Doctors at the epicentre of the COVID-19 outbreak in Italy have made an urgent call on the rest of the world to change the way they treat pandemic patients. In a paper published in NEJM Catalyst (21 March 2020) they say patient-centred care is no longer feasible in a pandemic and that ‘community-centred’ care should be the new norm.
They say that hospitals might be the main COVID-19 carriers as they are rapidly filled with infected patients.
“This disaster could be averted only by massive deployment of outreach services,” they emphasize.
The doctors (Nacoti M, et al – At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation) who work at Papa Giovanni XXIII Hospital in Bergamo, a brand-new state-of-the-art facility with 48 intensive-care beds, say: “Our own hospital is highly contaminated, and we are far beyond the tipping point: 300 beds out of 900 are occupied by Covid-19 patients. Fully 70% of ICU beds in our hospital are reserved for critically ill Covid-19 patients with a reasonable chance to survive. The situation here is dismal as we operate well below our normal standard of care. Wait times for an intensive care bed are hours long. Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact.
“But the situation in the surrounding area is even worse. Most hospitals are overcrowded, nearing collapse while medications, mechanical ventilators, oxygen, and personal protective equipment are not available. Patients lay on floor mattresses. The health care system struggles to deliver regular services — even pregnancy care and child delivery — while cemeteries are overwhelmed, which will create another public health problem.
They say pandemic solutions are required for the entire population, not only for hospitals.
Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.
Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments.
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Using laser light techniques, University of Amsterdam physicists and medical researchers have found that small cough droplets, potentially containing virus particles, can float in the air in a room for many minutes, especially when the room is poorly ventilated. Good ventilation in public spaces (e.g. public transport, nursing homes) is therefore crucial to slow down the spread of the coronavirus. The results were published in The Lancet Respiratory Medicine on 28 May 2020.
The research was carried out by physicists Daniel Bonn, Stefan Kooij and Cees van Rijn from the UvA Institute of Physics, together with medical researchers Aernout Somsen (Cardiology Centers of the Netherlands) and Reinout Bem (Amsterdam University Medical Centers).
The researchers asked healthy test persons to speak and to cough, and used laser light to analyse the droplets that were produced. Both during speech and coughing, large amounts of small droplets (between roughly 1 and 10 micrometres in size) were observed. During coughing, larger droplets (up to 1 millimeter in size) are also produced. Those droplets fall to the ground within one second, however, and therefore have a much smaller probability of transmitting viruses.
The small droplets only move very slowly to the ground due to the large amount of air drag they experience. The researchers found that such droplets can stay in the air for several minutes. After a single cough, it takes about five minutes for the number of small droplets in the air to be halved. These tiny droplets are therefore much more dangerous when it comes to possible transmission of the coronavirus. Ventilation When the same measurements were repeated in a well-ventilated room, the results improved dramatically. With only mechanical ventilation turned on, half of the droplets disappeared within 2.5 minutes, but in a room that also had a door and window open, the number of droplets was halved after 30 seconds – ten times faster than in the unventilated room.
The result is important for making better policies to slow down the spread of the coronavirus. Despite physical distancing, spaces like public transportation and nursing homes can still be centres for spreading the virus if insufficiently ventilated. When droplets remain in the air for a long time, proximity tracing via smartphone apps is also an insufficient precaution. The researchers therefore recommend healthcare authorities consider recommendations to ensure adequate ventilation wherever possible in public spaces
Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission – The Lancet Respiratory Medicine https://doi.org/10.1016/S2213-2600(20)30245-9
Indoor environments Meanwhile, in a similar study, scientists from Surrey’s Global Centre for Clean Air Research (GCARE), with partners from Australia’s Queensland University and Technology, argue that the lack of adequate ventilation in many indoor environments – from the workplace to the home – increases the risk of airborne transmission of Covid-19.
They note that Covid-19, like many viruses, is less than 100mn in size but expiratory droplets (from people who have coughed or sneezed) contain water, salts and other organic material, along with the virus itself. However, as the water content from the droplets evaporate, the microscopic matter becomes small and light enough to stay suspended in the air and over time the concentration of the virus will build up, increasing the risk of infection – particularly if the air is stagnant like in many indoor environments.
The study highlights improving building ventilation as a possible route to tackling indoor transmission of Covid-19.
Could fighting airborne transmission be the next line of defence against COVID-19 spread? www.sciencedirect.com/science/article/pii/S2590252020300143
Modelling Additionally, a study carried out in March this year by four Finnish research organisations modelled the transport and spread of coronavirus through the air. They note that preliminary results indicate that aerosol particles carrying the virus can remain in the air longer than was originally thought, so it is important to avoid busy public indoor spaces. This also reduces the risk of droplet infection, which remains the main path of transmission for coronavirus.
The research has been has been submitted for peer-review and published on https://arxiv.org/abs/2005.12612. The paper details how they have modelled the airborne transport of different-sized droplets. These are emitted through coughing, so the study evaluated the quantities of particles that someone could come into contact with upon entering a supermarket or any other indoor public space.
Assistant professor at Aalto University, and project coordinator, Ville Vuorinen, says that both previous related research, and a number of well-known infection spikes, indicate a substantial risk of coronavirus through inhalation of aerosol particles, as well as direct droplet transmission and transmission from surfaces. The 3D flow simulations and analyses carried out in the project also support these ideas. The 3D simulation shows how droplets of varying size travel in an indoor airflow
https://youtu.be/f7I0O0C_eqg
credit: Aalto University / Finnish Meteorological Institute / VTT / University of Helsinki / IT Center for Science CSC. Animation: Jyrki Hokkanen, CSC – IT Center for Science Ltd.
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Waltham, MA–Nova Biomedical to host “COVID-19 Bedside Glucose Management: Risk of Ascorbic Acid and Hematocrit Interference,” a webinar led by Charbel Abou-Diwan, PhD, Director of Medical and Scientific Affairs, to help inform and support healthcare workers treating COVID-19 patients.
Interest in the antioxidant properties of ascorbic acid use in critically ill patients is growing especially during the in the COVID-19 pandemic. As clinicians search for effective treatments for COVID-19, sepsis, and other critical illness, high dose ascorbic acid is widely considered. These patients are admitted to the ICU where routine POC glucose monitoring becomes part of their care path. Unfortunately, two widely used hospital glucose meters have a substantial interference from ascorbic acid that radically elevates glucose meter results, leading to potential adverse events. This webinar examines the risk of inaccurate glucose meter results due to ascorbic acid interference and how hospitals can protect their patients and protect themselves against this threat.
The webinar will be delivered on three dates: Thursday, April 30th at 2:00 PM EST, Thursday, May 28th at 1:00 PM EST, and Thursday, June 18th at 4:00 PM EST. Attendees can earn educational credits for attending and can register online at novabiomedical.com/poc/glu/covid
About Nova Biomedical
Incorporated in 1976 and based in Waltham, MA, Nova Biomedical is a world leader in the development and manufacturing of state-of-the-art, whole blood, point-of-care and critical care analyzers, as well as providing the biotechnology industry with the most advanced instruments for cell culture monitoring. Nova is one of the fastest growing in vitro diagnostic companies in the world. Nova’s biosensor technology is incorporated in products ranging from handheld meters for glucose self- and point-of-care testing to critical care whole blood analyzers designed for rapid measurement of over 20 analytes. Nova’s biotechnology-specific BioProfile line has pioneered comprehensive cell culture testing, providing over 20 critical cell culture tests with over 12 unique instrument offerings for broad range of cell culture applications. Nova employs over 1,300 people worldwide and has wholly owned subsidiaries located in Brazil, Canada, Great Britain, France, Spain, Italy, Germany, Switzerland, and Japan.
www.novabiomedical.com
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The Nellcor Bedside SpO2 System technology continuously monitors oxygen saturation (SpO2) and pulse rate for adult, paediatric and neonatal patients. The monitoring system gives clinicians instant access to comprehensive trending respiratory information, enabling them to detect subtle yet critical variations and respiratory complications earlier. The system features enhanced digital signal processing for precise SpO2 readings during low perfusion or other challenging conditions. It also incorporates an alarm management technology to differentiate between serious and minor events and reduce clinically insignificant oxygen desaturation alarms. The monitor further offers an intuitive, multicolour screen that is easy to read in any light and from many angles. Hospital technicians can set institutional defaults, replace the battery, perform diagnostics and generally maintain the monitor within the hospital, saving time and resources. Read more
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The IntelliVue patient monitoring platform is now available with Masimo rainbow SET technology. Philips also offers its customers the option to add rainbow SET to existing IntelliVue monitors, and the company is working to integrate the technology into its Philips SureSigns and Philips Efficia patient monitoring platforms. In conjunction with the appropriate patient monitoring platform, Masimo rainbow SET technology analyses multiple wavelengths of light to accurately measure total hemoglobin (SpHb), oxygen content (SpOC), carboxyhemoglobin (SpCO), methemoglobin (SpMet) and Pleth Variability Index (PVI) noninvasively and continuously. Continuous monitoring of rainbow SpHb on a Philips monitor at the point-of-care provides clinicians with real-time visibility to changes in hemoglobin in between invasive blood sampling. To ensure that customers have choice of SpO2 pulse oximetry measurement technology, the company continues to offer Philips FAST SpO2 pulse oximetry and Covidien’s OxiMax SpO2 pulse oximetry, depending on the patient monitoring platform. Read more
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Xenios AG, a company of the Fresenius Medical Care Group, reports that it has seen a significant growth in demand for its extracorporeal membrane oxygenation (ECMO) devices, which can be used for the treatment of patients who develop severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 infection.
Jürgen Böhm, CMO of Xenios, explained that for critically ill COVID-19 patients with acute lung failure and refractory hypoxemia – despite use of standard therapy – “our treatment often remains the last therapeutic option and has been a lifesaver for many patients”.
Xenios’s ECMO therapy bypasses the function of the lungs. The patient’s blood is freed from carbon dioxide outside the body and enriched with oxygen. The lungs are thus given time to heal. Because of the increase of critically ill COVID-19 patients, more physicians are opting for ECMO therapy, and thus the increase in demand for Xenios’s ECMO devices.
To meet the demand, the company has increased production of its ECMO devices. “We have put many measures in place to maximize the utilization of our capacity to manufacture ECMO devices as well as patient kits. Our biggest challenge right now is the availability of specific components for our products,” said Andreas Terpin, CEO of Xenios.
For more information, visit: www.xenios-ag.com Read more
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Pisa University Hospital has received support from Fujifilm Italia to improve and speed up the analysis of lung CT images which are important for the diagnosis of COVID-19. This has been possible thanks to an update by Fujifilm of the configuration of the Synapse 3D software used by emergency room radiologists.
The hospital says this new technological development has been useful to improving management of patients affected by COVID-19, during the emergency.
Synapse3D is a 3D medical image analysis system that uses Fujifilm’s image recognition technology to construct and analyze highprecision 3D images, compiled from tomographic images from CT and MRI. It delivers 3D visualization of medical images and has applications in image-based diagnosis and surgery simulation.
Synapse 3D delivers clinical value through fast, accurate, efficient and robust image processing for radiology, cardiology and surgical preoperation simulation.
It was developed in Japan (where it is named Synapse VINCENT) and it consists of more than 50 different processing modules.
The Synapse3D Lung Analysis/Airway module enables the analysis of density ranges in the lung in a quick, easy, objective and reproducible way.
At Pisa University Hospital the configuration of Synapse 3D was completed quickly, with the study of density ranges and a feasibility analysis carried out in a few days, meaning that this updated integrated workflow has been possible to use in the hospital since April 1.
The Pisa University Hospital had already set up three levels of assessing Coronavirus patients, and with the support of Synapse 3D software, doctors have had the ability to quickly and easily identify the stage of pneumonia, and therefore hospitalise patients accordingly:
normal hospitalisation for patients with mild pneumonia not requiring respiratory support
assessment by a pulmonologist or intensive care doctor for patients with moderate pneumonia to plan suitable respiratory support
intensive care assessment for patients with severe pneumonia with a view to transferring them to the intensive care unit
The density analysis provided by Synapse 3D has made it is possible to analyse the lung according to the different pixel densities of the CT images. Three groups were therefore defined based on different density ranges that allow the radiologist to evaluate the percentage of lung with lower density (emphysema), higher density (interstitial effort) and normal lung.
Dr. Chiara Romei, MD, PhD, Radiologist at the Pisa University Hospital, explained: “In a time of emergency such as this, it is crucial for us radiologists to detect accurate data as quickly as possible. Synapse 3D has enabled a quantitative analysis that is much faster and more objective than the visual analysis of the radiologist; in a couple of minutes it is possible to obtain data relating to the percentage of lung with greater and lesser density and to have a precise and objective, reproducible and shareable value.”
It is important to note that the data obtained by Synapse 3D does not replace the molecular diagnoses made through the nasopharyngeal swab (RT-PCR) and does not replace the analysis and diagnostic work by the radiologist, but instead it supports the reporting of daily exams to monitor and study the evolution of the disease, thus optimising workflow.
For medical professionals – download the take-away: https://synapse.fujifilm.eu/fujifilm-takeaway/ Read more
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Siemens is bringing a new and flexible telemedicine solution to the market with its teamplay myCare Companion software. The software enables remote care for patients with chronic diseases. The teamplay myCare Companion allows healthcare providers to design their own telemedicine programs and flexibly adapt the underlying technology to their needs.
The solution has initially been used at the German Heart and Diabetes Center in Bad Oeynhausen for the care of patients with chronic heart failure.
During the COVID-19 pandemic, the occupational health and safety medical center at Mannheim University Hospital has been using teamplay myCare Companions’ documentation and communication components as a “coronavirus diary” for clinical. The staff records their health status every day and medical officers can respond quickly to any changes.
“Previously we used to receive piles of diaries in paper form, but now everything is nicely arranged for software to analyse”, said Dr. Margit Eisenbarth. medical officer. “Employees can enter their data conveniently via an app or website. That saves them valuable time, and we get an immediate overview.”
Wido Menhardt, Executive Vice President Digital Health at Siemens Healthineers, said: “Thanks to state-of-the-art telemedicine solutions like teamplay myCare Companion, a large number of patients can be cared for with a relatively low use of employee resources, and the number of unscheduled hospital visits can be reduced. That can substantially lower costs and is also conducive to better quality of life for chronically ill patients. Additional uses for the program that make life a little easier for medical officers and clinical employees in the current situation show just how flexible this software is.”
Teamplay myCare Companion basically consists of two components: an intuitive smartphone app for patients and a special workstation for medical care providers. Patients use the app to report their health status, wellness, the medications they’re taking, and their vital parameters to the nursing staff. Among other things, the program helps employees quickly identify patients whose state of health may have worsened. The attending doctors can then decidewhether a scheduled hospital visit should be moved forward or if more intensive remote medical care would be beneficial.
Siemens Healthineers supplies the software and supports healthcare providers with the design, installation, and operation of their own telemedicine centre. In addition, the company can assist with procurement of the measuring devices needed to monitor patients’ vital parameters at home (such as scales and blood pressure devices).
This telemedicine solution was developed in a partnership between Siemens Healthineers, the Austrian Institute of Technology (AIT), and TELBIOMED Medizintechnik und IT Service in Austria. The partners agreed to set up a global sales and development partnership at the beginning of 2020. Read more
Azienda Socio Sanitaria Territoriale (ASST) Vimercate Hospital in Italy has implemented Fujifilm’s REiLI artificial intelligence system to assist healthcare practitioners on the frontline in the fight against the COVID-19 pandemic.
Due to the pandemic, operations and workflows in Italian hospitals were disrupted, which significantly increased workloads. As a consolidated partner of Vimercate, Fujifilm wanted to ensure its cutting-edge tools were available to reduce the impact caused by the rapid spread of COVID-19 by assisting in speeding up workflows.
REiLI’s processing of CT scans and chest x-rays provides important support for radiologists, offering them an extremely rapid, quantitative and objective assessment of the various zones of the lungs. The chest x-ray, in particular, is the best example of applying the new AI technology, in that it produces a quick and simple examination which provides a large amount of useful information for evaluating the presence of the pulmonary parenchymal consolidation caused by the virus.
The data obtained from artificial intelligence does not replace the molecular diagnoses performed using the nasopharyngeal swab (RT-PCR), nor does it replace the analyses and diagnoses performed by the radiologist. The data, however, does provide support in reporting on daily examinations conducted to monitor and study the development of the disease, and constitute a second opinion for the operators.
Commenting on the REiLI artificial intelligence system, Marcello Intotero, Head of Radiology Structure and Diagnostic Services Department at ASST Vimercate Hospital, said: “REiLI’s support has allowed our radiologists to report examinations with greater speed and efficiency. This new technology has given great support to the workflow; all images that the artificial intelligence system identified as suspected COVID-19 were subjected to processing by the radiologist in a faster and more urgent manner.”
REiLI is integrated with the Lunit Insight CXR module for the analysis and detection of the main types of pulmonary disease. The Lunit Insight CXR3 module was updated to provide support in specifically identifying the pulmonary parenchymal consolidation caused by the virus.
Giovanni Delgrossi, Head of the IT Department at ASST Vimercate noted that during the health emergency, more than 80 chest x-rays of patients were analysed each day at the hospital. “If no priority is set for the examinations to be reported, it may take hours to identify a particular x-ray which may require prompt, immediate action from doctors. In an emergency like the current one, we need to react and act even more quickly,” he said.
Discussing Fujifilm’s REiLI AI system, Nicola Bilibio, Clinical Specialist Medical Informatics (CSE) Fujifilm Europe GmbH explained that AI is a new operating concept projected towards collaborative intelligence between machine and man. “This is a fundamental tool for optimizing workflow and for screening patients for COVID-19. During the emergency, we promptly made our most advanced technologies available to make a concrete contribution to the crisis.”
For more information, visit: http://reili.fujifilm.com
About REiLI on YouTube: https://youtu.be/M6ISuRmvQbY
Breast Imaging The 3Dimensions Mammography System is the industry’s fastest and highest resolution breast tomosynthesis system on the market. The system offers a variety of features designed to provide higher quality 3D images for radiologists, and enhanced workflow for technologists, with lowdose options, for patients. For example, the system includes Intelligent 2D imaging technology, which works with the system’s Clarity HD highresolution 3D imaging to deliver unprecedented clarity, contrast and detail at a lower dose.
Another feature available with the 3Dimensions system is the Quantra 2.2 breast density assessment software, which enables standardization in patient protocols, providing reproducible and consistent breast density assessment. Furthermore, thanks to the addition of the SmartCurve breast stabilization system, the 3Dimensions system is also clinically proven to deliver a more comfortable mammogram compared to standard compression, without compromising on speed, dose or accuracy. Interventional
The Brevera® Breast Biopsy System with CorLumina® Imaging Technology is a real-time breast biopsy and verification system that improves the patient experience and streamlines the biopsy process from start to finish. Before the Brevera system, radiologists performing stereotactic breast biopsy procedures to diagnose breast cancer were often required to leave the patient under compression while they moved to another room to image and verify tissue samples. With the Brevera system, radiologists are able to obtain and image tissue samples in the procedure room in just a few seconds, potentially saving up to 10 minutes per patient and cutting the procedure time by up to 25%.
The Affirm® Prone Breast Biopsy System is the only dedicated prone biopsy system offering superior 2D or tomosynthesis imaging. Thanks to this high-quality 2D or tomosynthesis imaging and a field of view that’s more than 6.5 times larger than older generations of prone biopsy systems, clinicians can visualize more tissue and pinpoint subtle lesions and faint calcifications that may not be visible on older systems. Of note, more than 95% of patients reported their Affirm prone biopsy procedure was faster, more comfortable and less painful than expected. The system is designed with patients’ physical and emotional comfort in mind. Direct view of the biopsy needle is eliminated helping to reduce patient stress, and clinicians can quickly identify, target and access lesions to help reduce time spent in compression.
The Faxitron™ Core Specimen Radiography System is designed for efficiency. Within seconds this self-contained, table top unit provides highresolution imaging for immediate core sample verification in the biopsy room. Breast Surgery The LOCalizer™ Wireless Radio Frequency Identification (RFID) Breast Lesion Localization System is a non-radioactive, radiofrequency localization system designed for precise marking and targeting of lesions in breast-conserving surgery. It was designed to replace the traditional wire-guided localization method, which requires placement of a wire on the day of surgery. With the tag, placement can be done weeks or months prior to surgery. For patients, this means they can arrive closer to their surgery time and experience fewer interventional procedures.
The Trident® HD Specimen Radiography System delivers enhanced image quality, improved workflow and instant sample verification during breastconserving surgeries and stereotactic breast biopsies. The Trident products are the only specimen radiographs on the market to use amorphous selenium direct capture imaging – the same detector technology used in Hologic’s 3Dimensions mammography system – to generate crisp, clear, high-resolution images. Ultrasound The Viera™ Portable Breast Ultrasound System is a wireless, handheld ultrasound device that delivers accurate, high-resolution diagnostic images at the point of care, enabling optimization of clinical workflow and patient pathway. The system seamlessly transmits images to smart devices and communication systems (PACS) in the office, exam room or surgical suite, and allows facilities to add interventional breast ultrasound services for a fraction of the cost of comparable cart systems. Additionally, the Supersonic Mach 30 Breast Ultrasound System provides fast, high quality imaging and is the first to offer an intuitive touchpad control and large adjustable touchscreen display. The system’s enhanced ergonomics are designed to increase usability. Read more
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