Remote Hospital Care for Recovering COVID-19 Patients Using Telemedicine: A Randomised Controlled Trial

Background: To ensure availability of hospital beds and improve COVID-19 patients’ well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, but the beneficial effect has yet to be established. Methods: We conducted a single centre, randomised trial from January to June 2021, including hospitalised COVID-19 patients who were in the recovery stage of the disease. Hospital care for the intervention group was transitioned to the patient’s home, including oxygen therapy, medication and remote monitoring. The control group received in-hospital care as usual. The primary endpoint was the number of hospital-free days during the 30 days following randomisation. Secondary endpoints included health care consumption during the follow-up period and mortality. Results: A total of 62 patients were randomised (31 control, 31 intervention). The mean difference in hospital-free days was 1.7 (26.7 control vs. 28.4 intervention, 95% CI of difference −0.5 to 4.2, p = 0.112). In the intervention group, the index hospital length of stay was 1.6 days shorter (95% CI −2.4 to −0.8, p < 0.001), but the total duration of care under hospital responsibility was 4.1 days longer (95% CI 0.5 to 7.7, p = 0.028). Conclusion: Remote hospital care for recovering COVID-19 patients is feasible. However, we could not demonstrate an increase in hospital-free days in the 30 days following randomisation. Optimising the intervention, timing, and identification of patients who will benefit most from remote hospital care could improve the impact of this intervention.

Implementation of a Physician-Based Stroke Unit in a Remote Hospital of North-East India-Tezpur Model

Objective The study aims to determine the effects of implementing stroke unit (SU) care in a remote hospital in North-East India. Materials and Methods This before-and-after implementation study was performed at the Baptist Christian Mission Hospital, Tezpur, Assam between January 2015 and December 2017. Before the implementation of stroke unit care (pre-SU), we collected information on usual stroke care and 1-month outcome of 125 consecutive stroke admissions. Staff was then trained in the delivery of SU care for 1 month, and the same information was collected in a second (post-SU) cohort of 125 patients. Statistical Analysis Chi-square and Mann–Whitney U test were used to compare group differences. The loss to follow-up was imputed by using multiple imputations using the Markov Chain Monto Carlo method. The sensitivity analysis was also performed by using propensity score matching of the groups for baseline stroke severity (National Institute of Health Stroke Scale) using the nearest neighbor approach to control for confounding, and missing values were imputed by using multiple imputations. The adjusted odds ratio was calculated in univariate and multivariate regression analysis after adjusting for baseline variables. All the analysis was done by using SPSS, version 21.0., IBM Corp and R version 4.0.0., Armonk, New York, United States. Results The pre-SU and post-SU groups were age and gender matched. The post-SU group showed higher rates of swallow assessment (36.8 vs. 0%, p < 0.001), mobility assessment, and re-education (100 vs. 91.5%, p = 0.037). The post-SU group also showed reduced complications (28 vs. 45%, p = 0.006) and a shorter length of hospital stay (4 ± 2.16 vs. 5 ± 2.68 days, p = 0.026). The functional outcome (modified ranking scale) at 1-month showed no difference between the groups, good outcome in post-SU (39.6%) versus pre-SU (35.7%), p = 0.552. Conclusion The implementation of this physician-based SU care model in a remote hospital in India shows improvements in quality measures, complications, and possibly patient outcomes.

Electives in the Developing World

Choosing to do an elective in a developing country can be a gamble. Everyone has heard stories of unsuspecting students being deposited in a remote hospital and told that actually they are the doctor, and here are the hordes of patients they must look after for the next eight weeks. As if this isn't enough, the students often find themselves suffering severe culture shock, working in a health care service that bears no resemblance to the one they are accustomed to and encountering patients who frequently present with either unfamiliar diseases or unfamiliar presentations of familiar diseases.

Phonocardiography Signals Compression with Deep Convolutional Autoencoder for Telecare Applications

Phonocardiography (PCG) signals that can be recorded using the electronic stethoscopes play an essential role in detecting the heart valve abnormalities and assisting in the diagnosis of heart disease. However, it consumes more bandwidth when transmitting these PCG signals to remote sites for telecare applications. This paper presents a deep convolutional autoencoder to compress the PCG signals. At the encoder side, seven convolutional layers were used to compress the PCG signals, which are collected on the patients in the rural areas, into the feature maps. At the decoder side, the doctors at the remote hospital use the other seven convolutional layers to decompress the feature maps and reconstruct the original PCG signals. To confirm the effectiveness of our method, we used an open accessed dataset on PHYSIONET. The achievable compress ratio (CR) is 32 when the percent root-mean-square difference (PRD) is less than 5%.

Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network

Background In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI. Methods In the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI). Results Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up. Conclusions Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.

Pretraining and Precredentialing Staff for Disaster: A Lesson Learned From the Experience of the 2016 Kumamoto Earthquakes

ABSTRACTThe integration of external staff into a hospital’s disaster response can present technical challenges. Although hospitals will always prefer to use their own staff in disaster response, there have been many historical examples where external staffing is required. During the 2016 Kumamoto Earthquakes, the Oita Prefectural Hospital required medical professionals to expand disaster response staff. They were able to identify 2 appropriate emergency physicians belonging to a remote hospital who had previously worked at the Oita Prefectural hospital. The physicians were effectively able to supplement the hospital staff, providing care for additional patients, and giving the existing on-duty staff some respite. Based on our experience, we suggest that hospital coalitions and disaster response authorities explore mechanisms of cross-credentialing and cross-training staff to make it easier to share staff in a disaster.

IoT-Based Ambulatory Vital Signs Data Transfer System

In emergencies or life-threatening situations, patients are generally shifted to hospitals in ambulances. The health conditions of on-board patients can become critical if they are not evaluated and treated in time. Chances of saving lives can increase significantly if patients’ vital signs inside an ambulance or on-site triage area are transferred to a hospital in real time. If the ambulances are linked to target hospitals, then the physicians in emergency rooms can monitor on-board patients’ vital signs and issue instructions to paramedics to stabilize patients’ medical conditions before they reach the assigned hospitals. Transferred vital signs data may also be archived for medical records. The Internet of things (IoT) is a paradigm which envisions Internet connectivity of virtually everything on the earth. In this paper, an IoT-based low-cost solution is proposed to monitor, archive, analyze, and tag the vital signs data of multiple patients and transfer them to the remote hospital in real time. This opens up a lot of possibilities in telemedicine and disaster management. As a proof of concept, the functionality of the proposed system was validated by developing a prototype model utilizing an IoT-enabled medical sensor board and a Linux server mimicking the remote hospital server. Results of actual data transmission obtained during experimentation are also provided. It is hoped that the proposed system can play a role in saving human lives in disaster situations.

Making Endovascular Neurosurgery Safer: Role of the Neuroanesthesiologist

The increasing use of endovascular technique for treating neurovascular diseases underscores the need for the neuroanesthesiologist to be aware of its potentially serious perioperative complications that can directly impact the anesthetic outcome. These unique complications, including intracranial thromboembolism, hemorrhage, and vasospasm, and significant non-neurological complications that necessitate deft handling by experienced anesthesiologists. However, anesthesia for endovascular neurosurgery is generally being managed in remote hospital locations by relatively junior anesthesiologists who are likely to underestimate the importance of these closed-cranium procedures. This review reacquaints the anesthetist with the periprocedural complications of endovascular neurosurgery that would enable their anticipation, prompt diagnosis, and effective management.

Traumatic abdominal wall hernia repair: an experience in remote hospital of Karnali Academy of Health Sciences Teaching Hospital

Not available.