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      The Importance of Telemedicine during COVID-19 Pandemic: A Focus on Diabetic Retinopathy

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          Abstract

          Recently, telemedicine has become remarkably important, due to increased deployment and development of digital technologies. National and international guidelines should consider its inclusion in their updates. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized. In particular, its use in diabetes and complication monitoring has been remarkably increasing, due to the high risk of poor prognosis. New evidence and technological improvements in telemedicine application in diabetic retinopathy (DR) have demonstrated efficacy and usefulness in screening. Moreover, despite an initial increase for devices and training costs, teleophthalmology demonstrated a good cost-to-efficacy ratio; however, no national screening program has yet focused on DR prevention and diagnosis. Lack of data during the COVID-19 pandemic strongly limits the possibility of tracing the real management of the disease, which is only conceivable from past evidence in normal conditions. The pandemic further stressed the importance of remote monitoring. However, the deployment of device and digital application used to increase screening of individuals and monitor progression of retinal disease needs to be easily accessible to general practitioners.

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          Virtually Perfect? Telemedicine for Covid-19

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            Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

            The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission. We hereby review the peer-reviewed and pre-print reports pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
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              Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

              The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
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                Author and article information

                Contributors
                Journal
                J Diabetes Res
                J Diabetes Res
                JDR
                Journal of Diabetes Research
                Hindawi
                2314-6745
                2314-6753
                2020
                14 October 2020
                : 2020
                : 9036847
                Affiliations
                1Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
                2Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio 7, 80138 Naples, Italy
                3Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Via F. De Sanctis, 1, 86100 Campobasso, Italy
                Author notes

                Academic Editor: Patrizio Tatti

                Author information
                https://orcid.org/0000-0002-7766-3430
                https://orcid.org/0000-0002-0310-3529
                https://orcid.org/0000-0003-3320-3878
                https://orcid.org/0000-0002-6541-3821
                https://orcid.org/0000-0002-1239-7012
                https://orcid.org/0000-0001-7761-7533
                https://orcid.org/0000-0002-6532-7122
                https://orcid.org/0000-0001-8453-4912
                https://orcid.org/0000-0001-8477-6188
                https://orcid.org/0000-0002-9142-7848
                Article
                10.1155/2020/9036847
                7584941
                33123599
                44ef62b2-8aef-44f3-a8dc-7ddac0384a8f
                Copyright © 2020 Raffaele Galiero et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 June 2020
                : 3 August 2020
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                Review Article

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