Forward Triage Research Articles

Telemedicine data secure sharing scheme based on heterogeneous federated learning

The forward triage characteristic of telemedicine highlights its importance again in the COVID-19 pandemic. Telemedicine can provide timely emergency response in the case of environmental or biological hazards, and the patient’s medical privacy data generated in this process can also accelerate the establishment of models for preventing and treating infectious diseases. However, the reuse process of telemedicine user privacy data based on federated learning also faces significant challenges. Differences in regions, economic levels, and grades lead to heterogeneous data and resource-constrained environments, seriously damaging the federated learning process. Besides, the weak password authentication of medical terminals and eavesdropping attacks on transmission channels may cause illegal access to terminals and platforms and leakage of sensitive data. This paper proposed a telemedicine data secure-sharing scheme based on heterogeneous federated learning. Specifically, we proposed a heterogeneous federated learning scheme with model alignment to guide telemedicine practice through the reuse of telemedicine data; in addition, we designed an SM9 threshold identity authentication scheme to guarantee that the patient’s medical privacy data is protected from leakage during the federated learning process. We evaluated our scheme using two third-party medical datasets. The evaluation results indicate that this scheme can still assist the federated learning process in resisting data heterogeneity and resource constraints with almost no performance cost.

A Retrospective Assessment of the Continuous Health Care Provided to COVID-19 Patients Consulted Via Videoconference.

Telemedicine has been defined as a valuable tool in delivering care for COVID-19 patients. However, clinicians and policymakers should be convinced that traditional and new technological methods of clinical management may be equally effective. The purpose of this study was to generate some initial recommendations based on the clinical utility of videoconference consultation in forward triage and follow-up for COVID-19 patients. This retrospective cross-sectional study evaluated the medical records of 100 COVID-19 patients consulted using a videoconference program (Skype), from September 1, 2020, to February 3, 2021. The data were analyzed on demographic characteristics, disease history, the need for physical examination after videoconference consultation, pre-diagnostics and diagnostics, treatment decisions, number of videoconference consultation sessions in follow-up, duration of sessions, and final outcome. The male COVID-19 patients constituted 54% of the total sample. The median age was 51 (42-61) years. The median duration of the initial videoconference consultation session was 16 (12-21) minutes. Following the initial videoconference consultation session, 14 patients required follow-up with all face-to-face visits; the remaining patients were primarily followed with videoconference consultation sessions. For 25 patients, it was sufficient to provide only videoconference consultation sessions; they were not required to be in the hospital for physical examination or any subsequent investigation at all. A total of 14 patients were hospitalized. There was no statistically significant difference between the high-risk group and the other patients according to the components of the disease management process via videoconference consultation. Videoconference consultation enables a holistic assessment regardless of the patient's characteristics and allows for more time to be spent on each patient, particularly during the pandemic period without risk of contagion. It can be used as a forward triage and follow-up tool to identify patients in need of emergency hospitalization and continuous health care.

Detection of Suicide Risk Using Vocal Characteristics: Systematic Review.

