Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period.

CONTEXT: The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit. OBJECTIVE: We have developed and applied an emergency plan, tailored for Outpatients with endocrine diseases. DESIGN: Cross-sectional study from March to May 2020. SETTING: Referral University-Hospital center. PATIENTS: 1262 patients in 8 weeks. INTERVENTIONS: The emergency plan is based upon the endocrine triage, the stay-safe procedures and the tele-Endo. During endocrine triage every patient was contacted by phone to assess health status and define if the visit will be performed face-to-face (F2F) or by tele-Medicine (tele-Endo). In case of F2F, targeted stay-safe procedures have been adopted. Tele-Endo, performed by phone and email, is dedicated to COVID-19-infected patients, to elderly or frail people, or to those with a stable disease. MAIN OUTCOME MEASURE: To assess efficacy of the emergency plan to continue the follow-up of Outpatients. RESULTS: The number of visits cancelled after endocrine triage (9%) is lower than that cancelled independently by the patients (37%, p < 0.001); the latter reduced from 47 to 19% during the weeks of lockdown (p = 0.032). 86% of patients contacted by endocrine-triage received a clinical response (F2F and tele-Endo visits). F2F visit was offered especially to young patients; tele-Endo was applied to 63% of geriatric patients (p < 0.001), visits' outcome was similar between young and aged patients. CONCLUSIONS: The emergency plan respects the WHO recommendations to limit viral spread and is useful to continue follow-up for outpatients with endocrine diseases.

A telerobotic haptic system for minimally invasive stereotactic neurosurgery.

Medical robotics and computer assisted surgery are feasible and promising applications of robotic technology, whose main goals are surgical augmentation, information enhancement and improved surgical action. Neurosurgery probably presents the most major challenges, and can considerably benefit from the introduction of computers and robots to guide surgical procedures. This paper presents an innovative master-slave haptic robotic system for minimally invasive neurosurgery, which can help surgeons overcome human shortcomings and perform more accurate, repeatable, and reliable stereotactic neurosurgery. The system, named LANS, consists of a slave mechatronic actuator and a haptic master. The slave is designed to move linearly a laser pointer, a biopsy needle or a low-energy X-ray emitter along a pre-planned axis. The tool insertion into the brain is guided by the surgeon through the haptic master which also provides force feedback to the operator. Not only can the haptic master reproduce the contact force between the surgical tool and the treated tissue, but it can also produce virtual forces aimed at assisting surgeons during the operations. Experiments have been conducted to prove the soundness and accuracy of the overall system mechanical design and to assess the effectiveness of the control schemes synthesized for the master and the slave.