapse
|
23
|
Cortegiani A, Tripodi VF, Castioni CA, Esposito C, Galdieri N, Monzani R, Rispoli M, Simonini A, Torrano V, Giarratano A, Gratarola A. Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:29. [PMID: 37386538 PMCID: PMC9214464 DOI: 10.1186/s44158-022-00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's surgical process. METHODS The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent. RESULTS Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect. CONCLUSION A balanced preoperative multidisciplinary risk-benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.
Collapse
Affiliation(s)
- Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Francesco Tripodi
- Department of Surgery, Anesthesia and Intensive Care Unit, Policlinico Gaetano Martino, University of Messina, Messina, Italy
| | - Carlo Alberto Castioni
- IRCCS, Istituto Delle Scienze Neurologiche, UOC Anestesia E Rianimazione, Bologna, Italia
| | - Clelia Esposito
- Critical Area Department, Anesthesia and Intensive Care, AO Dei Colli, Vincenzo Monaldi Hospital, Naples, Italy
| | - Nicola Galdieri
- Critical Area Department, Intensive Care in Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Marco Rispoli
- Critical Area Department, Anesthesia and Intensive Care, AO Dei Colli, Vincenzo Monaldi Hospital, Naples, Italy
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, Ancona, Italy
| | - Vito Torrano
- Department of Emergency and Urgency, Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Angelo Gratarola
- Department of Emergency, Anesthesia and Intensive Care Unit, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
| |
Collapse
|
24
|
Mihalj M, Corona A, Andereggen L, Urman RD, Luedi MM, Bello C. Managing bottlenecks in the perioperative setting: Optimizing patient care and reducing costs. Best Pract Res Clin Anaesthesiol 2022; 36:299-310. [DOI: 10.1016/j.bpa.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
|
25
|
Dougherty D, Thompson AR, Speck KE, Perrone EE. Preoperative virtual video visits only: a convenient option that should be offered to caregivers beyond the pandemic. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000403. [DOI: 10.1136/wjps-2021-000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveDuring the COVID-19 pandemic, our group implemented preoperative video visits (VVs) to limit physical contact. The aim of this study was to determine caregivers’ and providers’ perceptions of this practice and to determine feasibility for continuation.MethodsAll patients who had only a preoperative VV prior to an elective surgery were identified from March–October 2020. Caregivers, surgeons, and clinic staff were surveyed about their experiences.ResultsThirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit. Of the 31 caregiver surveys completed, the majority strongly agreed that the VV was more convenient (87%, n=27). Eighty-one percent (n=25) strongly agreed or agreed that the VV saved them money. Ninety-four percent (n=29) strongly agreed or agreed that they would choose the VV option again. Caregivers saved an average travel distance of 60.3 miles one way (range 6.1–480). Of the 13/17 providers who responded, 77% (n=10) expressed that the practice should continue.ConclusionsVirtual health became a necessity during the pandemic, and caregivers were overwhelmingly satisfied. Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.
Collapse
|
26
|
Knörr V, Dini L, Gunkel S, Hoffmann J, Mause L, Ohnhäuser T, Stöcker A, Scholten N. Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians. BMC PRIMARY CARE 2022; 23:92. [PMID: 35461212 PMCID: PMC9034069 DOI: 10.1186/s12875-022-01699-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany. METHODS The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians. RESULTS The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients. CONCLUSION The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.
Collapse
Affiliation(s)
- Vera Knörr
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Lorena Dini
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Gunkel
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Jan Hoffmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Laura Mause
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Arno Stöcker
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany.