In an age when telehealth services are increasingly being used for forward triage, there is a need for accurate suicide risk detection. Vocal characteristics analyzed using artificial intelligence are now proving capable of detecting suicide risk with accuracies superior to traditional survey-based approaches, suggesting an efficient and economical approach to ensuring ongoing patient safety. This systematic review aimed to identify which vocal characteristics perform best at differentiating between patients with an elevated risk of suicide in comparison with other cohorts and identify the methodological specifications of the systems used to derive each feature and the accuracies of classification that result. A search of MEDLINE via Ovid, Scopus, Computers and Applied Science Complete, CADTH, Web of Science, ProQuest Dissertations and Theses A&I, Australian Policy Online, and Mednar was conducted between 1995 and 2020 and updated in 2021. The inclusion criteria were human participants with no language, age, or setting restrictions applied; randomized controlled studies, observational cohort studies, and theses; studies that used some measure of vocal quality; and individuals assessed as being at high risk of suicide compared with other individuals at lower risk using a validated measure of suicide risk. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies tool. A random-effects model meta-analysis was used wherever mean measures of vocal quality were reported. The search yielded 1074 unique citations, of which 30 (2.79%) were screened via full text. A total of 21 studies involving 1734 participants met all inclusion criteria. Most studies (15/21, 71%) sourced participants via either the Vanderbilt II database of recordings (8/21, 38%) or the Silverman and Silverman perceptual study recording database (7/21, 33%). Candidate vocal characteristics that performed best at differentiating between high risk of suicide and comparison cohorts included timing patterns of speech (median accuracy 95%), power spectral density sub-bands (median accuracy 90.3%), and mel-frequency cepstral coefficients (median accuracy 80%). A random-effects meta-analysis was used to compare 22 characteristics nested within 14% (3/21) of the studies, which demonstrated significant standardized mean differences for frequencies within the first and second formants (standardized mean difference ranged between -1.07 and -2.56) and jitter values (standardized mean difference=1.47). In 43% (9/21) of the studies, risk of bias was assessed as moderate, whereas in the remaining studies (12/21, 57%), the risk of bias was assessed as high. Although several key methodological issues prevailed among the studies reviewed, there is promise in the use of vocal characteristics to detect elevations in suicide risk, particularly in novel settings such as telehealth or conversational agents. PROSPERO International Prospective Register of Systematic Reviews CRD420200167413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020167413.

Identifying Policy Gaps in a COVID-19 Online Tool Using the Five-Factor Framework

Introduction: Worldwide health systems are being faced with unprecedented COVID-19-related challenges, ranging from the problems of a novel condition and a shortage of personal protective equipment to frequently changing medical guidelines. Many institutions were forced to innovate and many hospitals, as well as telehealth providers, set up online forward triage tools (OFTTs). Using an OFTT before visiting the emergency department or a doctor’s practice became common practice. A policy can be defined as what an institution or government chooses to do or not to do. An OFTT, in this case, has become both a policy and a practice. Methods: The study was part of a broader multiphase sequential explanatory design. First, an online survey was carried out using a questionnaire to n = 176 patients who consented during OFTT usage. Descriptive analysis was carried out to identify who used the tool, for what purpose, and if the participant followed the recommendations. The quantitative results shaped the interview guide’s development. Second, in-depth interviews were held with a purposeful sample of n = 19, selected from the OFTT users who had consented to a further qualitative study. The qualitative findings were meant to explain the quantitative results. Third, in-depth interviews were held with healthcare providers and authorities (n = 5) that were privy to the tool. Framework analysis was adopted using the five-factor framework as a lens with which to analyze the qualitative data only. Results: The five-factor framework proved useful in identifying gaps that affected the utility of the COVID-19 OFTT. The identified gaps could fit and be represented by five factors: primary, secondary, tertiary, and extraneous factors, along with a lack of systems thinking. Conclusion: A theory or framework provides a road map to systematically identify those factors affecting policy implementation. Knowing how and why policy practice gaps come about in a COVID-19 OFFT context facilitates better future OFTTs. The framework in this study, although developed in a universal health coverage (UHC) context in South Africa, proved useful in a telehealth context in Switzerland, in Europe. The importance of systems thinking in developing digital tools cannot be overemphasized.

Public health communication: Attitudes, experiences, and lessons learned from users of a COVID-19 digital triage tool for children.

BackgroundThe pandemic has made public health communication even more daunting because acceptance and implementation of official guidelines and recommendations hinge on this. The situation becomes even more precarious when children are involved. Our child-specific COVID-19 online forward triage tool (OFTT) revealed some of the public health communication challenges. We aimed to explore attitudes, experiences, and challenges faced by OFTT users and their families, in regard to public health recommendations.MethodsWe selected key informants (n = 20) from a population of parents, teachers, guardians, as well as doctors who had used the child-specific COVID-19 OFTT and had consented to a further study. Videos rather than face-face interviews were held. Convenience and quota sampling were performed to include a variety of key informants. Interviews were recorded, transcribed verbatim, and analyzed for themes.ResultsSeveral themes emerged, namely; (1) definition and expectations of high-risk persons, (2) quarantine instructions and challenges, (3) blurred division of responsibility between authorities and parents, (4) a novel condition and the evolution of knowledge, (5) definition and implications of socioeconomic status, (6) new normal and societal divisions, and (7) the interconnectedness of these factors-systems thinking.ConclusionAs the virus is evolving and circumstances are changing rapidly, the communication of public health to the different interest groups becomes, both an art and science, even more so when using a new technological communication channel: an OFTT. A myriad of interconnected factors seems to influence attitudes toward public health recommendations, which calls for systems thinking in public health communication.

