Tag: 4/2/21

Categories : HospitalsTags :

Life-saving Benefits of Telemedicine in ICUs

On By ModernMedia

A study in Cleveland, USA, showed that at hospitals without 24/7 on-site intensivists, those that had intensivists available to deliver telemedicine had lower ICU mortality rates.

Presented at the Society of Critical Care Medicine’s virtual 50th Critical Care Congress, Cleveland Clinic intensivist Dr Chiedozie Udeh, commented that the COVID pandemic has thrust ICU telemedicine into the spotlight.

“In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” Udeh said.

Out of patients treated at one of nine hospitals within the Cleveland Clinic Health System, patients receiving ICU telemedicine were 18% less likely to die and were discharged 2 days sooner than patients who received traditional ICU care, without 24/7 on-site intensivist care.  

The unadjusted 30-day mortality among the telemedicine patients was 5.5%, while in the standard care group it was significantly higher at 6.9%.ICU length of stay was significantly shorter in the ICU telemedicine group, as was the length of total hospital stay.

Udeh said that an intensivist monitoring patients via telemedicine has access to relevant data and can perform the same functions as an on-site clinician, short of physical contact. Intensivists can monitor multiple patients and have two-way communication with bedside nurses. Dedicated software is available, including tools to identify deteriorating patients needing care.

Speaking to MedPage Today, Udeh said ICU telemedicine offers an intermediate treatment strategy between large academic centres with 24/7 on-site intensivist care, and smaller hospitals without such care. More research is needed to understand how telemedicine leads to reduced mortality, he added.

“If I had to speculate I would imagine this would probably be due to patients’ receiving more timely needed interventions,” he said.

“We think these findings provide further reassurance about the value of ICU telemedicine, particularly in light of our collective experience in 2020,” said Udeh. “With the COVID-19 pandemic, telemedicine in general assumed greater prominence.”

CU telemedicine can benefit both large hospital systems and smaller, individual hospitals, he said.

“Smaller hospitals may have no intensivist at all or they may have only one,” he said. He added that, according to one recent survey, about half of US hospitals do not have an intensivist on staff.

ICU telemedicine still has considerable expenses associated with it, however; at $50 000 per bed in first year costs, it may be hard to justify for resource-constrained hospitals.

Source: MedPage Today

Presentation information: Udeh CI, et al “ICU telemedicine and clinical risks associated with 30-day mortality: a retrospective cohort study” SCCM2021.

Categories : COVIDTags :

Viral Load Drives the Transmission of COVID

On By ModernMedia

Knowing what factors drive the transmission of COVID is crucial to informing schemes to contain and adapt to its spread.

There is abundant data on location and duration of exposure to COVID, but there is precious little on any other factors, the researchers noted.

The SARS-CoV-2 virus is detectable in respiratory tract samples 1-2 days before symptom onset, and can continue for several weeks afterward. But the detection of viral RNA is not necessarily related to infectiousness, and no studies had established the connection between viral load and COVID transmission, although viral load had been linked to COVID mortality.

The researchers used linked index cases of COVID to determine that viral load was the principle factor behind COVID transmission, and is the largest such study to date. This emphasises the need for initiating proper contact tracing.

The researchers conducted a post-hoc analysis of 314 cases during the initial COVID wave in Spain, of whom 90% (282) had at least one close contact, resulting in a total of 753 contacts. Viral load was the key indicator of COVID transmission.

The overall secondary attack rate (proportion of COVID-positive contacts) during the study period was 17%. However, this rate varied from 12% when the viral load of the index case was lower than 1×10⁶ copies per mL, to 24% when it was 1×10¹⁰ copies per mL or higher.

Running multivariate analyses, the researchers found no association between sex, age, diabetes, cardiovascular disease, or respiratory disease and the risk of or time to developing symptomatic COVID. There was a significant association of incubation time with initial viral load, increasing from five days among patients with a high viral load to seven days among participants with a low viral load.

The researchers wrote: “Taken together, our results indicate that the viral load, rather than symptoms, might be the predominant driver of transmission.”

They conclude that all cases should be considered potential transmitters of the virus. They also suggest viral load assessment in patients with large numbers of contacts, and risk stratification by time to symptom appearance based on viral load. 

Source: News-Medical.Net

Journal information: Marks M, et al. Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study. The Lancet Infectious Disease, 2021. DOI: https://doi.org/10.1016/S1473-3099(20)30985-3, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30985-3/fulltext

Categories : CancerTags :

New Ultrasonic Tumour Therapy

On By ModernMedia

A new technique has been developed that uses ultrasound to vapourise encased nano-droplets, at the tumour site. This technology could be used to image the tumour, damage it or even deliver chemotherapy drugs with precision.

Existing applications of ultrasound therapy include thermal excitation of tissues, for example to dilate blood vessels, and creating cavitation to break up kidney stones. Ultrasonic toothbrushes have also been shown to remove dental plaque with better efficiency than conventional toothbrushes, and about the same as that of mechanical electrical toothbrushes. Micrometre-sized droplets, encased in a stabilising shell, can already be visualised with ultrasound, but these are too large to enter tumours. Nanometre-sized droplets can do so, however.