| |
Collapse
|
27
|
Connelly Y, Lotan R, Brzezinski Sinai Y, Rolls D, Beker A, Abensour E, Neudorfer O, Stocki D. Implementation of a Personalized Digital Application for Pediatric Pre-Anesthesia Evaluation and Education: An Ongoing Usability Analysis and Dynamic Improvement Scheme. JMIR Form Res 2022; 6:e34129. [PMID: 35416171 PMCID: PMC9121218 DOI: 10.2196/34129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-anesthesia evaluation session is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plan per patient, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last two decades, electronic health (eHealth) and mobile health (mHealth) settings gradually replaced part of the face-to-face encounters as the platform for pre-anesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Yet, there is a lack of studies examining the effectiveness of surgical mHealth applications focusing on the pediatric preanesthetic setting and addressing their usability among families. OBJECTIVE This study describes a dynamic approach for the development process of GistMD's pre-anesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. METHODS The study was conducted in four departments in a 1500-beds quaternary, academic medical center in Tel Aviv, Israel. During the study period, pre-anesthesia system was sent via text message to families whose children were about to undergo surgery. The system included pre-anesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Ongoing collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. RESULTS In a period of 141 days of implementation, GistMD pre-anesthesia management system was sent to 769 families. Three product fit actions were applied during this term: (1) Change of text message scheduling, aimed at addressing learnability and accessibility, resulted in a significant increase of 27% (χ2 [1] = 12.65, P<.001) in view rates and 27.4% (χ2 [1] = 30.01, P<.001) in satisfaction rates; (2) Reduce the number of screens, aimed at increasing efficiency and operability, resulted in a significant decrease of 8.6% of cases in which users did not perform any activity on the system after logging in (χ2 [1] = 6.18, P=.02); (3) Patient-focused campaign in two departments aimed at addressing memorability, resulted in significant increases in eight of twelve usability indicators. CONCLUSIONS Our results indicate that mHealth product-fit decisions derived from theory-based approach and ongoing usability data analysis allow tailoring of most appropriate responses for usability gaps, as reflected in increasing use rates and satisfaction. In the case of the pre-anesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains. CLINICALTRIAL
Collapse
Affiliation(s)
- Yaron Connelly
- GistMD, Stricker, 163, Tel Aviv, IL.,ICET - The Israeli Center for Emerging Technologies in Healthcare, Samir Medical Center, Zerifin, IL
| | | | - Yitzhak Brzezinski Sinai
- Department of Anesthesiology and Intensive Care, Tel Aviv Medical Center, Tel Aviv, IL.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IL
| | | | | | | | - Orit Neudorfer
- GistMD, Stricker, 163, Tel Aviv, IL.,Dizengoff Pediatric Community Center, Clalit Health Services, Tel Aviv, IL
| | - Daniel Stocki
- Department of Anesthesiology and Intensive Care, Tel Aviv Medical Center, Tel Aviv, IL.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IL
| |
Collapse
|
28
|
Croke L. Best practices for the use of telemedicine. AORN J 2022; 115:P7-P9. [PMID: 35333393 DOI: 10.1002/aorn.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
29
|
Neumann C, Schleifer G, Strassberger-Nerschbach N, Kamp J, Massoth G, Görtzen-Patin A, Cudian D, Velten M, Coburn M, Schindler E, Wittmann M. Digital Online Anaesthesia Patient Informed Consent before Elective Diagnostic Procedures or Surgery: Recent Practice in Children—An Exploratory ESAIC Survey (2021). J Clin Med 2022; 11:jcm11030502. [PMID: 35159954 PMCID: PMC8836584 DOI: 10.3390/jcm11030502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: One undisputed benefit of digital support is the possibility of contact reduction, which has become particularly important in the context of the COVID-19 pandemic. However, to the best of our knowledge, there is currently no study assessing the Europe-wide use of digital online pre-operative patient information or evaluation in the health sector. The aim of this study was to give an overview of the current status in Europe. Methods: A web-based questionnaire covering the informed consent process was sent to members of the European Society of Anaesthesia and Intensive Care Medicine (ESAIC) in 47 European countries (42,433 recipients/930 responses). Six questions related specifically to the practice in paediatrics. Results: A total of 70.2% of the respondents indicated that it was not possible to obtain informed consent via the Internet in a routine setting, and 67.3% expressed that they did not know whether it is in line with the legal regulations. In paediatric anaesthesia, the informed consent of only one parent was reported to be sufficient by 77.6% of the respondents for simple interventions and by 63.8% for complex interventions. Just over 50% of the respondents judged that proof of identity of the parents was necessary, but only 29.9% stated that they ask for it in clinical routine. In the current situation, 77.9% would favour informed consent in person, whereas 60.2% could imagine using online or telephone interviews as an alternative to a face-to-face meeting if regulations were changed. Only 18.7% participants reported a change in the regulations due to the current pandemic situation. Conclusion: Whether informed consent is obtained either online or on the telephone in the paediatric population varies widely across Europe and is not currently implemented as standard practice. For high-risk patients, such as the specific cohort of children with congenital heart defects, wider use of telemedicine might provide a benefit in the future in terms of reduced contact and reduced exposure to health risks through additional hospital stays.