The Utility of an Online Forward Triage Tool During the SARS-CoV-2 Pandemic: Health Care Provider and Health Authority Perspectives.

IntroductionThe SARS CoV-2 pandemic poses major challenges not only to patients but also to health care professionals and policy-makers, with rapidly changing, sometimes complex, recommendations, and guidelines to the population. Online forward triage tools (OFTT) got a major boost from the pandemic as they helped with the implementation and monitoring of recommendations.MethodsA multiphase mixed method sequential explanatory study design was employed. Quantitative data were collected first and informed the qualitative interview guides. Video interviews were held with key informants (health care providers and health authorities) between 2 September and 10 December 2020. Audio-recordings were transcribed verbatim, coded thematically and compared with patient perspectives (framework).ObjectivesTo explore the perspectives of health care providers and authorities in Canton Bern on the utility of a COVID-19 OFTT, as well as elicit recommendations for telehealth in future.ResultsThe following themes emerged; (i) accessibility (ii) health system burden reduction (iii) utility in preventing onward transmission (iv) utility in allaying fear and anxiety (v) medical decision-making utility (vi) utility as information source (vii) utility in planning and systems thinking. The health care providers and health authorities further provided insights on potential barriers and facilitators of telehealth in future.ConclusionSimilar to patients, health care providers acknowledge the potential and utility of the COVID-19 OFTT particularly as an information source and in reducing the health system burden. Data privacy, doctor-patient relationship, resistance to change, regulatory, and mandate issues, and lack of systems thinking were revealed as barriers to COVID-19 OFTT utility.

Chronic Pain Management During a Pandemic: Evidence-Based Review.

Chronic pain is the leading cause of morbidity in the world and is strongly associated with physical and psychological disabilities. In this pandemic, most of the pain care centers are forced to shut their doors leaving patients in dismay and adding to their misery. A systematic review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All research articles from March 2020 to September 15, 2020, available on PubMed, Google scholar, and EmBase were included in this study. The keywords used for data search were “chronic pain,” “coronavirus,” “pain management,” “COVID-19,” “drugs usage in covid-19,” “recommendation,” and “guidelines”. This review summarizes findings from the current literature available worldwide from different databases regarding guidelines to practice during chronic pain in coronavirus disease (COVID) crisis. This article acts as a specimen on how to handle future pandemics. We concluded that chronic pain management is a fundamental right and telemedicine is the silver lining that can be used for primary, follow-up consultation and to address mental health issues in chronic pain patients. Outpatient department visits should be scheduled using “forward triage.” Pain Interventions should be carried out if urgent or semi-urgent with necessary precautions. Reopening of elective procedures with COVID testing can be planned, considering pain interventions to be usually percutaneous, of short duration, and involving office procedures with minimal aerosol generation. Drugs contributing to immune suppression, for example, strong opioids and steroids, should be avoided. Regenerative therapy can be used instead during pain interventions. Physicians are expected to follow the recommended government guidelines before prescribing any drugs.

The Utility of a Pediatric COVID-19 Online Forward Triage Tool in Switzerland.

BackgroundTo offset the burden on the health system, hospitals set up telehealth interventions, such as online forward triage tools (OFTT). The website www.coronabambini.ch was developed to specifically address the needs of children and their families in Switzerland and to facilitate the decision to test, isolate, attend school, or access the health care system.MethodsVideo interviews were held with key informants (n = 20) from a population of parents, teachers, guardians, as well as doctors who had used the child-specific COVID-19 OFTT and had consented to a further study. Convenience and quota sampling were done to include a variety of key informants. Interviews were recorded, transcribed verbatim, and analyzed for themes.ResultsThree main themes emerged: i) the usefulness of the OFTT to the users, ii) expectation management and importance of stakeholder involvement in OFTT development, and iii) OFTT limitations.ConclusionOur study highlights opportunities, limitations, and lessons to consider when developing a pediatric COVID-19 OFTT. The involvement of stakeholders, parents, teachers, and health care providers in the design, set up, implementation, and evaluation of telehealth interventions is critical as this can help with expectation management and enhance OFTT utility.

Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: a mixed method study and patient perspectives, Switzerland

ObjectiveTo assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 online forward triage tool (OFTT) in a pandemic context.DesignA mixed method sequential explanatory study was employed. Quantitative data...

A Utility Framework for COVID-19 Online Forward Triage Tools: A Swiss Telehealth Case Study.

The SARS-CoV-2 pandemic caused a surge in online tools commonly known as symptom checkers. The purpose of these symptom checkers was mostly to reduce the health system burden by providing worried people with testing criteria, where to test and how to self-care. Technical, usability and organizational challenges with regard to online forward triage tools have also been reported. Very few of these online forward triage tools have been evaluated. Evidence for decision frameworks may be of particular value in a pandemic setting where time frames are restricted, uncertainties are ubiquitous and the evidence base is changing rapidly. The objective was to develop a framework to evaluate the utility of COVID-19 online forward triage tools. The development of the online forward triage tool utility framework was conducted in three phases. The process was guided by the socio-ecological framework for adherence that states that patient (individual), societal and broader structural factors affect adherence to the tool. In a further step, pragmatic incorporation of themes on the utility of online forward triage tools that emerged from our study as well as from the literature was performed. Seven criteria emerged; tool accessibility, reliability as an information source, medical decision-making aid, allaying fear and anxiety, health system burden reduction, onward forward transmission reduction and systems thinking (usefulness in capacity building, planning and resource allocation, e.g., tests and personal protective equipment). This framework is intended to be a starting point and a generic tool that can be adapted to other online forward triage tools beyond COVID-19. A COVID-19 online forward triage tool meeting all seven criteria can be regarded as fit for purpose. How useful an OFTT is depends on its context and purpose.

Telemedicine as a component of forward triage in a pandemic

Objective(s)Coronavirus disease 2019 (COVID-19) presents an enormous challenge to healthcare systems globally. Optimizing access to healthcare while minimizing face-to-face patient encounters is critical to limiting exposures, conserving resources, and preserving health. We aimed to evaluate the utility of a COVID-focused telehealth program in avoiding potential in-person visits while maintaining high patient satisfaction. MethodsAll patients with COVID-related virtual visits at our center between March and May 2020 were included. Demographic, satisfaction, and clinical information were gathered using a modified, validated telehealth satisfaction questionnaire disseminated via email or telephone. Data were analyzed using Stata. ResultsOf 581 eligible patients, 180 (31%) responded to the survey. Symptoms (73%) and possible exposure (22%) were the main reasons cited for pursuing a virtual visit; cough (44%) and fever (36%) were the most common presenting symptoms. Regarding patient satisfaction, most patients rated the experience as “very good” or “excellent”, and 94% of respondents said they would recommend COVID-focused triage through telehealth to others. Over 81% of patients indicated that, if telehealth was not an option, they would have sought an in-person encounter. Ultimately, only 27% of patients reported pursuing a face-to-face encounter after participating in the virtual visit. ConclusionBased on patient self-reporting, telemedicine potentially prevented face-to-face COVID-related encounters. Patients expressed satisfaction with the virtual process and were less likely to pursue in-person consultation. Leveraging a telehealth strategy for forward triage has the potential to reduce exposures while conserving healthcare resources.

Is It Time to Consider Implementation of Telemedicine in Current Oral Health Care Services?

