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Background: Wearables have the potential to transform healthcare by enabling early detection and monitoring of chronic diseases. This study aimed to assess wearables' acceptance, usage, and reasons for non-use. Methods: Anonymous questionnaires were used to collect data in Germany on wearable ownership, usage behaviour, acceptance of health monitoring, and willingness to share data. Results: Out of 643 respondents, 550 participants provided wearable acceptance data. The average age was 36.6 years, with 51.3% female and 39.6% residing in rural areas. Overall, 33.8% reported wearing a wearable, primarily smartwatches or fitness wristbands. Men (63.3%) and women (57.8%) expressed willingness to wear a sensor for health monitoring, and 61.5% were open to sharing data with healthcare providers. Concerns included data security, privacy, and perceived lack of need. Conclusion: The study highlights the acceptance and potential of wearables, particularly for health monitoring and data sharing with healthcare providers. Addressing data security and privacy concerns could enhance the adoption of innovative wearables, such as implants, for early detection and monitoring of chronic diseases.
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Dispositivos Electrónicos Vestibles , Humanos , Alemania , Femenino , Masculino , Adulto , Estudios Transversales , Dispositivos Electrónicos Vestibles/estadística & datos numéricos , Encuestas y Cuestionarios , Persona de Mediana Edad , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Monitoreo Ambulatorio/instrumentación , Monitoreo Ambulatorio/métodos , Monitoreo Ambulatorio/estadística & datos numéricosRESUMEN
BACKGROUND: Emergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care. AIM: To describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED. METHOD: A 4-hour online nominal group technique workshop with follow up surveys. RESULTS: Twelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience. CONCLUSION: This study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice.
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Consenso , Servicio de Urgencia en Hospital , Signos Vitales , Humanos , Signos Vitales/fisiología , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/estadística & datos numéricos , Monitoreo Fisiológico/normas , Australasia , Encuestas y Cuestionarios , Australia , Medicina de Emergencia/métodos , Medicina de Emergencia/normasRESUMEN
In recent years, due to the combined effects of individual behavior, psychological factors, environmental exposure, medical conditions, biological factors, etc., the incidence of preterm birth has gradually increased, so the incidence of various complications of preterm infants has also become higher and higher. This article is aimed at studying the therapeutic effects of preterm infants and proposing the application of rSO2 and PI image monitoring based on deep learning to the treatment of preterm infants. This article introduces deep learning, blood perfusion index, preterm infants, and other related content in detail and conducts experiments on the treatment of rSO2 and PI monitoring images based on deep learning in preterm infants. The experimental results show that the rSO2 and PI monitoring images based on deep learning can provide great help for the treatment of preterm infants and greatly improve the treatment efficiency of preterm infants by at least 15%.
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Encéfalo/metabolismo , Aprendizaje Profundo , Recien Nacido Prematuro/fisiología , Oxígeno/metabolismo , Índice de Perfusión/métodos , Biología Computacional , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Interpretación de Imagen Asistida por Computador/estadística & datos numéricos , Recién Nacido , Masculino , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Redes Neurales de la Computación , Índice de Perfusión/estadística & datos numéricos , Postura/fisiología , Nacimiento PrematuroRESUMEN
PURPOSE: Real-time continuous glucose monitoring (RT-CGM) provides information on glycemic variability (GV), time in range (TIR), and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. METHODS: Between September 2014 and January 2017, 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV], and SD) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy, or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. RESULTS: Individuals with microvascular complications were older (P < 0.001), had a longer diabetes duration (P < 0.001), a higher HbA1c (7.8 ± 0.9 vs 7.5 ± 0.9%, P < 0.001), and spent less time in range (60.4 ± 12.2 vs 63.9 ± 13.8%, P = 0.022) compared with those without microvascular complication. Diabetes duration (odds ratio [OR] = 1.12 [1.09-1.15], P < 0.001) and TIR (OR = 0.97 [0.95-0.99], P = 0.005) were independent risk factors for composite microvascular complications, whereas SD and CV were not. Age (OR = 1.08 [1.03-1.14], P = 0.003) and HbA1c (OR = 1.80 [1.02-3.14], P = 0.044) were risk factors for macrovascular complications. TIR (OR = 0.97 [0.95-0.99], P = 0.021) was the only independent risk factor for hospitalizations for hypoglycemia or ketoacidosis. CONCLUSIONS: Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD, and CV were not associated with macrovascular complications.