Vapourisation is tricky to control in reality, since the process requires a point of nucleation. The researchers demonstrated an efficient way to achieve vapourisation: by applying a frequency at the exact resonant frequency of the droplet, the pressure inside suddenly drops and the liquid vapourises. This is much the same principle as shattering a crystal glass by bombarding it with sound at its resonant frequency.

The researchers used hydrofluorocarbons,  which have a very low boiling point,   for the droplets. The resonance of the droplet being six times higher makes vapourisation much easier. The speed of sound of the droplet fluid being lower than the speed of sound in the bodily fluids surrounding it.
This resonant droplet vapourisation technology has a number of possible medical applications. The bubbles from the bursting droplets could be used to physically damage the tumour. Or, the droplets could contain chemotherapy drugs and made to break open precisely inside the tumour and reducing exposure of the rest of the body.

Source: News-Medical.Net

Journal information: Lajoinie, G. et al. (2021) High-Frequency Acoustic Droplet Vaporization is Initiated by Resonance’ by Guillaume Lajoinie, Tim Segers, and Michel Versluis. Physical Review Letters. doi.org/10.1103/PhysRevLett.126.034501.

Categories : Injury & Trauma TransplantsTags :

First Successful Face and Double Hand Transplant

On By ModernMedia

Doctors in New York have performed the world’s first successful face and double hand transplant.

The patient, 22 year-old Joe DiMeo, had suffered burns over 80% of his body in a 2018 crash, resulting in his fingers being amputated. His eyelids and lips were also amputated. He had been driving home from a night shift when he fell asleep at the wheel and his car crashed, bursting into flames. He spent four months in a burns unit, much of it in an induced coma. After 20 reconstructive surgeries, he still had only limited use of his hands and face.

In a 23-hour operation, doctors attached the donor’s face and hands. He then spent 45 days in ICU, then a further two months in hospital. Mr DiMeo learned to open his new eyelids and move his hands, and is now spending up to five hours a day in rehab.

Eduardo Rodriguez, director of the Face Transplant Program, said: “We wanted to give him not only an operation that made him look better, but it ultimately had to work ideally, especially with the hands.” He added that Mr DiMeo is the most motivated patient he had met.

The doctors waited to ensure that the transplant had taken before calling it successful. While a face and double hand transplants had been performed before, one patient died from complications and the other had to have their hands amputated when they failed to thrive.

Hand transplants have progressed a great deal since the first successful one in 1998. Enormous strides have been made in immunosuppression since then, requiring fewer drugs with less resultant toxicity and side effects. There is also a protocol for using donor bone marrow and stem cells to modulate the immune system in place of typical immunosuppression.

Mr Dimeo says that he can now exercise and make breakfast unaided.

“This is a once-in-a-lifetime gift, and I hope the family can take some comfort knowing that part of the donor lives on with me,” Mr Dimeo said. “My parents and I are very grateful that I’ve been given this second chance.”

Source: BBC News

Categories : COVIDTags :

Pfizer Vaccine 90% Effective After a Single Dose

On By ModernMedia

A study from the University of East Anglia (UEA) reported that the Pfizer vaccine provides “very high” protection after a single dose.

The researchers drew on Israeli data, where the vaccine had been widely administered, and found that the vaccine was 90% effective at 21 days after the initial dose. This supports the plan that the UK and other nations have of delaying a second dose to achieve maximum coverage. However, they also noted that infection rates increased eight days after the first dose, which they attribute to people becoming less cautious as a result of the vaccination. The study is available on the medRxiv preprint server, and has not been peer reviewed, as it is a rapid response to the ongoing COVID pandemic.

Lead researcher and COVID expert Prof Paul Hunter, from UEA’s Norwich Medical School, said: “A second dose of the Pfizer vaccine would normally be given 21 days or more after the first to top up and lengthen the effect of the first dose.

“But here in the UK, the decision was made to delay the timing of the second injection until 12 weeks after the first.

“The logic behind this is to protect more people sooner and so reduce the total number of severe infections, hospitalisations, and deaths.

“But this decision caused criticism from some quarters due in part to a belief that a single injection may not give adequate immunity.”

Prof Hunter explains the motivation for the study was previous flawed research on the Pfizer vaccine, also using Israeli data. But the study did not consider effectiveness past day 18.

The researchers observed that case incidence rose up til day eight by which time it had doubled, then fell. Prof Hunter said: “We found that the vaccine effectiveness was still pretty much zero until about 14 days after people were vaccinated. But then after day 14 immunity rose gradually day by day to about 90 percent at day 21 and then didn’t improve any further. All the observed improvement was before any second injection.

“This shows that a single dose of vaccine is highly protective, although it can take up to 21 days to achieve this.”

Although the vaccine’s effectiveness beyond this is not known, it still supports the UK’s decision to space out vaccine doses, Prof Hunter concluded.

Source: Medical Xpress

Journal information: “Estimating the effectiveness of the Pfizer COVID-19 BNT162b2 vaccine after a single dose. A reanalysis of a study of ‘real-world’ vaccination outcomes from Israel” is published on the medRxiv pre-print server: www.medrxiv.org/content/10.110 … 021.02.01.21250957v1