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      Telemedicine for Women’s Health During COVID-19 Pandemic in India: A Short Commentary and Important Practice Points for Obstetricians and Gynaecologists

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      Author(s):
      Publication date (Electronic):
      Journal: Journal of Obstetrics and Gynaecology of India
      Publisher: Springer India
      Keywords: Telemedicine, Obstetrics and gynaecology, Pandemic, Lockdown

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          Abstract

          Background/purpose of study

          In view of restrictions on patients because of COVID-19 pandemic, face-to-face consultations are difficult. This short commentary tells us about the feasibility of telemedicine in this scenario in obstetrics and gynaecology.

          Methods

          The database from our teleconsultation application (Apollo 247 and Askapollo) was analysed to assess feasibility of telemedicine and to design a triage pathway to reduce hospital visits for non-emergency situations and also to identify emergency cases without delay during this lockdown phase. Existing guidelines by Ministry of Health and Family Welfare (MOHFW), Government of India, were accessed.

          Results

          This was a single-doctor experience of 375 consultations done over 65 days. We also designed a triage pathway for obstetrics and gynaecology cases, and we discussed general practice for obstetricians and gynaecologists with its utility and limitations.

          Conclusion

          Telemedicine has provided us the opportunity to manage women health problems and pregnancy concerns during this pandemic of COVID-19, except a few instances where face-to-face consultation or hospital visit is must. If we implement the triage pathway, we can minimize the risk of exposure for both patients and healthcare teams during COVID-19 pandemic.

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          Most cited references3

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          Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

          Ruiyun Li, Sen Pei, Bin Chen … (2020)
          Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.
          Article 0 comments Cited 1626 times – based on 0 reviews     Review now
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            Telemedicine in the Era of COVID-19

            Miho J Tanaka, Luke Oh, Scott D. Martin … (2020)
            Abstract: With the onset of the COVID-19 pandemic, the shifting of clinical care to telemedicine visits has been hastened. Because of current limitations in resources, many elective surgeons have been forced to venture into utilizing telemedicine, in which the standards for orthopaedic examinations have not previously been fully developed. We report our experience with protocols and methods to standardize these visits to maximize the benefit and efficiency of the virtual orthopaedic examination. At the time of scheduling, patients are asked to prepare for their virtual visit and are given a checklist. In addition to confirming audiovisual capabilities prior to the visit, patients are given specific instructions on camera positioning, body positioning, setting, and attire to improve the efficiency of the visit. During the examination, digital tools can be utilized as needed. In the setting of outpatient injury evaluations, a systematic virtual examination can aid in triaging and managing common musculoskeletal conditions. With the rapid incorporation of telehealth visits, as well as the unknown future with regard to the pandemic, the utilization and capabilities of telemedicine will continue to expand. Future directions include the development of validated, modified examination techniques and new technology that will allow for improved interactive physical examinations, as we rapidly move forward into the realm of telemedicine due to unexpected necessity.
            Article 0 comments Cited 113 times – based on 0 reviews     Review now
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              Managing Urology Consultations during COVID-19 Pandemic: Application of a Structured Care Pathway

              Alex Borchert, Lee Baumgarten, Deepansh Dalela … (2020)
              Objectives To describe and evaluate a risk-stratified triage pathway for inpatient urology consultations during the SARS-CoV-2 (COVID-19) pandemic. This pathway seeks to outline a urology patient care strategy that reduces the transmission risk to both healthcare providers and patients, reduces the healthcare burden, and maintains appropriate patient care. Methods Consultations to the urology service during a three-week period (March 16 to April 2, 2020) were triaged and managed via one of three pathways: Standard, Telemedicine, or High-Risk. Standard consults were in-person consults with non- COVID-19 patients, High-Risk consults were in-person consults with COVID-19 positive/suspected patients, and Telemedicine consults were telephonic consults for low-acuity urologic issues in either group of patients. Patient demographics, consultation parameters and consultation outcomes were compared to consultations from the month of March 2019. Categorical variables were compared using Chi-square test and continuous variables using Mann-Whitney U test. A p-value <0.05 was considered significant. Results Between March 16 and April 2, 2020, 53 inpatient consultations were performed. By following our triage pathway, a total of 19/53 consultations (35.8%) were performed via Telemedicine with no in-person exposure, 10/53 consultations (18.9%) were High-Risk, in which we strictly controlled the urology team member in-person contact, and the remainder, 24/53 consultations (45.2%), were performed as Standard in-person encounters. COVID-19 associated consultations represented 18/53 (34.0%) of all consultations during this period, and of these, 8/18 (44.4%) were managed successfully via Telemedicine alone. No team member developed COVID-19 infection. Conclusions During the COVID-19 pandemic, most urology consultations can be managed in a patient and physician safety-conscious manner, by implementing a novel triage pathway.
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                Author and article information

                Contributors
                Vimee Bindra: vimee.bindra@gmail.com
                Bio :
                Dr. Vimee Bindra

                completed her basic medical education from R G Kar Medical College, Kolkata (1998–2003) and post-graduation in Obstetrics and Gynecology Kolkata (2005–2008), followed by a Diploma in Advanced Gynecological Endoscopy from BEAMS Hopsitals, MUMBAI and advanced Laparoscopy and Hysteroscopy training from Clermont Ferrand (FRANCE). She has a keen interest in the field of Gynecological Endoscopy specially Endometriosis Excision Surgeries and Fertility enhancing surgeries. She has received her Advanced Reproductive Technology (ART) Training from, Homerton University Hospital, London (UK). She has done her Fellowship in Cosmetic Gynaecology from American Aesthetic Association. She was awarded “Vaidya Sree Award in 2019” and “Best Emerging Gynaecologist of the year” in 2020. She is an author of three well known medical books in the field of Gynaecology and Obstetrics.

                Journal
                Journal ID (nlm-ta): J Obstet Gynaecol India
                Journal ID (iso-abbrev): J Obstet Gynaecol India
                Title: Journal of Obstetrics and Gynaecology of India
                Publisher: Springer India (New Delhi )
                ISSN (Print): 0971-9202
                ISSN (Electronic): 0975-6434
                Publication date (Electronic): 16 July 2020
                Pages: 1-4
                Affiliations
                GRID grid.428010.f, ISNI 0000 0004 1802 2996, Apollo Hospitals, ; Hyderabad, India
                Article
                Publisher ID: 1346
                DOI: 10.1007/s13224-020-01346-0
                PMC ID: 7364737
                PubMed ID: 32760174
                SO-VID: c0220e6a-5b78-4c20-8a04-7b8aca1fd754
                Copyright © © Federation of Obstetric & Gynecological Societies of India 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 16 June 2020
                Date accepted : 26 June 2020
                Categories
                Subject: Short Commentary

                Keywords: telemedicine,obstetrics and gynaecology,pandemic,lockdown
                Data availability:
                Keywords: telemedicine, obstetrics and gynaecology, pandemic, lockdown

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