Efficacy of Telemedicine and At-Home Telemonitoring following Hospital Discharge in Patients with COVID-19.

Aim: This work aims to evaluate the safety and utility of an at-home telemedicine with telemonitoring program for discharged COVID-19 patients. Methods: This is a retrospective cohort study of all patients discharged home in Galicia between 6 March 2020 and 15 February 2021. We evaluated a structured, proactive monitoring program conducted by the ASLAM (Área Sanitaria de Lugo, A Mariña y Monforte de Lemos) Healthcare Area team compared to patients discharged in the rest of the Autonomous Community of Galicia. Results: During the study period, 10,517 patients were hospitalized for COVID-19 and 8601 (81.8%) were discharged. Of them, 738 (8.6%) were discharged in ASLAM and 7863 (91.4%) were discharged in the rest of Galicia. Of those discharged in ASLAM, 475 (64.4%) patients were monitored. Compared to patients in the rest of Galicia, the group monitored via telemedicine had a significantly shorter first hospital stay (p < 0.0001), a lower readmission rate (p = 0.05), and a shorter second hospital stay (p = 0.04), with no differences in emergency department visits or 90-day all-cause mortality. Conclusion: A structured, proactive telemedicine with telemonitoring program for discharged COVID-19 patients is a safe, useful tool that reduces the mean length of hospital stay and readmissions.

Efficacy of Telemedicine and Telemonitoring in At-Home Monitoring of Patients with COVID-19.

AIM: this work aims to assess if telemedicine and telemonitoring are clinically useful and safe for at-home monitoring of Coronavirus disease 2019 (COVID-19) patients. METHODS: This is a retrospective cohort study of all patients diagnosed with COVID-19 in Galicia (Northwestern Spain) between 26 December 2020 and 15 February 2021. The structured, proactive monitoring via telemonitoring (TELEA) of patients considered to be high-risk in the Lugo, A Mariña, and Monforte Healthcare Area (ASLAM) was evaluated compared to other models in the remaining healthcare areas of Galicia. RESULTS: Of the 47,053 COVID-19 patients, 4384 (9.3%) were in ASLAM. Of them, 1187 (27.1%) were monitored via TELEA, and the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored via other methods. Patients monitored in ASLAM via TELEA were older, consulted in the emergency department less frequently (p = 0.05), were hospitalized less frequently (p < 0.01), had shorter hospital stays (p < 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). No at-home life-threatening emergencies were recorded. CONCLUSIONS: these data suggest that, for COVID-19 patients, a care model involving proactive at-home monitoring with telemedicine and telemonitoring is associated with reduced pressure on hospital services and a lower mortality rate.

Usefulness of a Telemedicine Tool TELEA in the Management of the COVID-19 Pandemic.

Background: The usefulness of telemedicine in the management of the coronavirus disease 2019 (COVID-19) pandemic has not been evaluated. Methods: We conducted a descriptive study of the process of recruitment and follow-up of patients using a telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain. Results: A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6 ± 16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room. Conclusion: The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.

[Course of alcohol withdrawal syndrome in a general hospital]. / Curso temporal del síndrome de abstinencia alcohólica en un hospital general.

INTRODUCTION AND OBJECTIVE: There is little information available regarding the course of alcohol withdrawal syndrome in a general hospital. The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications. MATERIAL AND METHOD: A cohort study of patients with a diagnosis of alcohol withdrawal syndrome was carried out at the Xeral Hospital in Lugo (Spain) between 1987 and 2003, in accordance with DSM IV-TR criteria. Data on clinical characteristics and course were collected, with special attention to the timing of significant events. RESULTS: A total of 539 episodes were studied in 436 patients: 156 cases of alcohol withdrawal syndrome and 383 of alcohol withdrawal delirium. Mean time of abstinence until the diagnosis of alcohol withdrawal syndrome was 54 hours (D.T. = 31.1). Seizures occurred at 35 hours (D.T. = 23.3) after abstinence. The alcohol withdrawal syndrome lasted for 46.4 hours (D.T. = 23.1) after diagnosis. In cases in which delirium tremens developed, this occurred at 46.4 hours (D.T. = 23.1), and lasted 73.9 hours (D.T. = 41.5). Patients needing intensive care were admitted to the ICU 40.8 hours (D.T. = 60) after the diagnosis of alcohol withdrawal syndrome. The clinical features of alcohol withdrawal syndrome tended to be more prolonged in patients admitted with a medical or surgical diagnosis other than withdrawal syndrome than in those admitted because of withdrawal syndrome itself. CONCLUSIONS: The natural history of alcohol withdrawal syndrome in a general hospital setting and the timings of its principal events follow a clearly recognizable pattern. This knowledge can help to provide better assessment in relation to the monitoring and treatment of these patients.

