ABSTRACT
Hospital at Home (HaH) has been proposed as a solution to relieve pressure on hospital beds during the COVID-19 pandemic; however, caregivers' feelings of inadequacy and concerns on the need for tighter clinical monitoring might lead to unnecessary and potentially harmful hospital admissions in frail older patients with mild or atypical COVID-19. Here we report the case of a 91-year old woman with severe dementia and atypical COVID-19 that could be successfully managed by our HaH thanks to her highly motivated caregivers and the support of a telemedicine solution (TMS) to provide caregiver training and support as well as supplementary telemonitoring. Despite some well-known issues on TMS use, the hybrid in-person and tele-visit approach of TMS-assisted HaH could help to create a "secure" environment, empowering caregivers to manage frail older adults with COVID-19 at home, avoiding unnecessary admissions to closed wards and their negative physical, functional and psychological outcomes.
Subject(s)
COVID-19 , Dementia , Telemedicine , Aged , Aged, 80 and over , Caregivers , Dementia/epidemiology , Dementia/therapy , Female , Hospitals , Humans , Pandemics , SARS-CoV-2ABSTRACT
This article proposes the analysis of the admissions to hospital-at-home service within the framework of process mining. In addition to conventional modeling in standard languages, relying on interviews and continuous improvement, we propose the adoption of an automatic process discovery technique based on data collected by the hospital information system. We focus on the patient admission process, in which staff discriminate cases of interest for the service. Our methodological framework starts with the extraction of process information from the existing dataset. Once obtained meaningful data for an event log analysis, we propose the adoption of a process discovery algorithm by using a specific tool for process mining. In the context of Business Process Management, we suggest a practical application to be explored in order to improve standard modeling, opening the way to perform business process simulation with scenario analysis.
Subject(s)
Hospital Information Systems , HospitalizationABSTRACT
Intracranial malignancies can be complicated by seizure activity, and anticonvulsants such as phenytoin are usually administered to prevent this neurological kind of complication. Cranial radiation therapy is instead the treatment of choice when the tumor is unresectable. Anyway, the combination of phenytoin and cranial radiation therapy can lead to a rare and severe mucocutaneous complication called EMPACT syndrome. It is composed of "erythema (E) multiforme (M) associated with phenytoin (P) and (A) cranial radiation (C) therapy (T)." Herein, we report 2 cases of EMPACT syndrome related to the use of phenobarbital instead of phenytoin as usually described in literature.
Subject(s)
Anticonvulsants/adverse effects , Cranial Irradiation/adverse effects , Drug Eruptions/etiology , Erythema Multiforme/chemically induced , Phenobarbital/adverse effects , Adult , Brain Neoplasms/radiotherapy , Female , Humans , Italy , Seizures/drug therapy , SyndromeABSTRACT
A wide spectrum of skin toxicities has been described in patients receiving epidermal growth factor receptor (EGFR), inhibitors, including papulopustular rash, xerosis and fissures, pruritus, mucositis, paronychia, and hair changes.Trichomegaly of the eyelashes is a rare adverse effect of EGFR inhibitor therapy and is characterized by a paradoxical overgrowth of eyelashes. We present 3 cases of trichomegaly occurred during EGFR inhibitor therapy.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Drug Eruptions/etiology , ErbB Receptors/antagonists & inhibitors , Hair Diseases/chemically induced , Quinazolines/adverse effects , Erlotinib Hydrochloride , Exanthema/chemically induced , Eyelashes , Female , Humans , Middle Aged , PanitumumabABSTRACT
BACKGROUND: New chemotherapic agents and new protocols in oncology have led to an increasing survival rate in patients affected by tumors. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of patients' quality of life. Appropriate management of skin toxicity associated with chemotherapic agents is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes. METHODS: We have clinically examined 100 patients affected by cancer, determining type, frequency, treatment, and evolution of side effects related to chemotherapy. RESULTS: The prevalent cutaneous side effects in patients undergoing chemotherapy are skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical cases are reported in detail. CONCLUSION: Oncological therapies have become more selective and have low systemic toxicity because of their high specificity, but cutaneous side effects are common and may worsen the quality of life of these patients.
