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Cagino L, Seagly K, Noyes E, Prescott H, Valley T, Eaton T, McSparron JI. Outcomes and Management After COVID-19 Critical Illness. Chest 2024; 165:1149-1162. [PMID: 38104961 PMCID: PMC11214908 DOI: 10.1016/j.chest.2023.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
TOPIC IMPORTANCE COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments. REVIEW FINDINGS Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care. SUMMARY The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.
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Affiliation(s)
- Leigh Cagino
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
| | - Katharine Seagly
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Emily Noyes
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Hallie Prescott
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Thomas Valley
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Tammy Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Ann Arbor, MI
| | - Jakob I McSparron
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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2
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Du Y, Gu Y. The development of evaluation scale of the patient satisfaction with telemedicine: a systematic review. BMC Med Inform Decis Mak 2024; 24:31. [PMID: 38303031 PMCID: PMC10832124 DOI: 10.1186/s12911-024-02436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Since the outbreak of the COVID-19 pandemic, telemedicine become more and more popular, patients attempt to use telemedicine to meet personal medical needs. Patient satisfaction is a key indicator of insight into the patient experience. PURPOSE This systematic review aims to explore the measurement factors of patient satisfaction with telemedicine and develop a more comprehensive and systematic scale of patient satisfaction with telemedicine. METHODS In February 2023, a literature search was conducted on the PubMed, EMBASE, and Web of Science, identifying measurement factors and tools of patient satisfaction with telemedicine. For inclusion, the studies had to have or make a questionnaire about patient satisfaction with telemedicine delivered through video/audio visits in English. The quality of the studies was evaluated according to the Critical Appraisal Tool for Analytical Cross-Sectional Studies of the Joanna Briggs Institute (JBI). The dimensions and items in each tool were also analyzed. RESULTS The initial search showed 14,020 studies. After eliminating duplicates and utilizing inclusion and exclusion criteria, 44 studies were included. This systematic review identified and integrated the measurement factors and develops a scale of patient satisfaction with telemedicine, which was divided into 9 dimensions and consists of 37 items. CONCLUSION Future measurement and evaluation of telemedicine will benefit from scale that was developed in this study, and it will more directly reflecting patient needs when patient satisfaction with telemedicine is evaluated.
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Affiliation(s)
- Yifei Du
- Department of Medical Information Technology and Management, Yanjing Medical College, Capital Medical University, Beijing, China
| | - Yu Gu
- Department of Medical Information Technology and Management, Yanjing Medical College, Capital Medical University, Beijing, China.
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3
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Dale CM, Ambreen M, Kang S, Buchanan F, Pizzuti R, Gershon AS, Rose L, Amin R. Acceptability of the Long-Term In-Home Ventilator Engagement virtual intervention for home mechanical ventilation patients during the COVID-19 pandemic: A qualitative evaluation. Digit Health 2024; 10:20552076241228417. [PMID: 38282921 PMCID: PMC10822085 DOI: 10.1177/20552076241228417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
Background Clinical management of ventilator-assisted individuals (VAIs) was challenged by social distancing rules during the COVID-19 pandemic. In May 2020, the Long-Term In-Home Ventilator Engagement (LIVE) Program was launched in Ontario, Canada to provide intensive digital care case management to VAIs. The purpose of this qualitative study was to explore the acceptability of the LIVE Program hosted via a digital platform during the COVID-19 pandemic from diverse perspectives. Methods We conducted a qualitative descriptive study (May 2020-April 2021) comprising semi-structured interviews with participants from eight home ventilation specialty centers in Ontario, Canada. We purposively recruited patients, family caregivers, and providers enrolled in LIVE. Content analysis and the theoretical concepts of acceptability, feasibility, and appropriateness were used to interpret findings. Results A total of 40 individuals (2 VAIs, 18 family caregivers, 20 healthcare providers) participated. Participants described LIVE as acceptable as it addressed a longstanding imperative to improve care access, ease of use, and training provided; feasible for triaging problems and sharing information; and appropriate for timeliness of provider responses, workflows, and perceived value. Negative perceptions of acceptability among healthcare providers concerned digital workload and fit with existing clinical workflows. Perceived benefits accorded to LIVE included enhanced physical and psychological safety in the home, patient-provider relations, and VAI engagement in their own care. Conclusions Study findings identify factors influencing the LIVE Program's acceptability by patients, family caregivers, and healthcare providers during pandemic conditions including enhanced access to care, ease of case management triage, and VAI safety. Findings may inform the implementation of digital health services to VAIs in non-pandemic circumstances.
