Sandra
Forum Replies Created
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*Early triage of critically ill COVID-19 patients using deep learning*
“The sudden deterioration of patients with novel coronavirus disease 2019 (COVID-19) into critical illness is of major concern. It is imperative to identify these patients early. We show that a deep learning-based survival model can predict the risk of COVID-19 patients developing critical illness based on clinical characteristics at admission. We develop this model using a cohort of 1590 patients from 575 medical centers, with internal validation performance of concordance index 0.894 We further validate the model on three separate cohorts from Wuhan, Hubei and Guangdong provinces consisting of 1393 patients with concordance indexes of 0.890, 0.852 and 0.967 respectively. This model is used to create an online calculation tool designed for patient triage at admission to identify patients at risk of severe illness, ensuring that patients at greatest risk of severe illness receive appropriate care as early as possible and allow for effective allocation of health resources.”
The authors provide an online tool to calculate the critical illness risk: https://aihealthcare.tencent.com/COVID19-Triage_en.html
Liang W, Yao J, Chen A, et al. Early triage of critically ill COVID-19 patients using deep learning. Nat Commun. 2020;11(1):3543. Published 2020 Jul 15. doi:10.1038/s41467-020-17280-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363899/
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EPIDEMIX
Epidemix es una plataforma digital que ha recibido numerosos apoyos por parte de Sociedades científicas, colegios profesionales e instituciones. Tiene una doble función:
– Para el profesional sanitario, ofrece un repositorio de información de alta calidad: Artículos y los últimos protocolos relacionados con la COVID-19. También sirve de altavoz para los estudios que se están realizando o para contenidos audiovisuales que realizan los profesionales.
– Para el ciudadano: Ofrece información y noticias validadas científicamente.
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Thanks for your replies Joachim and Alexander!
I’ve been doing some research about these cloud based virtual contact centers and it’s getting more and more interesting! COVID-19 has created some needs that are perfectly met with these solutions: Remote work requirements and rapid scaling.
In the UK, the NHS has been using Amazon Web Services, especially during the COVID-19 outbreak. With Amazon Connect they have reduced calls that required an agent by 42% thanks basically to interactive voice response (IVR) and natural language processing (Amazon Lex and Amazon Polly). That way, the service is scalable and is “protected” against unexpected peaks of activity. Also, employees can be working at home with just a laptop and a VPN.
Do you know any company in Europe that is currently providing this kind of service?
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Detección precoz de insuficiencia respiratoria en COVID-19 y otras enfermedades:
El equipo de Machine Learning Salud de la Universidad Europea de Madrid, liderado por el Dr. Juan José Beunza, está desarrollando un prototipo para la detección precoz de insuficiencia respiratoria en pacientes de COVID-19 que se encuentran en su domicilio. La novedad de este dispositivo, formado por una cinta que se coloca en el pecho y una pinza (pulsioxímetro) para el dedo, reside en que reduce enormemente los costes habituales de estas soluciones de monitorización (habitualmente en torno a 1.000 euros), bajando su coste hasta los 50 euros. Sin duda es una gran oportunidad en estos momentos de pandemia donde las organizaciones sanitarias están al borde del colapso y sin una gran capacidad económica.
El paciente llevaría el dispositivo en su domicilio, y en el caso de que sus constantes vitales (frecuencia cardiaca, respiratoria y saturación de oxígeno en sangre) se salgan del rango considerado normal. se enviaría una alerta al móvil del médico para que se ponga en contacto con el paciente para valorarlo y tomar la decisión más adecuada. Sería una solución especialmente útil para aquellos pacientes que desarrollan una hipoxemia silente, sin repercusión clínica; de forma que podrán recibir atención médica precoz antes de que su situación empeore.
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Dear Johannes and colleagues,
It is truly a challenge to convince the population about isolation in case of being positive and asymptomatic or being a contact of a positive. Undoubtedly, especially in more disfavored areas, it has to be accompanied by the deployment of certain labor and social policies so that these people do not lose their jobs or their scarce economic resources. Otherwise, it will not be possible to ensure that quarantine is respected without using harsher confinements.
Are your contries developing any kind of policies to help in this cases?
Best regards,
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Hello!