Collapse
|
30
|
Greven ACM, Douglas JM, Couceyro J, Nakirikanti A, Dawoud R, Revuelta-Barbero M, Ward E, Giraldi EA, Ioachimescu A, Hoang KB, Bray DP, Oyesiku NM. Telemedicine for Neurosurgery Consultations at a Pituitary Center of Excellence: Patient Preference and Willingness to Proceed with Surgery. J Neurol Surg B Skull Base 2022; 84:1-7. [PMID: 36743713 PMCID: PMC9897892 DOI: 10.1055/a-1715-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Objective The purpose of this study was to evaluate pituitary tumor patient satisfaction with telemedicine, patient preference for telemedicine, potential socioeconomic benefit of telemedicine, and patients' willingness to proceed with surgery based on a telemedicine visit alone. Method In total, 134 patients who had pituitary surgery and a telemedicine visit during the coronavirus disease 2019 (COVID-19) pandemic (April 23, 2020-March 4, 2021) were called to participate in a 13-part questionnaire. Chi-square, ANOVA, and Wilcoxon Rank Sum tests were used to determine significance. Result Of 134 patients contacted, 90 responded (67%). Ninety-five percent were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating their visit was "the same" or "better" than previous in-person appointments. Eighty-two percent of the patients rated their telemedicine visit as "easy" or "very easy." On average, patients saved 150 minutes by using telemedicine compared with patient reported in-person visit times. Seventy-seven percent of patients reported the need to take off from work for in-person visits, compared with just 12% when using telemedicine. Forty-nine percent of patients preferred in-person visits, 34% preferred telemedicine, and 17% had no preference. Fifty percent of patients said they would feel comfortable proceeding with surgery based on a telemedicine visit alone. Patients with both initial evaluation and follow-up conducted via telemedicine were more likely to feel comfortable proceeding with surgery based on a telemedicine visit alone compared with patients who had only follow-up telemedicine visits ( p = 0.051). Conclusion Many patients are satisfied with telemedicine visits and feel comfortable proceeding with surgery based on a telemedicine visit alone. Telemedicine is an important adjunct to increase access to care at a Pituitary Center of Excellence.
Collapse
Affiliation(s)
- Alexander Craig McConnell Greven
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States,Address for correspondence Alexander Craig McConnell Greven, MBA Department of Neurosurgery, Emory University School of MedicineAtlanta, GA 30306United States
| | - James Miller Douglas
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jordan Couceyro
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Anudeep Nakirikanti
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Reem Dawoud
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Manuel Revuelta-Barbero
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Elisabeth Ward
- Department of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Erica Alexandra Giraldi
- Department of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Adriana Ioachimescu
- Department of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
| | | | - David Painton Bray
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Nelson M. Oyesiku
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
| |
Collapse
|
31
|
Affiliation(s)
- Samir Kendale
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
32
|
Paré G, Raymond L, Pomey MP, Grégoire G, Castonguay A, Ouimet AG. Medical students’ intention to integrate digital health into their medical practice: A pre-peri COVID-19 survey study in Canada. Digit Health 2022; 8:20552076221114195. [PMID: 35898286 PMCID: PMC9309785 DOI: 10.1177/20552076221114195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/30/2022] [Indexed: 12/16/2022] Open
Abstract
Objective We aimed to explore the factors that influence medical students’ intention to
integrate dHealth technologies in their practice and analyze the influence
of the COVID-19 pandemic on their perceptions and intention. Methods We conducted a two-phased survey study at the University of Montreal's
medical school in Canada. The study population consisted of 1367 medical
students. The survey questionnaire was administered in two phases, that is,
an initial survey (t0) in February 2020, before the Covid-19
pandemic, and a replication survey (t1) in January 2021, during
the pandemic. Component-based structural equation modeling (SEM) was used to
test seven research hypotheses. Results A total of 184 students responded to the survey at t0 (13%),
whereas 138 responded to the survey at t1 (10%). Findings reveal
that students, especially those who are in their preclinical years, had
little occasion to experiment with dHealth technologies during their degree.