Telemedicine offers an excellent opportunity to provide continuing health care for those in need during local/global pandemics and disasters. It provides a safe and effective communication tool between health professionals and can be used as "forward triage" to manage medical/dental emergencies and to minimize the contact between the patients and clinicians during the coronavirus disease (COVID-19) pandemic. Patients with noncommunicable diseases, like cancer, diabetes, cardiovascular, or chronic respiratory diseases, may present with critical health problems due to less access to health care systems during global disasters; opportunities for screening oral mucosa might be significantly disrupted, leading to delayed diagnosis of malignant/potentially malignant lesions. Telemedicine and oral health care associated mobile applications should be implemented to provide equal access to care, to eliminate unnecessary visits to health centers, and to improve practical coordination between professionals and health facilities.

Online forward triage during the COVID-19 outbreak

Health systems face major challenges during the COVID-19 pandemic with new information and challenges emerging daily and frequently changing guidelines. Online forward triage tools (OFTTs) provide useful information, direct patients...

Telemedicine in Heart Failure During COVID-19: A Step Into the Future.

During the Coronavirus Disease 2019 worldwide pandemic, patients with heart failure are a high-risk group with potential higher mortality if infected. Although lockdown represents a solution to prevent viral spreading, it endangers regular follow-up visits and precludes direct medical assessment in order to detect heart failure progression and optimize treatment. Furthermore, lifestyle changes during quarantine may trigger heart failure decompensations. During the pandemic, a paradoxical reduction of heart failure hospitalization rates was observed, supposedly caused by patient reluctance to visit emergency departments and hospitals. This may result in an increased patient mortality and/or in more complicated heart failure admissions in the future. In this scenario, different telemedicine strategies can be implemented to ensure continuity of care to patients with heart failure. Patients at home can be monitored through dedicated apps, telephone calls, or devices. Virtual visits and forward triage screen the patients with signs or symptoms of decompensated heart failure. In-hospital care may benefit from remote communication platforms. After discharge, patients may undergo remote follow-up or telerehabilitation to prevent early readmissions. This review provides a comprehensive appraisal of the many possible applications of telemedicine for patients with heart failure during Coronavirus disease 2019 and elucidates practical limitations and challenges regarding specific telemedicine modalities.

What is the optimal length of an Online Forward Triage Tool? The need for a framework.

What is the optimal length of an Online Forward Triage Tool? The need for a framework.

Abstract 14881: Impact of a Large-scale Telemedicine Network on Emergency Visits and Hospital Admissions During the Covid-19 Pandemic in Brazil: Data From the UNIMED-BH System

Introduction: A strategy for healthcare surge control in the Covid-19 pandemic is forward triage by on-demand telemedicine (TM), implemented by several providers. We aimed to evaluate the impact of a large-scale Covid-19 TM system on visits to emergency medical services (EMS) and all-cause and cardiovascular (CV) hospital admissions during the pandemic in Brazil. Methods: From March 18 - May 18, 2020 we evaluated the database of UNIMED-BH, a cooperative Brazilian private health insurance, with over 1.25 million clients. The Covid-19 TM system consisted of: a) online mobile app with questions about Covid-19 symptoms, which redirects to teleconsultations in case of moderate/severe manifestations; b) telemonitoring system, with regular phone calls to all clients with reported flu-like symptoms or Covid-19 diagnosis, to monitor disease progression; c) 24/7 emergency call and ambulance system (GMOV), with VOIP triage and counselling by 2 physicians: calls with suspected Covid-19 or respiratory abnormalities were computed. EMS visits and admissions in all accredited hospitals were recorded, with diagnoses assessed by the Diagnosis Related Groups (DRG) method. Covid-19 lab diagnosis and deaths were identified from the patients’ registries, and outcomes assessed until June 1 st . Results: In 60 days, 24,351 patients (1.9% of clients) accessed one of the TM systems, 59% women, median age was 35±18 years. The most frequently utilized system was telemonitoring (16,717, 69%), followed by teleconsultation (13,350, 55%) and GMOV (683, 3%); 6,330 patients accessed multiple systems. The rates of EMS and hospital admissions for each system were: telemonitoring 19.7% (3,296) and 4.6% (774); teleconsultation 17.3% (2,312) and 2.3% (311) and GMOV: 55.9% (382) and 56.2% (384) patients. At total 4.1% (996) had at least 1 hospital admission, 32% (321) with respiratory diseases (41 requiring mechanical ventilation) and 5.6% (56) with CV diagnoses (12 acute coronary syndromes). Overall, 277 (1.1%) patients had confirmed Covid-19 diagnosis, and 160 (0.7%) died, 9 with Covid-19. Conclusion: The TM system resulted in low rates of EMS visits and hospital admissions, suggesting a positive impact on healthcare utilization. The percent of admissions due to CV causes was low.