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Affiliation(s)
- Craig M. Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Munazzah Ambreen
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sohee Kang
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Francine Buchanan
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Regina Pizzuti
- Live Program, Ontario Ventilator Equipment Pool, Kingston, ON, Canada
| | - Andrea S. Gershon
- Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
- Department of Critical Care and Lane Fox Unit, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Reshma Amin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Clinical Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
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4
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Lubomski J, Malchrzak W, Babicki M, Kłoda K, Suwała S, Mastalerz-Migas A. Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients. Telemed J E Health 2024; 30:234-241. [PMID: 37406293 DOI: 10.1089/tmj.2023.0204] [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: 07/07/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.
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Affiliation(s)
- Jan Lubomski
- Ma-na-ma Huisartsgeneeskunde, KU Leuven, Belgium
| | - Wojciech Malchrzak
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Szymon Suwała
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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van Boven JFM, Drummond D, Chan AHY, Hew M, Hui CY, Adejumo I, Cano I, Hansen K, Poberezhets V, Costello RW, Pinnock H. ERS "CONNECT" Clinical Research Collaboration - moving multiple digital innovations towards connected respiratory care: addressing the over-arching challenges of whole systems implementation. Eur Respir J 2023; 62:2301680. [PMID: 37945041 DOI: 10.1183/13993003.01680-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Université Paris Cité, Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
| | - Amy H Y Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology Service, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chi Yan Hui
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
| | - Ireti Adejumo
- NIHR Nottingham Biomedical Research Centre, Respiratory Medicine, Nottingham, UK
| | - Isaac Cano
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Suñer (FRCB-IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Kjeld Hansen
- European Lung Foundation, Sheffield, UK
- School of Economics, Innovation and Technology, Oslo, Norway
| | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
- Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Pinnock
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
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6
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Wileman V, Rowland V, Kelly M, Steed L, Sohanpal R, Pinnock H, Taylor SJC. Implementing psychological interventions delivered by respiratory professionals for people with COPD. A stakeholder interview study. NPJ Prim Care Respir Med 2023; 33:35. [PMID: 37880342 PMCID: PMC10600190 DOI: 10.1038/s41533-023-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Implementing psychological interventions in healthcare services requires an understanding of the organisational context. We conducted an interview study with UK National Health Service stakeholders to understand the barriers and facilitators for implementing psychological interventions for people with chronic obstructive pulmonary disorder (COPD). We used TANDEM as an exemplar intervention; a psychological intervention recently evaluated in a randomised controlled trial. Twenty participants providing care and/or services to people with COPD were purposively sampled from NHS primary/secondary care, and commissioning organisations. Participants were recruited via professional networks and referrals. Verbatim transcripts of semi-structured interviews were analysed using thematic analysis. Four themes were identified: (1) Living with COPD and emotional distress affects engagement with physical and psychological services; (2) Resource limitations affects service provision in COPD; (3) Provision of integrated care is important for patient well-being; and (4) Healthcare communication can be an enabler or a barrier to patient engagement. People need support with physical and psychological symptoms inherent with COPD and healthcare should be provided holistically. Respiratory healthcare professionals are considered able to provide psychologically informed approaches, but resources must be available for training, staff supervision and service integration. Communication between professionals is vital for clear understanding of an intervention's aims and content, to facilitate referrals and uptake. There was widespread commitment to integrating psychological and physical care, and support of respiratory healthcare professionals' role in delivering psychological interventions but significant barriers to implementation due to concerns around resources and cost efficiency. The current study informs future intervention development and implementation.