This lack of exposure may explain why a vast majority felt that dHealth
should be integrated into medical education. Most respondents declared an
intention to integrate dHealth, including AI-based tools, into their future
medical practice. One of the most salient differences observed between
t0 and t1 brings telemedicine to the forefront of
medical education. SEM results confirm the explanatory power of the proposed
research model. Conclusions The present study unveils the specific dHealth technologies that could be
integrated into existing medical curricula. Formal training would increase
students’ competencies with these technologies which, in turn, could ease
their adoption and effective use in their practice.
Collapse
Affiliation(s)
| | - Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | | | | | | | | |
Collapse
|
33
|
Jin ML, Brown MM, Patwa D, Nirmalan A, Edwards PA. Telemedicine, telementoring, and telesurgery for surgical practices. Curr Probl Surg 2021; 58:100986. [PMID: 34895561 DOI: 10.1016/j.cpsurg.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Man Li Jin
- Resident in Ophthalmology, Henry Ford Hospital, Detroit, MI.
| | - Meghan M Brown
- Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Dhir Patwa
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Aravindh Nirmalan
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Paul A Edwards
- Chairman, Department of Ophthalmology, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
34
|
In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
35
|
Azizad O, Joshi GP. Telemedicine for preanesthesia evaluation: review of current literature and recommendations for future implementation. Curr Opin Anaesthesiol 2021; 34:672-677. [PMID: 34608053 DOI: 10.1097/aco.0000000000001064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The in-person preanesthesia visit serves multiple purposes including identification and optimization of comorbid conditions as well as patient education. However, it imposes a significant burden on patients and healthcare providers. In this review, we define the scope of telemedicine and present the most up-to-date literature supporting its role for the preanesthesia evaluation. The opportunities and challenges are discussed and approaches to implementation of telemedicine in preanesthesia care are offered. Finally, the future of telemedicine as it pertains to preanesthesia care is examined. RECENT FINDINGS Although telemedicine for preanesthesia practice was proposed almost two decades ago, the COVID-19 pandemic has accelerated its implementation. The potential benefits of telemedicine include improved patient satisfaction as well as the ability to provide cost-effective specialty services while reducing the burden on healthcare providers. Limitations to telemedicine include lack of technology, training, regulatory barriers, and an inability to perform a physical exam. SUMMARY Telemedicine will continue to expand and its application to the preanesthesia evaluation is a clear example of how technology will revolutionize anesthesia practice. In order for telemedicine to continue to expand in the postpandemic period, steps must be taken to ensure that healthcare facilities and providers keep up with the times.
Collapse
Affiliation(s)
- Omaira Azizad
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
36
|
Yadav A, Singh P. Telehealth Use by Living Kidney Donor Transplant Programs During the COVID-19 Pandemic and Beyond: a Practical Approach. CURRENT TRANSPLANTATION REPORTS 2021; 8:257-262. [PMID: 34812402 PMCID: PMC8597544 DOI: 10.1007/s40472-021-00339-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review COVID-19 pandemic led to a decline in living kidney donor evaluations and transplants. This was due to concerns for donor and recipient safety, restrictions on elective cases, and diversion of staff and resources in centers with a higher incidence of COVID-19 infections. Telehealth was explored as a strategy to continue living donor evaluations during the pandemic, but faced barriers including restrictive physician licensing, reduced reimbursement, lack of infrastructure, prohibitive local policies, limited exam, and personal biases. This review highlights these barriers and potential solutions. Recent Findings Telehealth usage in the transplant population improves medication adherence, reduces hospitalization rates for recipients, and makes living donor evaluation convenient. Transplant centers have implemented telehealth successfully for living kidney donor evaluations. Broad use of telemedicine will be possible only if policies support the changing landscape of healthcare delivery. Summary Telehealth may increase access to timely kidney transplants by expediting living kidney donor evaluations. However, supportive infrastructure, regulatory policies, and reimbursement are needed to sustain access to telehealth for living kidney donor evaluation and care.