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Glucemia/análisis , Hipoglucemia/epidemiología , Insulina/administración & dosificación , Cetosis/epidemiología , Monitoreo Fisiológico/estadística & datos numéricos , Adulto , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 1/sangre , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Hospitalización/estadística & datos numéricos , Humanos , Hipoglucemia/sangre , Hipoglucemia/etiología , Hipoglucemia/terapia , Insulina/efectos adversos , Sistemas de Infusión de Insulina , Cetosis/sangre , Cetosis/etiología , Cetosis/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
CONTEXT: Early glucose abnormalities in people with cystic fibrosis (PwCF) are commonly detected by continuous glucose monitoring (CGM). Relationships between these CGM abnormalities and oral glucose tolerance testing (OGTT) in PwCF have not been fully characterized. OBJECTIVE: This work aimed to determine the relationship between CGM and common OGTT-derived estimates of ß-cell function, including C-peptide index and oral disposition index (oDI) and to explore whether CGM can be used to screen for OGTT-defined prediabetes and cystic fibrosis-related diabetes (CFRD). METHODS: PwCF not on insulin and healthy controls aged 6 to 25 years were enrolled in a prospective study collecting OGTT and CGM. A subset underwent frequently sampled OGTTs (fsOGTT) with 7-point glucose, insulin, and C-peptide measurements. Pearson correlation coefficient was used to test the association between select CGM and fsOGTT measures. Receiver operating curve (ROC) analysis was applied to CGM variables to determine the cutoff optimizing sensitivity and specificity for detecting prediabetes and CFRD. RESULTS: A total of 120 participants (controlsâ =â 35, CFâ =â 85), including 69 with fsOGTTs, were included. CGM coefficient of variation correlated inversely with C-peptide index (Cpeptide30-Cpeptide0/Glucose30-Glucose0) (râ =â -0.45, Pâ <â .001) and oDIcpeptide (C-peptide index)(1/cpep0) (râ =â -0.48, Pâ <â .0001). In PwCF, CGM variables had ROCâ -â areas under the curve ranging from 0.43 to 0.57 for prediabetes and 0.47 to 0.6 for CFRD. CONCLUSION: Greater glycemic variability on CGM correlated with reduced ß-cell function. However, CGM performed poorly at discriminating individuals with and without OGTT-defined CFRD and prediabetes. Prospective studies are now needed to determine how well the different tests predict clinically relevant nonglycemic outcomes in PwCF.
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Fibrosis Quística/complicaciones , Diabetes Mellitus/epidemiología , Prueba de Tolerancia a la Glucosa/estadística & datos numéricos , Monitoreo Fisiológico/estadística & datos numéricos , Estado Prediabético/epidemiología , Adolescente , Adulto , Glucemia/análisis , Glucemia/metabolismo , Estudios de Casos y Controles , Niño , Fibrosis Quística/sangre , Fibrosis Quística/metabolismo , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiología , Femenino , Voluntarios Sanos , Humanos , Masculino , Estado Prediabético/sangre , Estado Prediabético/diagnóstico , Estado Prediabético/etiología , Estudios Prospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Adulto JovenRESUMEN
During the ongoing COVID-19 pandemic, Internet of Things- (IoT-) based health monitoring systems are potentially immensely beneficial for COVID-19 patients. This study presents an IoT-based system that is a real-time health monitoring system utilizing the measured values of body temperature, pulse rate, and oxygen saturation of the patients, which are the most important measurements required for critical care. This system has a liquid crystal display (LCD) that shows the measured temperature, pulse rate, and oxygen saturation level and can be easily synchronized with a mobile application for instant access. The proposed IoT-based method uses an Arduino Uno-based system, and it was tested and verified for five human test subjects. The results obtained from the system were promising: the data acquired from the system are stored very quickly. The results obtained from the system were found to be accurate when compared to other commercially available devices. IoT-based tools may potentially be valuable during the COVID-19 pandemic for saving people's lives.
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COVID-19/fisiopatología , Sistemas de Computación , Internet de las Cosas , Monitoreo Fisiológico/instrumentación , Adulto , Temperatura Corporal , COVID-19/diagnóstico , COVID-19/epidemiología , Biología Computacional , Sistemas de Computación/estadística & datos numéricos , Diseño de Equipo , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Monitoreo Fisiológico/estadística & datos numéricos , Saturación de Oxígeno , Pandemias , SARS-CoV-2 , Interfaz Usuario-Computador , Adulto JovenRESUMEN
Early identification of atypical infant movement behaviors consistent with underlying neuromotor pathologies can expedite timely enrollment in therapeutic interventions that exploit inherent neuroplasticity to promote recovery. Traditional neuromotor assessments rely on qualitative evaluations performed by specially trained personnel, mostly available in tertiary medical centers or specialized facilities. Such approaches are high in cost, require geographic proximity to advanced healthcare resources, and yield mostly qualitative insight. This paper introduces a simple, low-cost alternative in the form of a technology customized for quantitatively capturing continuous, full-body kinematics of infants during free living conditions at home or in clinical settings while simultaneously recording essential vital signs data. The system consists of a wireless network of small, flexible inertial sensors placed at strategic locations across the body and operated in a wide-bandwidth and time-synchronized fashion. The data serve as the basis for reconstructing three-dimensional motions in avatar form without the need for video recordings and associated privacy concerns, for remote visual assessments by experts. These quantitative measurements can also be presented in graphical format and analyzed with machine-learning techniques, with potential to automate and systematize traditional motor assessments. Clinical implementations with infants at low and at elevated risks for atypical neuromotor development illustrates application of this system in quantitative and semiquantitative assessments of patterns of gross motor skills, along with body temperature, heart rate, and respiratory rate, from long-term and follow-up measurements over a 3-mo period following birth. The engineering aspects are compatible for scaled deployment, with the potential to improve health outcomes for children worldwide via early, pragmatic detection methods.
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Conducta del Lactante/fisiología , Monitoreo Fisiológico/instrumentación , Movimiento/fisiología , Signos Vitales/fisiología , Tecnología Inalámbrica/instrumentación , Sesgo , Niño , Diseño de Equipo , Frecuencia Cardíaca , Humanos , Imagenología Tridimensional , Lactante , Miniaturización , Monitoreo Fisiológico/estadística & datos numéricos , Frecuencia Respiratoria , Piel , Grabación en Video , Tecnología Inalámbrica/estadística & datos numéricosRESUMEN
ABSTRACT: To investigate fatigue, health-related quality of life (HR-QOL), and sleep quality in women with primary Sjogren syndrome (pSS) or rheumatoid arthritis (RA) as compared with healthy controls using self-reports and wrist actigraphy.In this cross-sectional observational study, we evaluated a total of 25 patients (aged 40-75âyears) with pSS, 10 with RA, and 17 healthy control subjects living in Japan. The HR-QOL was assessed using the Short Form-36. Fatigue was evaluated using the Short Form-36 vitality score, visual analog scale (VAS) for fatigue, and 2 questionnaire items using scores based on a 4-point Likert scale. Sleep quality was measured using the Japanese version of the Pittsburgh Sleep Quality Index, VAS for sleep quality, and wrist actigraphy for 14âdays.Patients with pSS reported severer fatigue and lower HR-QOL than healthy controls, especially in mental health. Based on the Pittsburgh Sleep Quality Index score, 56% of the patients with pSS were poor sleepers, which was higher than healthy controls (29.4%). Furthermore, the patients with pSS scored significantly lower on the VAS for sleep quality than healthy controls (40.5 vs 63.7, Pâ=â.001). Although subjective assessments revealed slight sleep disturbances in patients with pSS, wrist actigraphy revealed no differences when compared with healthy controls for total sleep time (421.8âminutes vs 426.5âminutes), sleep efficiency (95.2% vs 96.4%), number of awakenings (1.4 vs 0.9), and wake after sleep onset (22.4âminutes vs 16.1âminutes). Poor subjective sleep quality was associated with enhanced fatigue. However, sleep efficiency, as determined by actigraphy, was not associated with fatigue. Notably, the patients with RA and healthy controls did not differ significantly in terms of fatigue or sleep quality, although patients with RA experienced more nocturnal awakenings than healthy controls (1.7 vs 0.9, Pâ=â.04).Patients with pSS experience severe fatigue, poor HR-QOL, and sleep disturbances, which are associated with fatigue. However, wrist actigraphy did not reveal differences in sleep quality, suggesting that it may not be an appropriate measure of sleep in patients with pSS.
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Artritis Reumatoide/complicaciones , Fatiga/clasificación , Síndrome de Sjögren/complicaciones , Sueño/fisiología , Actigrafía/instrumentación , Actigrafía/métodos , Actigrafía/estadística & datos numéricos , Adulto , Anciano , Artritis Reumatoide/epidemiología , Estudios Transversales , Fatiga/epidemiología , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Calidad de Vida , Autoinforme/estadística & datos numéricos , Síndrome de Sjögren/epidemiología , Encuestas y Cuestionarios , Muñeca/fisiología , Muñeca/fisiopatologíaRESUMEN
BACKGROUND: Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). METHODS: A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. RESULTS: A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. CONCLUSION: Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
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Traumatismos Abdominales/diagnóstico , Admisión del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad/estadística & datos numéricos , Heridas no Penetrantes/diagnóstico , Traumatismos Abdominales/terapia , Adolescente , Angiografía/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Lactante , Puntaje de Gravedad del Traumatismo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Heridas no Penetrantes/terapiaRESUMEN
BACKGROUND: Factors contributing to the accurate measurement of self-reported physical activity are not well understood in middle-aged adults. We investigated the associations between two self-reported surveys and objectively measured physical activity in middle-aged adults, and the influence of individual and sociodemographic factors on these associations, at different intensities utilizing an observational study design. METHODS: Participants (n = 156) wore a SenseWear Armband™ (SWA) for a continuous seven-day period over the triceps of the left arm, to measure energy expenditure in metabolic equivalents. Participants also completed the Physical Activity Recall questionnaire (PAR) and Active Australia Survey (AAS). Associations were analyzed separately in general linear models for each intensity. The influence of individual and sociodemographic factors was assessed through moderator analyses. RESULTS: The PAR and SWA were significantly positively associated at moderate (ß = 0.68, 95% CI 0.16-1.20), vigorous (ß = 0.36, 95% CI 0.20-0.53), moderate-to-vigorous physical activity (MVPA) (ß = 0.52, 95% CI 0.20-0.83), and total METmins (ß = 0.63, 95% CI 0.35-0.90), the AAS and SWA were associated at all intensities (moderate (ß = 0.41, 95% CI 0.15-0.67), vigorous (ß = 0.32, 95% CI 0.19-0.46), MVPA (ß = 0.42, 95% CI 0.18-0.65) and total METmins (ß = 0.62, 95% CI 0.29-0.96). A significant interaction between the PAR and sex for vigorous-intensity unveiled a weaker association in women. Both surveys tended to under-report physical activity. The largest margins of error were present at light and moderate intensities. For the PAR, participants reported over 20 hours, or 69% less light physical activity than recorded by the SWA per week. For the AAS, participants reported over 7 hours, or 38% less moderate physical activity. Compared to lighter intensities, time spent at a vigorous intensity was overreported by participants with the PAR and AAS by 91 and 43 minutes per week, respectively. The addition of Body Mass Index (BMI) resulted in non-significant interactions between the PAR and SWA for moderate-intensity, and the AAS and SWA for vigorous-intensity; a significant interaction between AAS and BMI indicated that the strength of the association differed by BMI for vigorous-intensity. CONCLUSIONS: The PAR and AAS are not equivalent to the SWA, and sex and BMI may alter the associations between the measures.
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Índice de Masa Corporal , Ejercicio Físico , Recuerdo Mental/fisiología , Equivalente Metabólico , Monitoreo Fisiológico/estadística & datos numéricos , Actividad Motora/fisiología , Autoinforme , Adulto , Metabolismo Energético , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. DESIGN: Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. SETTING: Patient safety incident reports (10 years, 2005-2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. PARTICIPANTS: Reports describing severe harm/death in acute medical unit were identified. MAIN OUTCOME MEASURES: Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. RESULTS: A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. CONCLUSION: This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.
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Daño del Paciente/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Seguridad del Paciente/normas , Mejoramiento de la Calidad , Administración de la Seguridad/normas , Enfermedad Aguda , Errores Diagnósticos/estadística & datos numéricos , Inglaterra , Hospitales , Humanos , Errores de Medicación/estadística & datos numéricos , Monitoreo Fisiológico/estadística & datos numéricos , Transferencia de Pacientes , Estudios Retrospectivos , GalesRESUMEN
Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = - 0.60; p = 0.001) and within-subjects correlation (r = - 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.
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COVID-19/complicaciones , Agua Pulmonar Extravascular/inmunología , Edema Pulmonar/mortalidad , Síndrome de Dificultad Respiratoria/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/mortalidad , Permeabilidad Capilar , Progresión de la Enfermedad , Agua Pulmonar Extravascular/virología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Pulmón/irrigación sanguínea , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Pronóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/inmunología , Edema Pulmonar/virología , Respiración Artificial , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Medición de Riesgo/métodos , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Termodilución/métodos , Termodilución/estadística & datos numéricos , Adulto JovenRESUMEN
AIMS: In response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study. METHODS: This study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of 'stay at home' lockdown measures in the form of 'minutes active per day' (min/day). RESULTS: Data were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001). CONCLUSIONS: In a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures. TRIAL REGISTRATION NUMBER: NCT04177199.
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Acelerometría , COVID-19 , Control de Enfermedades Transmisibles , Insuficiencia Cardíaca , Monitoreo Fisiológico , Distanciamiento Físico , Telemedicina , Acelerometría/instrumentación , Acelerometría/métodos , Acelerometría/estadística & datos numéricos , Actividades Cotidianas , Anciano , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Ejercicio Físico , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , SARS-CoV-2 , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Reino Unido/epidemiología , Dispositivos Electrónicos VestiblesRESUMEN
BACKGROUND: Kidney function may promote progression of AF. OBJECTIVE: We evaluated the association of kidney function to AF progression and resultant clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS: We performed a retrospective cohort study using national clinical data from the Veterans Health Administration linked to CIED data from the Carelink® remote monitoring data warehouse (Medtronic Inc, Mounds View, MN). All devices had atrial leads and at least 75% of remote monitoring transmission coverage. Patients were included at the date of the first AF episode lasting ≥6 minutes, and followed until the occurrence of persistent AF in the first year, defined as ≥7 consecutive days with continuous AF. We used Cox regression analyses with persistent AF as a time-varying covariate to examine the association to stroke, myocardial infarction, heart failure and death. RESULTS: Of, 10,323 eligible patients, 1,771 had a first CIED-detected AF (mean age 69 ± 10 years, 1.2% female). In the first year 355 (20%) developed persistent AF. Kidney function was not associated with persistent AF after multivariable adjustment including CHA2DS2-VASc variables and prior medications. Only higher age increased the risk (HR: 1.37 per 10 years; 95% CI:1.22-1.54). Persistent AF was associated to higher risk of heart failure (HR: 2.27; 95% CI: 1.88-2.74) and death (HR: 1.60; 95% CI: 1.30-1.96), but not stroke (HR: 1.28; 95% CI: 0.62-2.62) or myocardial infarction (HR: 1.43; 95% CI: 0.91-2.25). CONCLUSION: Kidney function was not associated to AF progression, whereas higher age was. Preventing AF progression could reduce the risk of heart failure and death.
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Fibrilación Atrial , Insuficiencia Cardíaca , Pruebas de Función Renal , Monitoreo Fisiológico , Accidente Cerebrovascular , Factores de Edad , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/fisiopatología , Correlación de Datos , Electrodos Implantados/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Pruebas de Función Renal/métodos , Pruebas de Función Renal/estadística & datos numéricos , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Resultados Negativos , Tecnología de Sensores Remotos/instrumentación , Tecnología de Sensores Remotos/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Estados Unidos/epidemiología , Salud de los Veteranos/estadística & datos numéricosRESUMEN
The coronavirus pandemic catalyzed a digital health transformation, placing renewed focus on using remote monitoring technologies to care for patients outside of hospitals. At NewYork-Presbyterian, the authors expanded remote monitoring infrastructure and developed a COVID-19 Hypoxia Monitoring program-a critical means through which discharged COVID-19 patients were followed and assessed, enabling the organization to maximize inpatient capacity at a time of acute bed shortage. The pandemic tested existing remote monitoring efforts, revealing numerous operating challenges including device management, centralized escalation protocols, and health equity concerns. The continuation of these programs required addressing these concerns while expanding monitoring efforts in ambulatory and transitions of care settings. Building on these experiences, this article offers insights and strategies for implementing remote monitoring programs at scale and improving the sustainability of these efforts. As virtual care becomes a patient expectation, the authors hope hospitals recognize the promise that remote monitoring holds in reenvisioning health care delivery.
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COVID-19/terapia , Continuidad de la Atención al Paciente/organización & administración , Monitoreo Fisiológico/estadística & datos numéricos , Telemedicina/organización & administración , Sistemas de Apoyo a Decisiones Clínicas , Humanos , Monitoreo Ambulatorio/estadística & datos numéricos , Ciudad de Nueva York , Evaluación de Resultado en la Atención de SaludRESUMEN
BACKGROUND: Partographs should be used universally to monitor the mother and fetus's conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian. METHODS: An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used. RESULT: The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization. CONCLUSIONS: The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it.
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Trabajo de Parto , Monitoreo Fisiológico/estadística & datos numéricos , Complicaciones del Trabajo de Parto/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Prenatal , Adulto , Centros de Asistencia al Embarazo y al Parto , Estudios Transversales , Etiopía , Femenino , Humanos , Masculino , Obstetricia , Embarazo , Encuestas y CuestionariosRESUMEN
PURPOSE: Advances in testicular cancer screening and therapy increased 10-year survival to 97% despite a rising incidence; eventually expanding the population of survivors requiring follow-up. We analyzed 10-year follow-up costs after testicular cancer treatment in Germany during 2000, 2008, and 2015. METHODS: Testicular cancer follow-up guidelines were extracted from the European Association of Urology. Per patient costs were estimated with a micro-costing approach considering direct and indirect medical expenses derived from expert interviews, literature research, and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. Cost progression was compared across cancer histology, stage, stakeholders, resource use, and follow-up years. RESULTS: Mean 10-year follow-up costs per patient for stage I seminomatous germ-cell tumors (SGCT) on surveillance declined from EUR 11,995 in 2000 to EUR 4,430 in 2015 (p < 0.001). Advanced SGCT spending shrank from EUR 13,866 to EUR 9,724 (p < 0.001). In contrast, expenditure for stage II SGCT increased from EUR 7,159 to EUR 9,724 (p < 0.001). While insurers covered 32% of costs in 2000, only 13% of costs were reimbursed in 2015 (p < 0.001). 70% of SGCT follow-up resources were consumed by medical imaging (x-ray, CT, ultrasound, FDG-PET). Spending was unevenly distributed across follow-up years (years 1-2: 50%, years 3-5: 39%, years 5-10: 11%). CONCLUSIONS: The increasing prevalence of testicular cancer survivors caused German statutory insurers to cut per patient cost by up to 80% by budgeting services and decreasing reimbursement rates. The economic burden was gradually redistributed to patients and providers.
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Costos de la Atención en Salud , Monitoreo Fisiológico/economía , Neoplasias de Células Germinales y Embrionarias , Neoplasias Testiculares , Adulto , Anciano , Anciano de 80 o más Años , Continuidad de la Atención al Paciente/economía , Continuidad de la Atención al Paciente/historia , Continuidad de la Atención al Paciente/tendencias , Costo de Enfermedad , Análisis Costo-Beneficio , Estudios de Seguimiento , Alemania/epidemiología , Adhesión a Directriz/economía , Adhesión a Directriz/historia , Adhesión a Directriz/tendencias , Costos de la Atención en Salud/historia , Costos de la Atención en Salud/tendencias , Gastos en Salud/historia , Gastos en Salud/tendencias , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Neoplasias de Células Germinales y Embrionarias/economía , Neoplasias de Células Germinales y Embrionarias/epidemiología , Neoplasias de Células Germinales y Embrionarias/terapia , Seminoma/economía , Seminoma/epidemiología , Seminoma/terapia , Neoplasias Testiculares/economía , Neoplasias Testiculares/epidemiología , Neoplasias Testiculares/terapiaRESUMEN
The internet of things (IoT) and deep learning are emerging technologies in diverse research fields, including the provision of IT services in medical domains. In the COVID-19 era, intelligent medication behavior monitoring systems for stable patient monitoring are further required, because many patients cannot easily visit hospitals. Several previous studies made use of wearable devices to detect medication behaviors of patients. However, the wearable devices cause inconvenience while equipping the devices. In addition, they suffer from inconsistency problems due to errors of measured values. We devise a medication behavior monitoring system that uses the IoT and deep learning to avoid sensing errors and improve user experiences by effectively detecting various activities of patients. Based on the real-time operation of our proposed IoT device, the proposed solution processes captured images of patents via OpenPose to check medication situations. The proposed system identifies medication status on time by using a human activity recognition scheme and provides various notifications to patients' mobile devices. To support reliable communication between our system and doctors, we employ MQTT protocol with periodic data transmissions. Thus, the measured information of patient's medication status is transmitted to the doctors so that they can periodically perform remote treatments. Experimental results show that all medication behaviors are accurately detected and notified to the doctor efficiently, improving the accuracy of monitoring the patient's medication behavior.
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Tratamiento Farmacológico de COVID-19 , Aprendizaje Profundo , Cumplimiento de la Medicación , Monitoreo Fisiológico/métodos , SARS-CoV-2 , Ingeniería Biomédica , Sistemas de Computación , Terapia por Observación Directa , Diseño de Equipo , Humanos , Internet de las Cosas , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/estadística & datos numéricos , Redes Neurales de la Computación , Pandemias , Programas Informáticos , Dispositivos Electrónicos VestiblesRESUMEN
The aim of this study was to evaluate the correlation between tools commonly used in the detection of physiological changes, such as clinical complaints, a biochemical marker of muscle injury, and performance data during official matches, with infrared thermography, which has been commonly used in the possible tracking of musculoskeletal injuries in athletes. Twenty-two athletes from a professional soccer club (age 27.7 ± 3.93 years; BMI 24.35 ± 1.80 kg/cm2) were followed during the season of a national championship, totaling 19 matches with an interval of 7 days between matches. At each match, the athletes used a Global Positioning System (GPS) device to collect performance data. Forty-eight hours after each match, every athlete's perception of recovery, fatigue, and pain was documented. Blood was collected for creatine kinase (CK) analysis, and infrared thermography was applied. Only athletes who presented pain above 4 in either limb were included for thermographic analysis. Each thermographic image was divided into 14 regions of interest. For statistical analysis, we included only the images that showed differences ≥ 1° C. Data normality was verified by the Kolmogorov-Smirnov test with Dallal-Wilkinson-Lilliefors correction. We used the Pearson correlation coefficient to verify the correlation between infrared thermography and the biochemical marker, performance data, and clinical recovery scales. No correlation was observed between mean skin temperature and blood CK levels, pain level, perception of recovery, and fatigue perception (r <0.2, p>0.05). Thus, infrared thermography did not correlate with CK level, pain, fatigue perception, or recovery, nor with performance variables within the field.
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Rendimiento Atlético/fisiología , Monitoreo Fisiológico/métodos , Temperatura Cutánea/fisiología , Termografía/métodos , Adulto , Atletas/estadística & datos numéricos , Biomarcadores/sangre , Creatina Quinasa/sangre , Estudios Transversales , Femenino , Sistemas de Información Geográfica , Humanos , Extremidad Inferior , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/estadística & datos numéricos , Tecnología de Sensores Remotos/instrumentación , Fútbol/fisiología , Termografía/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: Self-monitoring is a core component of behavioral obesity treatment, but it is unknown how digital health has been used for self-monitoring, what engagement rates are achieved in these interventions, and how self-monitoring and weight loss are related. METHODS: This systematic review examined digital self-monitoring in behavioral weight loss interventions among adults with overweight or obesity. Six databases (PubMed, Embase, Scopus, PsycInfo, CINAHL, and ProQuest Dissertations & Theses) were searched for randomized controlled trials with interventions ≥ 12 weeks, weight outcomes ≥ 6 months, and outcomes on self-monitoring engagement and their relationship to weight loss. RESULTS: Thirty-nine studies from 2009 to 2019 met inclusion criteria. Among the 67 interventions with digital self-monitoring, weight was tracked in 72% of them, diet in 81%, and physical activity in 82%. Websites were the most common self-monitoring modality, followed by mobile applications, wearables, electronic scales, and, finally, text messaging. Few interventions had digital self-monitoring engagement rates ≥ 75% of days. Rates were higher in digital- than in paper-based arms in 21 out of 34 comparisons and lower in just 2. Interventions with counseling had similar rates to standalone interventions. Greater digital self-monitoring was linked to weight loss in 74% of occurrences. CONCLUSIONS: Self-monitoring via digital health is consistently associated with weight loss in behavioral obesity treatment.