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Affiliation(s)
- V Wileman
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
- Health Psychology, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK.
| | - V Rowland
- School of Population Health and Environmental Sciences, King's College London, Addison House, Guy's Campus, London Bridge, London, SE1 9RT, UK
| | - M Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - L Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - R Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - H Pinnock
- Allergy and Respiratory Research Group, Usher Institute, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - S J C Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
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7
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Salim H, Cheong AT, Sharif-Ghazali S, Lee PY, Lim PY, Khoo EM, Hussein N, Harrun NH, Ho BK, Pinnock H. A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study. BMC Med Inform Decis Mak 2023; 23:194. [PMID: 37759184 PMCID: PMC10523795 DOI: 10.1186/s12911-023-02300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes. METHODS We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively. RESULTS We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members. CONCLUSIONS An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.
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Affiliation(s)
- Hani Salim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sazlina Sharif-Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute On Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ping Yein Lee
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Petaling Jaya, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Harzana Harrun
- Klinik Kesihatan Pandamaran, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Bee Kiau Ho
- Klinik Kesihatan Bandar Botanik, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Hilary Pinnock
- NIHR Global Health Research Unit On Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
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8
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Bloom CI. Covid-19 pandemic and asthma: What did we learn? Respirology 2023; 28:603-614. [PMID: 37154075 DOI: 10.1111/resp.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
This review addresses some of the major lessons we have learnt regarding asthma and the covid-19 pandemic, including susceptibility to SARS-CoV-2 infection and severe covid-19, potentially protective factors, comparison to other respiratory infections, changes in healthcare behaviour from the perspective of patients and clinicians, medications to treat or prevent covid-19, and post-covid syndrome.
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Affiliation(s)
- Chloe I Bloom
- Imperial College London, National Heart and Lung Institute, London, UK
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9
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Jiang Y, Spies C, Magin J, Bhosai SJ, Snyder L, Dunn J. Investigating the accuracy of blood oxygen saturation measurements in common consumer smartwatches. PLOS DIGITAL HEALTH 2023; 2:e0000296. [PMID: 37437005 DOI: 10.1371/journal.pdig.0000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 07/14/2023]
Abstract
Blood oxygen saturation (SpO2) is an important measurement for monitoring patients with acute and chronic conditions that are associated with low blood oxygen levels. While smartwatches may provide a new method for continuous and unobtrusive SpO2 monitoring, it is necessary to understand their accuracy and limitations to ensure that they are used in a fit-for-purpose manner. To determine whether the accuracy of and ability to take SpO2 measurements from consumer smartwatches is different by device type and/or by skin tone, our study recruited patients aged 18-85 years old, with and without chronic pulmonary disease, who were able to provide informed consent. The mean absolute error (MAE), mean directional error (MDE) and root mean squared error (RMSE) were used to evaluate the accuracy of the smartwatches as compared to a clinical grade pulse oximeter. The percent of data unobtainable due to inability of the smartwatch to record SpO2 (missingness) was used to evaluate the measurability of SpO2 from the smartwatches. Skin tones were quantified based on the Fitzpatrick (FP) scale and Individual Typology Angle (ITA), a continuous measure of skin tone. A total of 49 individuals (18 female) were enrolled and completed the study. Using a clinical-grade pulse oximeter as the reference standard, there were statistically significant differences in accuracy between devices, with Apple Watch Series 7 having measurements closest to the reference standard (MAE = 2.2%, MDE = -0.4%, RMSE = 2.9%) and the Garmin Venu 2s having measurements farthest from the reference standard (MAE = 5.8%, MDE = 5.5%, RMSE = 6.7%). There were also significant differences in measurability across devices, with the highest data presence from the Apple Watch Series 7 (88.9% of attempted measurements were successful) and the highest data missingness from the Withings ScanWatch (only 69.5% of attempted measurements were successful). The MAE, RMSE and missingness did not vary significantly across FP skin tone groups, however, there may be a relationship between FP skin tone and MDE (intercept = 0.04, beta coefficient = 0.47, p = 0.04). No statistically significant difference was found between skin tone as measured by ITA and MAE, MDE, RMSE or missingness.