Curso temporal del síndrome de abstinencia alcohólica en un hospital general / Course of alcohol withdrawal syndrome in a general hospital

Introducción y objetivo: Existe poca información sobre el curso temporal del síndrome de abstinencia alcohólica en el ámbito de un hospital general. El objetivo de este estudio es saber qué manifestaciones son atribuibles a la abstinencia y en qué momento de su evolución, así como sus implicaciones pronósticas. Material y método: estudio de cohortes sobre los enfermos diagnosticados de síndrome de abstinencia alcohólica en el Hospital Xeral de Lugo entre 1987 y 2003, según criterios del manual DSM IV-TR. Para cada caso se registraron datos clínicos y de seguimiento, con especial atención a los intervalos temporales de aparición y duración de sus manifestaciones. Resultados: Se estudiaron 539 episodios en 436 pacientes: 156 casos de síndrome de abstinencia no complicado y 383 casos de delirium tremens. El tiempo medio de abstinencia hasta el diagnóstico de síndrome de abstinencia alcohólica fue 54,4 horas (D.T. = 31,1). Las crisis comiciales aparecieron 35 horas (D.T. = 23,3) desde el cese de la ingesta. La duración del síndrome de abstinencia no complicado desde el diagnóstico fue 46,4 horas (D.T. = 23,1). Cuando evolucionaron a delirium tremens, estese diagnosticó a las 40,2 horas (D.T. = 29,4), y se prolongó durante 73,9 horas (D.T. = 41,5). Cuando fue preciso el traslado a la UCI, éste se produjo a las 40,8 horas (D.T. = 60) desde el diagnóstico de síndrome de abstinencia. Los enfermos en los que el síndrome de abstinencia alcohólica complicó un ingreso por otro motivo, presentaron manifestaciones clínicas más prolongadas que los que ingresaron por abstinencia. Conclusiones: las manifestaciones clínicas del síndrome de abstinencia alcohólica siguen una pauta evolutiva claramente reconocible. Su conocimiento puede ayudar a una mejor planificación de su atención y tratamiento (AU)

Introduction and objective: There is little information available regarding the course of alcohol withdrawal syndrome in a general hospital. The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications. Material and method: A cohort study of patients with a diagnosis of alcohol withdrawal syndrome was carried out at the Xeral Hospital in Lugo (Spain) between 1987 and 2003, in accordance with DSM IV-TR criteria. Data on clinical characteristics and course were collected, with special attention to the timing of significant events. Results: A total of 539 episodes were studied in 436 patients: 156 cases of alcohol withdrawal syndrome and 383 of alcohol withdrawal delirium. Mean time of abstinence until the diagnosis of alcohol withdrawal syndrome was 54 hours (D.T. = 31.1). Seizures occurred at 35 hours (D.T. =23.3) after abstinence. The alcohol withdrawal syndrome lasted for 46.4 hours (D.T. = 23.1) after diagnosis. In cases in which delirium tremens developed, this occurred at 46.4 hours (D.T. = 23.1), and lasted 73.9 hours (D.T. = 41.5). Patients needing intensive care were admitted to the ICU40.8 hours (D.T. = 60) after the diagnosis of alcohol withdrawal syndrome. The clinical features of alcohol withdrawal syndrome tended to be more prolonged in patients admitted with a medical or surgical diagnosis other than withdrawal syndrome than in those admitted because of withdrawal syndrome itself. Conclusions: The natural history of alcohol withdrawal syndrome in a general hospital setting and the timings of its principal events follow a clearly recognizable pattern. This knowledge can help to provide better assessment in relation to the monitoring and treatment of these patients (AU)