Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report

Background: Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). Objective: We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. Methods: A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called "modules" were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. Implementation (results): Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. Conclusions: Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change

Vitreous Substitutes: The Present and the Future

Vitreoretinal surgery has advanced in numerous directions during recent years. The removal of the vitreous body is one of the main characteristics of this surgical procedure. Several molecules have been tested in the past to fill the vitreous cavity and to mimic its functions. We here review the currently available vitreous substitutes, focusing on their molecular properties and functions, together with their adverse effects. Afterwards we describe the characteristics of the ideal vitreous substitute. The challenges facing every ophthalmology researcher are to reach a long-term intraocular permanence of vitreous substitute with total inertness of the molecule injected and the control of inflammatory reactions. We report new polymers with gelification characteristics and smart hydrogels representing the future of vitreoretinal surgery. Finally, we describe the current studies on vitreous regeneration and cell cultures to create new intraocular gels with optimal biocompatibility and rheological properties

A conformational switch controlling the toxicity of the prion protein

Prion infections cause conformational changes of the cellular prion protein (PrPC) and lead to progressive neurological impairment. Here we show that toxic, prion-mimetic ligands induce an intramolecular R208-H140 hydrogen bond (‘H-latch’), altering the flexibility of the α2–α3 and β2–α2 loops of PrPC. Expression of a PrP2Cys mutant mimicking the H-latch was constitutively toxic, whereas a PrPR207A mutant unable to form the H-latch conferred resistance to prion infection. High-affinity ligands that prevented H-latch induction repressed prion-related neurodegeneration in organotypic cerebellar cultures. We then selected phage-displayed ligands binding wild-type PrPC, but not PrP2Cys. These binders depopulated H-latched conformers and conferred protection against prion toxicity. Finally, brain-specific expression of an antibody rationally designed to prevent H-latch formation prolonged the life of prion-infected mice despite unhampered prion propagation, confirming that the H-latch is an important reporter of prion neurotoxicity

A bispecific immunotweezer prevents soluble PrP oligomers and abolishes prion toxicity

Antibodies to the prion protein, PrP, represent a promising therapeutic approach against prion diseases but the neurotoxicity of certain anti-PrP antibodies has caused concern. Here we describe scPOM-bi, a bispecific antibody designed to function as a molecular prion tweezer. scPOM-bi combines the complementarity-determining regions of the neurotoxic antibody POM1 and the neuroprotective POM2, which bind the globular domain (GD) and flexible tail (FT) respectively. We found that scPOM-bi confers protection to prion-infected organotypic cerebellar slices even when prion pathology is already conspicuous. Moreover, scPOM-bi prevents the formation of soluble oligomers that correlate with neurotoxic PrP species. Simultaneous targeting of both GD and FT was more effective than concomitant treatment with the individual molecules or targeting the tail alone, possibly by preventing the GD from entering a toxic-prone state. We conclude that simultaneous binding of the GD and flexible tail of PrP results in strong protection from prion neurotoxicity and may represent a promising strategy for anti-prion immunotherapy

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Construção de política para gestão de resíduos na Universidade de São Paulo como modelo para implementação da PNRS em IES