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Affiliation(s)
- Yihang Jiang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Connor Spies
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Justin Magin
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- School of Medicine, The University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Satasuk Joy Bhosai
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Laurie Snyder
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
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10
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Backer V, Cardell LO, Lehtimäki L, Toppila-Salmi S, Bjermer L, Reitsma S, Hellings PW, Weinfeld D, Aanæs K, Ulrik CS, Braunstahl GJ, Aarli BB, Danielsen A, Kankaanranta H, Steinsvåg S, Bachert C. Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions. FRONTIERS IN ALLERGY 2023; 4:1052386. [PMID: 36895864 PMCID: PMC9989256 DOI: 10.3389/falgy.2023.1052386] [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: 09/23/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines. Methods Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions. Results Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified. Conclusion This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.
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Affiliation(s)
- Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Lars Olaf Cardell
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Toppila-Salmi
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sietze Reitsma
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Peter W Hellings
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Kasper Aanæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arild Danielsen
- Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverre Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway
| | - Claus Bachert
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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11
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Koopirom P, Wiriyaamornchai P, Santeerapharp A. Telemedicine in Thai-otorhinolaryngology patients in COVID-19 situation; primary surveys. Digit Health 2022; 8:20552076221147795. [PMID: 36601287 PMCID: PMC9806494 DOI: 10.1177/20552076221147795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction COVID-19 pandemic has put a strain on various aspects of hospital management due to high rates of infection and increased preventive measures around the world. Physicians and patients alike are susceptible to the ongoing virus causing concern leading to loss or postpone of follow up. Thailand has just start integration of digital solutions such as telemedicine which expected similar level of medical care and efficiency while reducing risk of exposure during the COVID-19 pandemic. Objective Evaluation the willingness to accept telemedicine in otorhinolaryngology patients during the peak COVID-19 outbreaks in our institution. Methods Collected data from all patients who had a schedule follow up for otorhinolaryngology department between the months of June to August, 2021 at out-patient Center. Results Total of 299 otorhinolaryngology patients included, 213 patients (71.2%) denied a virtual medical visit whereas 86 patients (28.8%) accepted. The obstructive sleep apnea (OSA) was the only group to have more acceptance of telemedicine, 79.5% than denying 20.5% with statistical significance (p < 0.01). Age difference between the accepting and declining group also showed statistical significance, 48.5 years and 56 years respectively (p < 0.01). Main Reasons for their decision, 48% of patients accepted due to experiencing clinical improvement and stability. The main reason for not accepting telemedicine was 80% of patients preferred a special otorhinolaryngologic examination on follow up. Conclusions This primary surveys among Thai otorhinolaryngology patients about telemedicine. The greater number of patients not interested in telemedicine due to requirement of otorhinolaryngologic examination. Which OSA follow-up patients have more attention in telemedicine.
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Affiliation(s)
| | | | - Alena Santeerapharp
- Alena Santeerapharp, Department of
Otolaryngology-Head & Neck Surgery, Faculty of Medicine, Srinakharinwirot
University, Bangkok, Thailand.
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12
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Alsaif SS, Kelly JL, Little S, Pinnock H, Morrell MJ, Polkey MI, Murphie P. Virtual consultations for patients with obstructive sleep apnoea: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/166/220180. [PMID: 36517048 PMCID: PMC9879338 DOI: 10.1183/16000617.0180-2022] [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: 09/13/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has accelerated the adoption of virtual care strategies for the management of patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). RESEARCH QUESTION What is the effectiveness of virtual consultations compared to in-person consultations for the management of continuous positive airway pressure (CPAP) therapy in adult patients with OSAHS? METHODS A systematic review and meta-analysis (PROSPERO; CRD42022297532) based on six electronic databases plus manually selected journals was conducted in January 2022. Two researchers independently selected, quality appraised and extracted data. The co-primary outcomes were patient-reported sleepiness, assessed by the Epworth Sleepiness Scale (ESS), and reported cost-effectiveness. RESULTS 12 studies (n=1823 adults) were included in the review. Seven studies (n=1089) were included in the meta-analysis which showed no difference in the magnitude of improvement in patient-reported sleepiness scores between virtual and in-person consultations (mean difference -0.39, 95% CI -1.38-0.60; p=0.4), although ESS scores improved in both groups. Virtual care strategies modestly increased CPAP therapy adherence and were found to be less costly than in-person care strategies in the three Spanish trials that reported cost-effectiveness. CONCLUSION The findings of this review suggest that virtual care delivered by telephone or video consultations is as effective as in-person consultations for improving subjective sleepiness in patients with OSAHS treated with CPAP. This clinical management strategy may also improve CPAP adherence without increasing the costs, supporting its potential as a follow-up management strategy, where patients prefer this approach.