Collapse
Affiliation(s)
- Anju Yadav
- Division of Nephrology, Thomas Jefferson University Hospital, 833 Chestnut St, Suite 700, Philadelphia, PA USA
| | - Pooja Singh
- Division of Nephrology, Thomas Jefferson University Hospital, 833 Chestnut St, Suite 700, Philadelphia, PA USA
| |
Collapse
|
37
|
Sartori A, Balla A, Agresta F, Guerrieri M, Ortenzi M. Telemedicine in surgery during COVID-19 pandemic: are we doing enough? Minerva Surg 2021; 77:50-56. [PMID: 34693680 DOI: 10.23736/s2724-5691.21.09100-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain. EVIDENCE ACQUISITION All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included. EVIDENCE SYNTHESIS Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review. CONCLUSIONS In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients' health, cost-effectiveness and user satisfaction remain unsolved.
Collapse
Affiliation(s)
- Alberto Sartori
- Department of General Surgery, Hospital of Montebelluna, Montebelluna, Treviso, Italy
| | - Andrea Balla
- Unit of General Surgery, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Ferdinando Agresta
- Department of General Surgery, AULSS2 Trevigiana del Veneto, Hospital of Vittorio Veneto, Vittorio Veneto, Treviso, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy -
| |
Collapse
|
38
|
Luedi MM, Urman RD. Leading in the time of crisis: Considerations for providing safe perioperative and intensive care. Best Pract Res Clin Anaesthesiol 2021; 35:267-268. [PMID: 34511218 PMCID: PMC8428475 DOI: 10.1016/j.bpa.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University, Hospital, University of Bern, Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
39
|
Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, Kadner A, Schefold JC, Räber L, Potapov EV, Luedi MM. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:321-332. [PMID: 34511222 PMCID: PMC7826053 DOI: 10.1016/j.bpa.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 10/28/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.
Collapse
Affiliation(s)
- Maks Mihalj
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Selim Mosbahi
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Paul Philipp Heinisch
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| |
Collapse
|
40
|
Holthof N, Luedi MM. Considerations for acute care staffing during a pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:389-404. [PMID: 34511227 PMCID: PMC7726522 DOI: 10.1016/j.bpa.2020.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.
Collapse
Affiliation(s)
- Niels Holthof
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
41
|
Abstract
Telemedicine represents an area of rapid growth in anesthesiology. Remote preoperative evaluation is associated with high patient and physician satisfaction scores, reduced patient travel and wait times, and similar procedure cancellation rates compared with in-person clinic evaluation. Preoperative tele-evaluation has facilitated a return to normal function during the coronavirus disease 2019 (COVID-19) pandemic. Intraoperatively, remote vital sign monitoring and telecommunications technology combined with a care team model allows provision of expert care in areas experiencing a shortage of anesthesiologists. Virtual intensive care units provide overflow capability for postoperative patients, whereas patient smartphones can reduce the need for in-person evaluation.
Collapse
Affiliation(s)
- Kathryn Harter Bridges
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA.
