A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence.
- 作者列表："Grimes CL","Balk EM","Crisp CC","Antosh DD","Murphy M","Halder GE","Jeppson PC","Weber LeBrun EE","Raman S","Kim-Fine S","Iglesia C","Dieter AA","Yurteri-Kaplan L","Adam G","Meriwether KV
INTRODUCTION AND HYPOTHESIS:The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. METHODS:We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. RESULTS:Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. CONCLUSIONS:We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
引言和假设: 新型冠状病毒肺炎大流行和传播 “拉平曲线” 的愿望显著影响了提供者照顾患者的方式。女性盆腔医学和重建外科医生 (FPMRS) 必须通过远程医疗等远程访问提供高质量的护理。目前还没有关于在FPMRS中使用远程医疗的明确指南。使用快速文献综述方法，我们提供了关于大流行期间常见门诊泌尿妇科场景管理的指导。 方法: 我们将FPMRS条件分为虚拟管理不同于直接亲自访视的条件和治疗强调行为和保守咨询但不偏离当前管理模式的条件。我们对四个主题 (FPMRS中的远程医疗、子宫托管理、尿路感染、尿潴留) 进行了快速文献综述，并讨论了四个其他主题 (尿失禁、脱垂、大便失禁、排便功能障碍) 基于现有的系统综述和指南。我们进一步汇编了关于虚拟环境中FPMRS患者管理的专家共识，需要亲自就诊的场景，应该提醒提供者的症状，以及对FPMRS疑似或确诊新型冠状病毒肺炎患者的具体考虑。 结果: 行为、医学和保守治疗作为一线虚拟治疗将是有价值的。某些情况在虚拟环境中需要不同的治疗，而其他情况则需要亲自访问，尽管存在新型冠状病毒肺炎传播的风险。 结论: 我们根据快速文献回顾和专家共识，提出了通过远程医疗治疗FPMRS疾病的指导意见，并以可积极参考的格式提出。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.