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Affiliation(s)
- Sulaiman S. Alsaif
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,Corresponding author: Sulaiman S. Alsaif ()
| | - Julia L. Kelly
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Stuart Little
- Department of Respiratory Medicine, NHS Dumfries and Galloway, Dumfries, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mary J. Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael I. Polkey
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Sleep and Ventilation Services, Raigmore Hospital, Inverness, UK
| | - Phyllis Murphie
- Modernising Patients Pathways Programme, National Centre for Sustainable Delivery, Glasgow, UK
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13
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Williams S, Barnard A, Collis P, Correia de Sousa J, Ghimire S, Habib M, Jelen T, Kanniess F, Mak V, Martins S, Paulino E, Pinnock H, Roman M, Sandelowsky H, Tsiligianni I, van der Steen L, Weber Donatelli F. Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery. J Health Serv Res Policy 2022:13558196221140318. [PMID: 36484225 PMCID: PMC10363957 DOI: 10.1177/13558196221140318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.
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Affiliation(s)
- Siân Williams
- International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - Amanda Barnard
- School of General Practice, Rural and Indigenous Health, 2219The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Phil Collis
- 441760European Lung Foundation, Leamington Spa, UK
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, 56059University of Minho, Braga, Portugal
| | - Suraj Ghimire
- Institute of Medicine, 92959Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Monsur Habib
- 588669Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | - Tessa Jelen
- British Lung Foundation Support Group, Westminster, London, UK
| | - Frank Kanniess
- Practice for Family Medicine and Allergy, Reinfeld, Germany
| | - Vince Mak
- 8946Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Hilary Pinnock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Hanna Sandelowsky
- Department of Family Medicine and Primary Care, Inst. NVS, 27106Karolinska Institute, Stockholm, Sweden
| | - Ioanna Tsiligianni
- Faculty of Medicine, Department of Social Medicine, University of Crete, Greece
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14
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Do W, Russell R, Wheeler C, Lockwood M, De Vos M, Pavord I, Bafadhel M. Performance of Contactless Respiratory Rate Monitoring by Albus Home TM, an Automated System for Nocturnal Monitoring at Home: A Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197142. [PMID: 36236241 PMCID: PMC9573065 DOI: 10.3390/s22197142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 06/12/2023]
Abstract
Respiratory rate (RR) is a clinically important predictor of cardio-respiratory deteriorations. The mainstay of clinical measurement comprises the manual counting of chest movements, which is variable between clinicians and limited to sporadic readings. Emerging solutions are limited by poor adherence and acceptability or are not clinically validated. Albus HomeTM is a contactless and automated bedside system for nocturnal respiratory monitoring that overcomes these limitations. This study aimed to validate the accuracy of Albus Home compared to gold standards in real-world sleeping environments. Participants undertook overnight monitoring simultaneously using Albus Home and gold-standard polygraphy with thoraco-abdominal respiratory effort belts (SomnomedicsEU). Reference RR readings were obtained by clinician-count of polygraphy data. For both the Albus system and reference, RRs were measured in 30-s segments, reported as breaths/minute, and compared. Accuracy was defined as the percentage of RRs from the Albus system within ±2 breaths/minute of reference counts. Across a diverse validation set of 32 participants, the mean accuracy exceeded 98% and was maintained across different participant characteristics. In a Bland-Altman analysis, Albus RRs had strong agreement with reference mean differences and the limits of agreement of -0.4 and ±1.2 breaths/minute, respectively. Albus Home is a contactless yet accurate system for automated respiratory monitoring. Validated against gold -standard methods, it enables long-term, reliable nocturnal monitoring without patient burden.
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Affiliation(s)
| | - Richard Russell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | | | | | - Maarten De Vos
- Department of Electrical Engineering and Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Mona Bafadhel
- King’s Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
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