Forward Triage in the COVID-19 Era: The Plastic Surgery Experience.

Immediately after the COVID-19 outbreak was declared a pandemic by the World Health Organization,1 an administrative decision was made in our department to minimize unnecessary exposure of patients and staff while ensuring the continued standard medical care. We began by allocating the patients scheduled for the general plastic surgery clinic during the following weeks into separate groups according to their main reason for attendance. The indications for patients’ arrival to the scheduled clinic visit are summarized in Table 1. Biopsy-proven lesions requiring excision or wide excision, or those with positive margins, were automatically scheduled for surgery. Table 1. - Indications to Arrive to the Scheduled Clinic Appointment First postoperative visit following procedures under general anesthesia Signs of infection Signs of delayed wound healing Lesion suspicious of malignancy (e.g., malignant melanoma, SCC, BCC) Active burn/wound care Biopsy-proven lesion requiring wide excision SCC, squamous cell carcinoma; BCC, basal cell carcinoma. The results of our triage are summarized in Table 2. Our study period included the first 3 weeks of the COVID-19 pandemic, in which we had two planned clinics per week for a total of six clinics. Two hundred thirteen patients were contacted by telephone by the residents. Twenty-one patients did not respond to the phone call. Of a total of 213 patients, 28 (13 percent) met the indication to arrive, and 26 (12.2 percent) eventually arrived. Six patients did not show up despite existent indication and four insisted on attending contrary to medical recommendation. Most appointments were rescheduled for either future visit or telemedicine video appointment, and cancellation was done only in cases of complete healing and benign pathology report. Table 2. - Outcome of Forward Triage of the Patients Scheduled for the General Plastic Surgery Clinic during the First 3 Weeks of the COVID-19 Pandemic Reason for Clinic Visit No. of Patients No. of Patients with Indication to Arrive (%) No. of Patients Who Arrived (%) Immediately postoperatively after general anesthesia 10 7 (70) 5 (50) Immediately postoperatively after local anesthesia 63 5 (7.9) 7 (11.1) Late postoperatively after general anesthesia 30 2 (6.6) 3 (10) Late postoperatively after local anesthesia 28 1 (3.6) 0 (0) Scar follow-up 17 0 (0) 0 (0) Burn follow-up 8 1 (12.5) 1 (12.5) Wound follow-up 19 8 (42.1) 7 (36.8) Skin lesion follow-up 23 3 (13) 2 (8.7) First time visit 15 1 (6.6) 1 (6.6) Total 213 28 (13) 26 (12.2) In general, we managed to reduce visits to our general plastic surgery clinic by 87.8 percent during the first 3 weeks of the COVID-19 pandemic. None of the patients who rescheduled or cancelled visits attended the emergency room during this period and 1 week after. A main strategy for health care surge control is “forward triage”—the sorting of patients before they arrive in the emergency department. Direct-to-consumer (on demand) telemedicine, a twenty-first–century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and protecting patients, clinicians, and the community from exposure.2 The concept of forward triage has been drawn to our field as a bridge to a fully implemented telemedicine system ready to be operated by the plastic surgery staff. A systematic review found 23 articles focused on telemedicine in plastic surgery, specifically, in wound management, free flap care, and cleft lip/palate repair. The benefits include reductions in the number of unnecessary clinic visits and improvement in triage decisions.3 However, we also recognize the fear “that the implementation of telemedicine may introduce organizational changes and have a negative impact on quality of care” as expressed by Gignon.4 We believe that forward triage, deferring or reducing surveillance visits, must be considered as a means to minimize exposure. Rescheduled visits must be tracked to avoid patients being lost to follow-up. For further aspects of telemedicine in plastic surgery, we recommend following the “12 important considerations for plastic surgeons regarding the use of electronic communication” proposed by Eberlin et al. in 2018.5 Our purpose was to share our experience regarding the first step to telemedicine, forward triage, in the time of the current COVID-19 pandemic. DISCLOSURE No funding was provided for this article. Dr. Barnea is a speaker for Johnson Medical. None of the other authors has a financial interest or personal relationship to declare in relation to the content of this article.

Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

COVID‐19 and telemedicine: A revolution in healthcare delivery is at hand

<scp>COVID</scp>‐19 and telemedicine: A revolution in healthcare delivery is at hand

Medical information and social media in the time of COVID-19.

Humans are sociable beings, and societies thrive on positively reinforced communal interactions. In the past weeks, however, the global coronavirus disease 2019 (COVID-19) pandemic has imposed unprecedented change, both in how we interact as humans and in how we work and network as medical professionals. It is likely that for months after our imposed quarantines are over, elbow and toe taps will supersede handshakes and hugs. For some lucky medical institutions with resources and foresight, telemedicine is already being used effectively to supplement workforce capacity, remotely monitor intensive care unit beds, provide access to medical specialists supervising in-home treatments and to perform forward triage of patients with known or suspected COVID-19 infection (sorting patients before they arrive at the emergency department).1 Meanwhile, social distancing means that medical meetings and team communications are converted to teleconferencing, using a plethora of existing forums such as Zoom, Microsoft and Google's Hangout Meet. Healthcare workers from across the world, workers who previously shook hands and shared hors d'oevres at regional, national or international conferences, now communicate via social media platforms rather than risk being infected or infecting others with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thankfully, and in large part because of social media, healthcare professionals can rapidly share experiences fighting this highly transmissible and deadly virus. Humankind will overcome the existential threat posed by COVID-19 because we are and always have been ingenious, adaptable and entrepreneurial, whether forced by environmental shifts, pandemics or war, and today is no exception. Healthcare providers and medical scientists pave the way by adapting their means of communication and collaboration, and by driving improved efficiencies in healthcare systems and processes. Around the world, these are being adapted to keep up with the daily output of medical information. Front line workers currently in the thick of things, junior medical staff and healthcare students need immediate access to reliable medical literature. Knowledge, no longer the monopoly of an academic elite, is now at one's fingertips with the tap of a keyboard or the slide of a finger on a mobile phone.2 While some may argue that overburdened providers are deluged by a plethora of information, there is no doubt that virtually instantaneous access to research studies, clinical results and expert perspectives through the vehicle of social media provides value3 that both enriches and enlightens practitioners in need of information to make the best-informed decisions possible. Airway specialists are doing their part through the rapid distribution of medical societal guidelines and participation in global 24/7 communication networks using programmes such as WhatsApp, YouTube, Facebook or Telegram. Whether to exchange information, increase productivity or enhance interpersonal communications with colleagues, these platforms provide a vehicle for the rapid dissemination of knowledge.4 More specifically, and using each of these platforms to reach thousands of practitioners simultaneously, the COVIDBRONCH Initiative launched by Rob Lentz and Henri Colt in early March is an international network of airway specialists created to foster research and the rapid acquisition and dissemination of knowledge regarding the performance of airway procedures during the COVID-19 pandemic. One of this network's projects is a readily accessible repository of relevant papers that help guide clinical management of COVID-19-infected patients. This collection of peer-reviewed articles provides opportunities for self-education and encourages downstream personal use of pertinent literature. Articles are studied, carefully selected, highlighted and categorized into groups depending on the focus of the paper (e.g. clinical features, protocols, triage, ethics, etc.), before being placed in a Google Docs folder repository called COVIDBRONCH-LIT (https://drive.google.com/drive/folders/17adnJE8G0V9hKZZebq82h5m98LmRpnT9; Fig. 1). The aim of this project is to enable easier access and reading for overburdened healthcare workers so they may devote their energies to a more informed and evidence-based global fight against the COVID-19 pandemic. We thank the inspiring group of physicians from around the world who dedicate their precious time to the COVIDBRONCH Initiative and particularly COVIDBRONCH-LIT.