| | - Julie Ryan McSwain
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA
| |
Collapse
|
42
|
Şentürk M, El Tahan MR, Shelley B, Szegedi LL, Piccioni F, Licker MJ, Karzai W, Gil MG, Neskovic V, Vanpeteghem C, Pelosi P, Cohen E, Sorbello M, MBChB JB, Stoica R, Mourisse J, Brunelli A, Jimenez MJ, Drnvsek-Globoikar M, Yapici D, Morsy AS, Kawagoe I, Végh T, Navarro-Ripoll R, Marczin N, Paloczi B, Unzueta C, Gregorio GD, Wouters P, Rex S, Mukherjee C, Paternoster G, Guarracino F. Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee. J Cardiothorac Vasc Anesth 2021; 35:3528-3546. [PMID: 34479782 PMCID: PMC8313821 DOI: 10.1053/j.jvca.2021.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Mert Şentürk
- Dep. of Anesthesiology & Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Mohamed R El Tahan
- Cardiothoracic Anesthesiology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ben Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital/West of Scotland Heart and Lung Centre, University of Glasgow Academic Unit of Anaesthesia, Pain and Critical Care, Scotland
| | - Laszlo L Szegedi
- Department of Anesthesiology, CUB Hôpital Erasme, ULB Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marc-Joseph Licker
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Waheedullah Karzai
- Chefarzt, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee, Bad Berka, Germany
| | | | - Vojislava Neskovic
- Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | | | - Paolo Pelosi
- Università degli Studi di Genova, UNIGE, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Genoa, Italy
| | - Edmond Cohen
- Anesthesiology, Perioperative & Pain Medicine, Thoracic Surgery Specialty, Anesthesiology Icahn School of Medicine at Mount Sinai, New York, NY; Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele San Marco, Catania, Italy
| | - Massimiliano Sorbello
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Johan Bence MBChB
- Cardiothoracic Anaesthesiology, University Hospitals of Leicester Glenfield Hospital, Leicester, UK
| | - Radu Stoica
- Faculty of Medicine, Titu Maiorescu, Bucharest; Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Jo Mourisse
- Anesthesiology and ICU, Monza Oncolgy Hospital, Bucharest; Department of Anesthesia, Pain and Palliative Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Maria-José Jimenez
- Anesthesiology, Centro Medico Teknon, Universitat de Barcelona, Barcelona, Spain
| | | | - Davud Yapici
- Anesthesia and Intensive Care, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmed Salaheldin Morsy
- Department of Anesthesia, King Fahd Hospital of the Imam Abdulrahman bin Faisal University, Al Khober, Saudi Arabia
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan; Outcomes Research Consortium, Cleveland, OH
| | - Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | | | - Nandor Marczin
- Department of Anesthesiology, Ljubjljana University Medical Centre, Ljubljana, Slovenia; Section of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Balazs Paloczi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Carmen Unzueta
- Department of Anesthesiology, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Guido Di Gregorio
- Anesthesia and Critical Care Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Patrick Wouters
- Department of Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Steffen Rex
- Clinic Department of Anesthesiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Chirojit Mukherjee
- Department of Anaesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany
| | - Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care San Carlo Hospital (Potenza) Italy Via Potito Petrone, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| |
Collapse
|
43
|
Anaesthesia for minimally invasive cardiac procedures in the catheterization lab. Curr Opin Anaesthesiol 2021; 34:437-442. [PMID: 34184641 DOI: 10.1097/aco.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures. RECENT FINDINGS The latest studies, primarily focused on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr), demonstrate the need for reliable monitoring and appropriate training of the interdisciplinary teams involved in this high-risk NORA setting. SUMMARY Inappropriate sedation and concurrent inadequate oxygenation are main risk factors for claims involving NORA care. Current evidence deriving from TAVR shows that monitored anaesthesia care (MAC) is associated with shorter length of stay and lower mortality.
Collapse
|
44
|
Shanbehzadeh M, Kazemi-Arpanahi H, Kalkhajeh SG, Basati G. Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:211. [PMID: 34395648 PMCID: PMC8318195 DOI: 10.4103/jehp.jehp_1419_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/21/2020] [Indexed: 05/07/2023]
Abstract
With the onset of the coronavirus disease 2019 (COVID-19) outbreak, the transformation of the care delivery model from conventional in-person (face to face) to largely virtual or remote care has been accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard, telemedicine is a breakthrough technology to battle against the COVID-19 emergency. Therefore, we sought to identify the telemedicine applications in the COVID-19 pandemic (tele-COVID) according to interaction modes, transmission modalities, and disease categories. This systematic review was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine interactive mode during the COVID-19 pandemic, written in English language and published in peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results. Telemedicine provides a diversity of interaction modes and modalities affordable by patients and physicians including short message service, E-mail and web portals, secure telephone calls or VOIP, video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video conferencing. Transmission of video data using synchronized video calls via common social media had the highest and exchange of data using store-forward service via secure messaging technology and prerecorded multimedia had the lowest popularity for virtual disease management during the COVID-19 outbreak. Selection of telemedicine communication services and interaction modes with regard to its use-case, disease category, and application plays a significant role in the success of remote disease management infrastructures in this scenario and their implication for a better future healthcare system.
