Η ικανοποίηση των ασθενών με καρκίνο από τη χρήση της τηλεϊατρικής κατά την διάρκεια της πανδημίας του COVID-19 – μελλοντικές προοπτικές και προκλήσεις

Η ραγδαία εξάπλωση της τηλεϊατρικής κατά τη διάρκεια της πανδημίας του COVID-19 επισήμανε το ρόλο της στην παροχή υγείας σε ασθενείς με καρκίνο. Η τηλεϊατρική πρόσφερε ευκολία, ασφάλεια και μείωσε το φορτίο κόστους και μετακινήσεων για τους ασθενείς. Παρόλα αυτά η εφαρμογή της στην πράξη αντιμετώπισε πολλαπλά εμπόδια, όπως την ψηφιακή αγραμματοσύνη και τις ανισότητες στην πρόσβαση σε σχέση με την ηλικία, το κοινωνικοοικονομικό επίπεδο και τα φυλετικά ή εθνικά χαρακτηριστικά. Επιπλέον, η ικανοποίηση των ασθενών από την ψηφιακή τεχνολογία κατά τη διάρκεια της πανδημίας αποτέλεσε ζήτημα διχογνωμιών. Η παρούσα διπλωματική μελέτη αποτελεί μία ανασκόπηση της διεθνούς βιβλιογραφίας με σκοπό να αποσαφηνιστεί ο βαθμός ικανοποίησης των ασθενών και οι παράγοντες που διαμόρφωσαν τις απόψεις τους. Αν και η τηλεϊατρική αποδείχθηκε ικανοποιητική, η τάση των ασθενών για επιστροφή στις αλληλεπιδράσεις με φυσική παρουσία με τους ιατρούς τους, στην εκπνοή της πανδημίας, εξακολουθεί να υφίσταται. Προκειμένου να βιώσει κανείς τα οφέλη της τηλεϊατρικής απαιτείται κατάλληλη εκπαίδευση και εξάσκηση καθώς και προσοχή στις ανισότητες που προκύπτουν από το ψηφιακό χάσμα. Είναι άκρως σημαντικό επομένως, να διερευνηθούν περαιτέρω οι παράγοντες που προάγουν την ικανοποίηση των ασθενών, προκειμένου να εξασφαλιστεί η μακροχρόνια βιωσιμότητα της τηλειατρικής.The rapid escalation of telemedicine during the COVID-19 pandemic highlighted its potentially defining role in cancer care delivery. Telemedicine offered convenience, safety and reduced travel and cost burden. However, routine implementation of telemedicine policies addressed several barriers, such as digital illiteracy and access variances across diverse demographics, such as advanced age, lower socioeconomic status, and racial or ethnic minorities. Additionally, cancer patients΄ satisfaction with the use of telehealth during the COVID-19 has proven to be an issue of growing concern. The current master thesis consists of a scoping review of the literature that aims to clarify the level of patient satisfaction with telehealth during the pandemic and the factors that affected their perspectives. Although telehealth was satisfactory, a tendency to return to in-person visits, since the climbdown of the COVID-19 crisis remains. Experiencing the gains of telehealth demands appropriate education, training and focus on gaps, inherent in the digital divide. It is critical though to further investigate the factors that promote satisfaction to ensure long-term sustainability of telehealth service provision

Relation Between Central Venous, Peripheral Venous and Arterial Lactate Levels in Patients With Sepsis in the Emergency Department

Background: Sepsis and multi-organ failure remain a major clinical problem with high morbidity and mortality worldwide. Lactate measurement remains part of the initial assessment and management of patients with sepsis. Although arterial blood is most commonly used for lactate measurement, there is increasing use of peripheral venous lactate for initial assessment and for monitoring of response to treatment in patients with sepsis. The aim of this study was to evaluate the relation between lactate levels measured from central line, peripheral vein and arterial line in patients treated for sepsis in the emergency department (ED). Methods: This prospective study enrolled 31 patients with diagnosis of sepsis who were evaluated and treated in the ED of a university hospital. During initial resuscitation, blood samples from the artery, peripheral vein and central vein (when available) were collected and lactate concentrations were measured. Correlation between lactate values from the three different locations was assessed using Pearson correlation. Bland-Altman plots were used to evaluate agreement between lactate measurements in different sampling locations. All patients were eventually admitted to the Internal Medicine Department ward or to the intensive care unit (ICU) for further treatment. Results: Our data showed strong, highly significant correlation between arterial and peripheral venous lactate levels (r = 0.880, P \u3c 0.0001), between arterial and central venous blood lactate (r = 0.898, P \u3c 0.0001) and between central and peripheral venous blood lactate (r = 0.941, P \u3c 0.0001). Conclusions: In this study we observed strong correlation between arterial, central vein and peripheral vein lactate concentrations in 31 patients assessed and treated for sepsis. We suggest that lactate measurement in peripheral venous blood could be used for screening and for monitoring response to therapy in sepsis patients. However, because this is a small study in only 31 patients and published data are limited, larger studies are needed in order to confirm the validity of our findings

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT 65MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving \u3b2-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of 65 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infection