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IntroductionLenusCOPD has been co-designed to enable digital transformation of COPD services for proactive preventative care. Patient-facing progressive web application, clinician dashboard and support website integrate patient-reported outcomes (PROs), self-management resources, structured clinical summary, wearable and home NIV data with asynchronous patient-clinician messaging. We commenced the implementation-effectiveness observational cohort RECEIVER trial in September 2019, with the primary endpoint of sustained patient usage and secondary endpoints including admissions, mortality, exacerbations, service workload and quality of life. We paused recruitment in March 2021 and provided LenusCOPD as routine care in the "DYNAMIC-SCOT" COVID-19 response service scale-up. Methods83 RECEIVER trial participants and 142 DYNAMIC-SCOT participants had completed minimum 1 year follow-up when we censored data on 31st August 2021. We established a control cohort with 5 patients matched per RECEIVER participant from de-identified contemporary routine clinical data. ResultsSustained patient app utilisation was noted in both cohorts. Median time to admission or death was 43 days in control, 338 days in RECEIVER and 400 days in DYNAMIC-SCOT participants who had had a respiratory-related admission in the preceding year. The 12-month risk of admission or death was 74% in control patients, 53% in RECEIVER and 47% in the DYNAMIC-SCOT sub-cohort participants. There was a median of 2.5 COPD exacerbations per patient per year with stable quality of life across follow up and a manageable workload for clinical users. ConclusionsA high proportion of people continued to use the co-designed LenusCOPD application during extended follow-up. Outcome data supports scale-up of this digital service transformation. Key messages What is the key question?Can sustained patient interaction and improved patient outcomes be achieved with digital transformation of a COPD service? What is the bottom line?Participants continue to use the LenusCOPD patient app, with an average of 3-3.5 interactions per person per week sustained >1-year post-onboarding. COPD- related hospital admissions and occupied bed days were reduced following LenusCOPD onboarding in participants with a history of a severe exacerbation in the previous year, with a median time to readmission of 380 days compared with 50 days in a contemporary matched control patient cohort. Why read on?Feasibility and utility results support scale-up adoption of these digital tools, to support optimised co-management of COPD and other long-term conditions within a continuous implementation-evaluation framework. This will establish a test-bed infrastructure for additional innovations including artificial intelligence-insights for MDT decision support.
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The COVID-19 [SARS-COV-2] pandemic has had a devastating global impact, with both the human and socio economic costs being severe. One result of the COVID-19 pandemic is the emergence of an urgent requirement for effective techniques and technologies for screening individuals showing symptoms of infection in a non-invasive and non-contact way. Systems that exploit thermal imaging technology to screen individuals show promise to satisfy the desired criteria, including offering a non-contact, non-invasive method of temperature measurement. Furthermore, the potential for mass and passive screening makes thermal imaging systems an attractive technology where current standard of care methods are not practical. Critically, any fever screening solution must be capable of accurate temperature measurement and subsequent prediction of core temperature. This is essential to ensure a high sensitivity in identifying fever while maintaining a low rate of false positives. This paper discusses the results and analysis of a clinical trial undertaken by Thales UK Ltd and the Queen Elizabeth University Teaching Hospital in Glasgow to assess the accuracy and operation of the High Temperature Detection (HTD) system developed by Thales UK Ltd when used in a clinical setting. Results of this single centre prospective observational cohort study show that the measured laboratory accuracy of the Thales HTD system (RMSE=0.1{degrees}C) is comparable to the accuracy when used in a clinical setting (RMSE = 0.15{degrees}C) when measuring a calibrated blackbody source at typical skin temperature. For measurement of forehead skin temperature, the system produced results commensurate with close contact measurement methods (R = 0.86, Mean error=0.05{degrees}C).. Compared to measured tympanic temperatures, measurement of the forehead skin temperature by the HTD system showed a moderate correlation (R = 0.43),), which is stronger than close contact IR forehead thermometers (R = 0.20,0.35) An improved correlation was observed between the maximum facial temperature measured by the HTD system and measured tympanic temperatures (R = 0.53), which is significantly stronger than the close contact methods. A linear predictive model for tympanic temperature based on the measured maximum facial temperatures resulted in a root mean square error (RMSE = 0.50{degrees}C) that is marginally larger than what is expected as a compound of errors in the measuring devices (RMSE=0.45{degrees}C). The study demonstrates that the HTD could be applied in the clinical and non-clinical setting as a screening mechanism to detect citizens with raised temperature. This approach would enable high volume surveillance and identification of individuals that contribute to further spread of COVID-19. Deployment of the HTD system could be implemented as part of a screening tool to support measures to enhance public safety and confidence in areas of high throughput, such as airports, shopping centres or places of work.
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Many western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44-9.59), case-fatality (RR 5.62, 95% CI 4.47-7.07) and population mortality (RR 57.56, 95% 44.06-75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82-4.42) and population mortality (RR 25.41, 95% CI 20.36-31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age [≥]70 years accounted for 49.55% of deaths. In conclusion, shielding has not been effective at preventing deaths in individuals at high risk. Also, to be effective as a population strategy, shielding criteria would need to be widely expanded to include other criteria, such as the elderly.
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IntroductionVery little is known about possible clinical sequelae that may persist after resolution of the acute Coronavirus Disease 2019 (COVID-19). A recent longitudinal cohort from Italy including 143 patients recovered after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60 day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical ICU patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. Methods and analysisThis is an international open-access prospective, observational multi-site study. It will enrol patients following a diagnosis of COVID-19. Tier 1 is developed for following up patients day 28 post-discharge, additionally at 3 to 6 months intervals. This module can be used to identify sub-sets of patients experiencing specific symptomatology or syndromes for further follow up. A Tier 2 module will be developed for in-clinic, in-depth follow up. The primary aim is to characterise physical consequences in patients post-COVID-19. Secondary aim includes estimating the frequency of and risk factors for post-COVID-19 medical sequalae, psychosocial consequences and post-COVID-19 mortality. A subset of patients will have sampling to characterize longer term antibody, innate and cell-mediated immune responses to SARS-CoV-2. Ethics and disseminationThis collaborative, open-access study aims to characterize the frequency of and risk factors for long-term consequences and characterise the immune response over time in patients following a diagnosis of COVID-19 and facilitate standardized and longitudinal data collection globally. The outcomes of this study will inform strategies to prevent long term consequences; inform clinical management, direct rehabilitation, and inform public health management to reduce overall morbidity and improve outcomes of COVID-19. Article summaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIAs an international prospective, observational study we provide open-access standardised tools that can be adapted by any site interested in following up patients with COVID-19, for independent or combined analysis, to forward knowledge into short and long term consequences of COVID-19. C_LIO_LIThis study aims to inform strategies to prevent longer term sequalae; inform clinical management, rehabilitation, and public health management strategies to reduce morbidity and improve outcomes. C_LIO_LIThe protocol will be used for a sub-set of patients, already included in the existing cohort of more than 85,973 individuals hospitalized with confirmed COVID-19 infection across 42 countries (as of 20 July 2020), using the ISARIC/WHO standardized Core- or RAPID Case Report Forms (CRFs). C_LIO_LIThe data will be linked with data on pre-existing comorbidities, presentation, clinical care and treatments documented in the existing cohort already documented using the ISARIC/WHO standardized Core- or RAPID CRFs. C_LIO_LIThe data collection tool is developed to facilitate wide dissemination and uptake, by enabling patient self-assessment, however, follow up of patients requires consent and resources, which might limit the uptake and bias the data towards countries /sites with capacity to follow up patients over time. C_LI