Collapse
Affiliation(s)
- Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Heath Information Technology, Abadan University of Medical Sciences, Abadan, Iran
- Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
| | | | - Gholam Basati
- Department of Biochemistry, School of Medicine Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
45
|
Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room. Ann Surg 2021; 273:1108-1114. [PMID: 33630452 DOI: 10.1097/sla.0000000000004755] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country. SUMMARY OF BACKGROUND DATA Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns.1 As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions2; if it were itself a nation, US healthcare would rank 13th globally in emissions.3 As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards.4 Further, ORs and labor/delivery suites produce 50%-70% of waste across the hospital.5,6 Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change "the biggest global health threat of the 21st century" and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients.7. METHODS/RESULTS We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings, and highlight resources for clinicians interested in pursuing this work. CONCLUSION Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.
Collapse
|
46
|
Ball E, Willmott F, Rivas C, Talati C. COVID-19 in Women's health: Pre-operative gynaecological assessment and shared decision making. Best Pract Res Clin Obstet Gynaecol 2021; 73:12-21. [PMID: 33865717 PMCID: PMC7970420 DOI: 10.1016/j.bpobgyn.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022]
Abstract
The National Health Service (NHS) response to the coronavirus disease 2019 (COVID-19) pandemic brought about rapid and innovative changes to surgical care in gynaecology, shared decision making around operative procedures and pre-operative gynaecological pathways. Short-term changes are linked to the redeployment of resources away from elective gynaecology and long-term changes relate to accelerating the streamlining of treatments, telemedicine and education in patient self-management. The speed and recency of the response does not yet permit the creation of a large evidence base for effective and acceptable interventions, apart from anecdotal observations of 'what works well'' good practice and guidance from the Royal Colleges and the National Institute for Health and Care Excellence (NICE).
Collapse
Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, United Kingdom; Department of Women's and Child Health, City University London, United Kingdom.
| | - Fredric Willmott
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, United Kingdom
| | - Carol Rivas
- University College London Social Research Institute, University College London (UCL) London, United Kingdom
| | - Chiraag Talati
- Department of Anaesthesia, Homerton University Hospital NHS Trust, United Kingdom
| |
Collapse
|
47
|
Alhaidari F, Almuhaideb A, Alsunaidi S, Ibrahim N, Aslam N, Khan IU, Shaikh F, Alshahrani M, Alharthi H, Alsenbel Y, Alalharith D. E-Triage Systems for COVID-19 Outbreak: Review and Recommendations. SENSORS (BASEL, SWITZERLAND) 2021; 21:2845. [PMID: 33920744 PMCID: PMC8072881 DOI: 10.3390/s21082845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients' conditions and identifying their severity levels.
Collapse
Affiliation(s)
- Fahd Alhaidari
- Department of Networks and Communications, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Abdullah Almuhaideb
- Department of Networks and Communications, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Shikah Alsunaidi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Nehad Ibrahim
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Nida Aslam
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Irfan Ullah Khan
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Fatema Shaikh
- Department of Computer Information Systems, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Mohammed Alshahrani
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Hajar Alharthi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Yasmine Alsenbel
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Dima Alalharith
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| |
Collapse
|
48
|
Addison PS, Smit P, Jacquel D, Addison AP, Miller C, Kimm G. Continuous non-contact respiratory rate and tidal volume monitoring using a Depth Sensing Camera. J Clin Monit Comput 2021; 36:657-665. [PMID: 33743106 PMCID: PMC7980749 DOI: 10.1007/s10877-021-00691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
The monitoring of respiratory parameters is important across many areas of care within the hospital. Here we report on the performance of a depth-sensing camera system for the continuous non-contact monitoring of Respiratory Rate (RR) and Tidal Volume (TV), where these parameters were compared to a ventilator reference. Depth sensing data streams were acquired and processed over a series of runs on a single volunteer comprising a range of respiratory rates and tidal volumes to generate depth-based respiratory rate (RRdepth) and tidal volume (TVdepth) estimates. The bias and root mean squared difference (RMSD) accuracy between RRdepth and the ventilator reference, RRvent, across the whole data set was found to be -0.02 breaths/min and 0.51 breaths/min respectively. The least squares fit regression equation was determined to be: RRdepth = 0.96 × RRvent + 0.57 breaths/min and the resulting Pearson correlation coefficient, R, was 0.98 (p < 0.001). Correspondingly, the bias and root mean squared difference (RMSD) accuracy between TVdepth and the reference TVvent across the whole data set was found to be - 0.21 L and 0.23 L respectively. The least squares fit regression equation was determined to be: TVdepth = 0.79 × TVvent-0.01 L and the resulting Pearson correlation coefficient, R, was 0.92 (p < 0.001). In conclusion, a high degree of agreement was found between the depth-based respiration rate and its ventilator reference, indicating that RRdepth is a promising modality for the accurate non-contact respiratory rate monitoring in the clinical setting. In addition, a high degree of correlation between depth-based tidal volume and its ventilator reference was found, indicating that TVdepth may provide a useful monitor of tidal volume trending in practice. Future work should aim to further test these parameters in the clinical setting.