Also I would like to point out a problem that probably has affected many countries: Due to the sudden COVID-19 outbreak and the hospital collapse, we didn’t have the chance to keep any “clean hospital” meant to receive other pathologies. I think this is a huge mistake and certainly is a lesson to be learned in the event of a new outbreak. A lot of pathologies like cancer, chronic diseases, etc. haven’t been treated properly and that for sure will have consecuences in the future mortality and morbidity.
A possible solution for this could be to keep some hospitals or spaces “COVID free” to ensure that at least the most serious pathologies can be treated with a lower risk of aggravating their situation by getting COVID-19.
Best,
Sandra Rueda , MD
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Do you have some ideas about how can this innovative EMS trainings be cost effective?
I mean, for example, if we develop a complex VR environment to train EMS professionals to treat victims on a building fire, it would turn out expensive if we try to develop one solution for each emergency medical service. Fragmentation in this case is an expensive outcome. How can we tackle this and other issues to make these technological solutions affordable?
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Here you can find ILCOR recommendations:
- We suggest that chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols (weak recommendation, very low certainty evidence).
- We suggest that in the current COVID-19 pandemic lay rescuers consider compressions and public-access defibrillation (good practice statement).
- We suggest that in the current COVID-19 pandemic, lay rescuers who are willing, trained and able to do so, consider providing rescue breaths to infants and children in addition to chest compressions (good practice statement).
- We suggest that in the current COVID-19 pandemic, healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation (weak recommendation, very low certainty evidence).
- We suggest it may be reasonable for healthcare providers to consider defibrillation before donning personal protective equipment for aerosol generating procedures in situations where the provider assesses the benefits may exceed the risks (good practice statement).
https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest
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Hello Everyone!
I would like to highlight an organisational problem that COVID has made even more obvious: long working hours, especially 24-hour working hours. I’m aware some countries have been able to put an end to this practice, which has proved so harmful to the health of professionals and even to patient safety. In Spain unfortunately we still keep doing these crazy 24-hours shifts.
During covid 19 outbreak, some hospitals abolished these 24-hour shifts by changing them to 8-12 hours, as it proved impossible to keep professionals 24 hours without rest under the profound stress of the accumulation of hundreds of patients in emergency rooms, this added to the difficulty of spending long periods of time in a personal protective equipment.
Hopefully this would teach us to take care of our professionals as we take care of our patients, and to not leave them exposed to the physiological and psychological stress of long shifts.
Best,
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Hello everyone!
The problem of homogenisation goes beyond prescription. In my opinion the first step would be to standardize which members should go in which type of ambulance and what training each of them receives (at European level).Once the training is homogeneous it is easier to agree which procedures or drugs can each one apply.
About the technological solution, a decision support application could be added to the electronic patient care record. Then, when a EMS professional tries to add a prescription, it would not allow certain profiles to prescribe, dispense and administer certain drugs at the time of the emergency. Or at least request permission from the partner who has the appropriate training.
It’s not related with this, but in case someone is not aware, there’s an ongoing european initiative about e-prescription. Following the 2011/24 Directive on the application of patients’ rights in cross-border healthcare, Europe is making a huge effort to ensure that drugs prescribed in one EU country can be dispensed in another member country. These ePrescriptions work thanks to the eHealth Digital Service Infrastructure and they are expected to work throughout nearly the entire EU by the end of 2021.
https://ec.europa.eu/commission/presscorner/detail/en/IP_18_6808Best,
Sandra Rueda Charro, MD -
Thanks John!
As I can see, Austria has already implemented some “COVID Laws” right? That’s very helpful, because without those specific laws we’re having a lot of problems with regional and national competencies, and everytime a region tries to come up with some new regulations most of them are stopped because they’re against individual rights… And this is happening because no law has yet been enacted to ensure the containment measures of the covid.
This Corona traffic light is actually a good approach also for people, is easy to understand.
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Dear Maria,
I think it should have been plain to European countries that critical health supplies cannot be left to other countries, especially after what we have experienced. I hope that this learning will indeed serve at least to prepare us to reduce our external dependence on critical supplies to face a second wave or future pandemics to come.
Best regards,
Sandra Rueda, MD
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