The actual scenario of the University of São Paulo (USP) has, in an isolated form, various environmental initiatives in diverse fronts, according to the reality of its campi. In 2010, USP designated an Environmental Management coordinator attached to the university’s rectory. The following year USP approved the its Environmental Policy, that promotes environmental sustainability in all its campi. In 2012 the Environmental Management Superintendence (SGA) was created as an office responsible for environmental management of the university, with the objective of developing norms for environmental issues in agreement to the proposed environmental policy. This superintendence created in 2012 a Working Group for dealing with issues related to solid residues generated in USP. This group, composed of specialists in this area and coordinated by an member of the SGA, developed, using participative processes, strategies and procedures for the elaboration and implementation of the Solid Residue Management Policy (PGRUSP). This policy following a previous model (PUSP-C, 2010), has as objective adequate the National Solid Residue Policy (PNRS) to the university’s environment. An initial version of the PGRUSP was presented to the academic community in a Forum promoted by the SGA. In this occasion, representatives of all the categories coming from the university’s different campi, apart from members of the external community, analyzed the document and made suggestions on its contents that were later included in the final document. PGRUSP determines the elaboration of Residue Management Plans in all the units that belong to USP. At this moment, the Working Group is elaborating directives for the training of the academic community for the execution of an ample residue diagnosis, with the objective of also mobilizing and publicizing the directives of the PGRUSP. The training and residue management plan construction presupposes learning about the practical issues of residue management. Data production and indicator construction will be the basis for the continuous and efficient implementation of this policy. For the ordering of the data a virtual platform is being developed. With such a platform, USP pretends to control generation, stocking, treatment and destination of Solid Residues produced in its academic units. It pretends with this database, to generate information that will permit the SGA to make decisions that will improve residue management in USP’s campi and, consequently, minimize environmental impacts caused in all levels of its activities. O cenário atual da Universidade de São Paulo (USP) tem, isoladamente, diversas ações ambientais em diferentes frentes, de acordo com a realidade de seus campi. Em 2010, a USP designou um coordenador de Gestão Ambiental junto à Reitoria. No ano seguinte, regulamentou a Política Ambiental da USP, que visa promover a sustentabilidade ambiental nos campi. Em 2012, foi criado um órgão institucional responsável pela gestão ambiental, a Superintendência de Gestão Ambiental (SGA), que tem como premissa ditar normas para questões ambientais em consonância com a política ambiental proposta. Esta superintendência formou, em 2012, um Grupo de Trabalho para cuidar das questões relativas aos resíduos gerados na USP. Tal grupo, composto por especialistas na área, sob a coordenação de um assessor de gabinete da própria SGA, priorizou desenvolver, através de processos participativos, estratégias e procedimentos para elaboração e implantação de uma Política de Gestão de Resíduos (PGRUSP), com base na Política Nacional de Resíduos Sólidos. A PGRUSP prevê a elaboração dos planos de gerenciamento de resíduos em todas as unidades pertencentes à USP e prevê também a capacitação da comunidade acadêmica para a realização de um diagnóstico de resíduos e sistematização dos indicadores numa plataforma virtual unificada de resíduos. Assim, pretende-se controlar tanto os insumos utilizados como a geração, o armazenamento, os tratamentos e os descartes relacionados aos resíduos gerados em nossas Unidades e, consequentemente, minimizar impactos ambientais causados em todos os níveis e atividades

Construction of a Residue Management Policy in the University of São Paulo: A model for the implementation of the NSRP in HEI

O cenário atual da Universidade de São Paulo (USP) tem, isoladamente, diversas ações ambientais em diferentes frentes, de acordo com a realidade de seus campi. \ud Em 2010, a USP designou um coordenador de Gestão Ambiental junto à Reitoria. No ano seguinte, regulamentou a Política Ambiental da USP, que visa promover a \ud sustentabilidade ambiental nos campi. Em 2012, foi criado um órgão institucional responsável pela gestão ambiental, a Superintendência de Gestão Ambiental (SGA), \ud que tem como premissa ditar normas para questões ambientais em consonância com a política ambiental proposta. Esta superintendência formou, em 2012, um \ud Grupo de Trabalho para cuidar das questões relativas aos resíduos gerados na USP. Tal grupo, composto por especialistas na área, sob a coordenação de um assessor \ud de gabinete da própria SGA, priorizou desenvolver, através de processos participativos, estratégias e procedimentos para elaboração e implantação de uma Política de \ud Gestão de Resíduos (PGRUSP). Esta Política, aos moldes de um trabalho anterior (PUSP-C, 2010), tem como proposta adequar as especificidades contidas na Política \ud Nacional de Resíduos Sólidos, para o contexto universitário.Uma versão inicial da PGRUSP foi apresentadapara a comunidade acadêmica em um Fórum promovido \ud pela SGA. Nesta ocasião, representantes de todas as categorias advindos dos diversos campi da USP, além de outros da comunidade externa, fizeram considerações \ud sobre o conteúdo desta versão, que foi, então, reformulada. A PGRUSP prevê a elaboração dos planos de gerenciamento de resíduos em todas as unidades pertencentes \ud à USP. Neste momento, o Grupo de Trabalho está elaborando diretrizes para a capacitação da comunidade acadêmica para a realização de um diagnóstico de resíduos, \ud com intuito também de mobilizar e conscientizar sobre os ditames da PGRUSP. A partir da capacitação e da elaboração dos planos de gerenciamento de resíduos, \ud pressupõe-se um aprendizado sobre questões práticas da gestão de resíduos. A geração de dados e de indicadores fornecerá embasamento para uma implementação \ud contínua e eficaz da política. Para sistematização destes dados, está sendo desenvolvida uma plataforma virtual unificada. Assim, pretende-se controlar tanto os \ud insumos utilizados como a geração, o armazenamento, os tratamentos e os descartes relacionados aos resíduos gerados em nossas Unidades. Pretende-se, ainda, com \ud esta sistematização, fornecer informações que permitam à SGA atomar medidas norteadoras para melhora na gestão dos resíduos nos campi, e,consequentemente, \ud minimizar impactos ambientais causados em todos os níveis e atividades

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks