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Background: Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries. Material and methods: This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians. Results: The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system. Conclusion: Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19. Methods: This study was a single-center, randomized, open-label, controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19. According to the 1:1 ratio between the study groups (ivermectin group and standard treatment group), patients were randomly admitted to each intervention arm. Results: The mean age of the participants in the ivermectin group was (48.37±13.32) years. Eighteen of them were males (54.5%) and the participants in the control group had a mean age of (46.28±14.47) years, with nineteen of them being males (59.4%). As a primary outcome, after 5 days of randomization, there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital (P=0.168). ICU admission (P=0.764), length of stay in ICU (P=0.622), in-hospital mortality (P=0.427), adverse drug reactions, and changes in the mean difference of laboratory data had not any significant difference between the two groups (except for urea change). In addition, the radiologic findings of the two groups of patients were not significantly different. Linear regression analysis showed that for every 10 years increase of age, 0.6 day of hospitalization duration was increased. There was no statistically significant association between other variables and clinical outcomes. Conclusions: Among adult hospitalized patients with moderate to severe COVID-19, there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement, and mortality of the participants. [ABSTRACT FROM AUTHOR]

Introduction: Although a long time past since COVID-19 was broken out, it is hard to determine which pharmacological combination regimen is more efficacious. The present study aimed to evaluate the efficacy of lopinavir/ritonavir (LPV/r) plus interferon (IFN) beta-1a regimen compared to the hydroxychloroquine (HCQ) regimen in moderately ill patients with COVID-19. Methods: A multiple-centre retrospective observational case-controlled study was performed between March and September 2020, including adults with confirmed COVID-19. The patients were categorised into age- and sex-matched two groups; LPV/r plus IFN beta-1a (n = 102) and HCQ (n = 298) regimens. Clinical outcomes and mortality rates were compared between the groups. Results: LPV/r plus interferon (INF) beta-1a regimen had improved none of the clinical outcomes and mortality rate compared to the HCQ regimen. The length of stay (LOS) in the hospital and the need for oxygen therapy were slightly worse in the LPV/r plus INF beta-1a regimen (4.73 ± 2.93 days, 63%) than in the HCQ group (3.74 ± 3.30 days, 48.3%). No statistically significant difference was observed between the two groups in care of intensive care unit (ICU) admission, LOS in ICU, the need for non-invasive ventilation and the need for invasive mechanical ventilation as well as in-hospital mortality rate. Conclusions: LPV/r plus IFN beta-1a regimen did not show any meaningful improvement in clinical outcomes or mortality compared to the HCQ regimen. Larger randomised controlled trials are needed to assess the efficacy of this combination further. [ABSTRACT FROM AUTHOR]

Background: The clinical characteristics of COVID-19 are diverse from a simple common cold symptom to acute respiratory distress syndrome (ARDS). In the present study, we attempted to identify the associated factors in surviving COVID-19 intensive care unit (ICU) patients based on their clinical characteristics. Materials and Methods: This retrospective study was performed on 114 laboratory-confirmed COVID-19 patients admitted to the intensive care units of Hormozgan University of Medical Sciences, Iran. Demographic, medical, clinical manifestations at admission time, and outcome data were obtained from the patient's medical records. Results: Of 114 participants included in this study, 64.9% were men. Their mean age was approximately 54 years old, 69.3% of them died and 30.7% of them were discharged. The mortality rate was 2.96 times higher in people who had ARDS compared to their counterparts, 1.37 times higher in people under non-invasive ventilation, and 3.56 times higher in people under invasive mechanical ventilation. Three common underlying diseases among them were hypertension in 34.2%, diabetes in 23.7%, and cardiovascular diseases in 17.5% of them. Alive and dead patients significantly differed only in the following laboratory tests: D-dimer, urea, troponin, Procalcitonin, and ferritin. Conclusion: The mortality rate among COVID-19 patients admitted to ICU is generally high. Dyspnea, as the initial presentation and comorbidity, especially hypertension, diabetes, and cardiovascular diseases, may be associated with a higher risk of developing severe disease and consequent mortality. Therefore, D-dimer, urea, troponin, Procalcitonin, and ferritin at the time of hospital admission could predict the severity of the disease and its probable mortality. [ABSTRACT FROM AUTHOR]