Collapse
Affiliation(s)
- Paul S Addison
- Video Biosignals Group, Patient Monitoring, Medtronic, Technopole Centre, Edinburgh, EH26 0PJ, UK.
| | - Philip Smit
- Video Biosignals Group, Patient Monitoring, Medtronic, Technopole Centre, Edinburgh, EH26 0PJ, UK
| | - Dominique Jacquel
- Video Biosignals Group, Patient Monitoring, Medtronic, Technopole Centre, Edinburgh, EH26 0PJ, UK
| | - Anthony P Addison
- Video Biosignals Group, Patient Monitoring, Medtronic, Technopole Centre, Edinburgh, EH26 0PJ, UK
| | - Cyndy Miller
- Respiratory Interventions, Medtronic, Ventilation, Carlsbad, CA, USA
| | - Gardner Kimm
- Respiratory Interventions, Medtronic, Ventilation, Carlsbad, CA, USA
| |
Collapse
|
49
|
Addison AP, Addison PS, Smit P, Jacquel D, Borg UR. Noncontact Respiratory Monitoring Using Depth Sensing Cameras: A Review of Current Literature. SENSORS (BASEL, SWITZERLAND) 2021; 21:1135. [PMID: 33561970 PMCID: PMC7915793 DOI: 10.3390/s21041135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
There is considerable interest in the noncontact monitoring of patients as it allows for reduced restriction of patients, the avoidance of single-use consumables and less patient-clinician contact and hence the reduction of the spread of disease. A technology that has come to the fore for noncontact respiratory monitoring is that based on depth sensing camera systems. This has great potential for the monitoring of a range of respiratory information including the provision of a respiratory waveform, the calculation of respiratory rate and tidal volume (and hence minute volume). Respiratory patterns and apneas can also be observed in the signal. Here we review the ability of this method to provide accurate and clinically useful respiratory information.
Collapse
Affiliation(s)
- Anthony P. Addison
- Medtronic, Video Biosignals Group, Patient Monitoring, Edinburgh EH26 0PJ, UK; (A.P.A.); (P.S.); (D.J.)
| | - Paul S. Addison
- Medtronic, Video Biosignals Group, Patient Monitoring, Edinburgh EH26 0PJ, UK; (A.P.A.); (P.S.); (D.J.)
| | - Philip Smit
- Medtronic, Video Biosignals Group, Patient Monitoring, Edinburgh EH26 0PJ, UK; (A.P.A.); (P.S.); (D.J.)
| | - Dominique Jacquel
- Medtronic, Video Biosignals Group, Patient Monitoring, Edinburgh EH26 0PJ, UK; (A.P.A.); (P.S.); (D.J.)
| | - Ulf R. Borg
- Medtronic, Medical Affairs, Patient Monitoring, Boulder, CO 80301, USA;
| |
Collapse
|
50
|
L Jacklyn Y, Y Joanne Y, Neo SH, K C, Gobindram A. Telemedicine in COVID-19 pandemic: Anaesthetic assessment of elective surgical patients through mobile application-based questionnaire. Indian J Anaesth 2021; 65:892-900. [PMID: 35221362 PMCID: PMC8820339 DOI: 10.4103/ija.ija_733_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
|