Background: Telemedicine technology with the development of mobile applications (apps) has provided a new approach for the follow-up of patients. Objectives: This study aims to carry out an overview of the studies related to the use of mobile apps in the follow-up of surgical patients. Methods: In this study, an electronic search of four databases included PubMed, Scopus, Embase, and web of science was carried out. It included studies in the English language from the beginning of 2009 to June 2019. Results: Twenty-three articles were selected for the final analysis, that all of them were published from 2015 onwards. In most studies, fourteen to thirty-days follow-up period for different outpatient and inpatient surgeries was planned. Apps' components in the studies mostly include indexes for evaluation of recovery quality, pain level, and the surgical site infection. The most important achievement of studies included feasibility, early detection of complications, reducing unscheduled in-person visits, patients' self-efficiency, and satisfaction. Conclusions: Our review showed that mHealth-based interventions have potential that may support better management of post-discharge systematic follow-up of surgery patients. [ABSTRACT FROM AUTHOR]

Background: Information and communications technologies (ICTs) may facilitate shorting length of stay (LOS) of patients through the optimization of processes and delivery services. Objectives: This study aims to provide technologybased solutions and interventions based on health information technology (HIT) that have optimization potentials of patients' LOS. Methods: This review study searched papers in PubMed, Scopus as well as Google Scholar without presuming time limits by the end of 2019. English and Persian Papers were included, which addressed an association between the ICT and LOS as well as its positive effect in shortening LOS. Results: Identified technologies were finally classified into eleven groups. Based on the findings, common health technologies such as health information systems, telemedicine especially tele-consultation, electronic discharge planning tools, and visual analytical dashboards in order to expedite the process and help to optimize LOS seem appropriate. Conclusions: HIT-based interventions have potential that may support better management of processes related to patients' admission, hospitalization, and discharge. However consistently evaluation along with using any new technology is necessary. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of surgical site infection (SSI) and other surgical complications in the post-discharge period is important and can prevent many patients' readmissions. Telemedicine and mHealth-based services appear to be a valid option to follow up surgical wounds. Objective: This study aims to develop a follow-up system for remote surveillance of SSIs in abdominal surgeries. Material and Methods: In this applied study first, the necessary components and information infrastructure of the system were extracted through a systematic literature review and then was validated by clinical experts. In the second phase, the system was designed and tested. Finally, the system usability was evaluated as a pilot study by the participation of twenty patients and clinicians from Shahid-Mohammadi hospital in Bandar Abbas city. Results: The main components of the web-based app included indicators and criteria for regular and emergency assessment of self-reported symptoms, visual analog scale (VAS), as well as a feature for regular uploading patient-generated wound images, reminders and notifications, education material, and teleconsultation services. The risk-based models are embedded in the database for early detection of wound complications and poor recovery via monitoring dashboards for healthcare providers. It including main rules set created from incidence, frequency, and severity of SSIrelated symptoms. The result of a pilot evaluation showed high users' satisfaction and willingness to use the program. Conclusion: Implementing this new system potentially is feasible. However, this method is not a substitute for conventional clinic follow-up but applying it as part of routine postoperative care management can provide positive effects and outcomes especially in the era of COVID-19 that more willingness to virtual care service is seen. [ABSTRACT FROM AUTHOR]

Background: The clinical characteristics of COVID-19 are diverse from a simple common cold symptom to acute respiratory distress syndrome (ARDS). In the present study, we attempted to identify the associated factors in surviving COVID-19 intensive care unit (ICU) patients based on their clinical characteristics., Materials and Methods: This retrospective study was performed on 114 laboratory-confirmed COVID-19 patients admitted to the intensive care units of Hormozgan University of Medical Sciences, Iran. Demographic, medical, clinical manifestations at admission time, and outcome data were obtained from the patient's medical records., Results: Of 114 participants included in this study, 64.9% were men. Their mean age was approximately 54 years old, 69.3% of them died and 30.7% of them were discharged. The mortality rate was 2.96 times higher in people who had ARDS compared to their counterparts, 1.37 times higher in people under non-invasive ventilation, and 3.56 times higher in people under invasive mechanical ventilation.Three common underlying diseases among them were hypertension in 34.2%, diabetes in 23.7%, and cardiovascular diseases in 17.5% of them. Alive and dead patients significantly differed only in the following laboratory tests: D-dimer, urea, troponin, Procalcitonin, and ferritin., Conclusion: The mortality rate among COVID-19 patients admitted to ICU is generally high. Dyspnea, as the initial presentation and comorbidity, especially hypertension, diabetes, and cardiovascular diseases, may be associated with a higher risk of developing severe disease and consequent mortality. Therefore, D-dimer, urea, troponin, Procalcitonin, and ferritin at the time of hospital admission could predict the severity of the disease and its probable mortality., (Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease.)

Background: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19., Methods: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1., Results: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality., Conclusions: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)