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1.
Hepatol Commun ; 8(8)2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39037370

RESUMO

BACKGROUND: Remote patient monitoring (RPM) is an emerging focus in health care, and specialized programs may reduce medical costs, supplement in-office visits, and improve patient satisfaction. In this study, we describe the development, feasibility, and early outcomes of an RPM program for patients with decompensated cirrhosis. METHODS: Forty-six patients were offered enrollment at the time of hospital discharge in the cirrhosis RPM program (CiRPM), of which 41 completed at least 30 days of monitoring. Participants were mailed remote monitoring equipment and a tablet to be used for patient-reported outcomes. Alerts were continuously monitored by virtual nursing staff who could perform targeted interventions. A cohort of historical controls (n = 74) was created for comparison using inverse probability of treatment weighting. RESULTS: Patients were enrolled in the program for a mean of 83.9 days, with 28 (68%) completing the full 90-day program. Participants uploaded vital signs and responded to symptom-based questionnaires on 93% of the monitored days. On end-of-program surveys, over 75% of patients expressed satisfaction with the program. Gender, age, and MELD-Na were similar between CiRPM and weighted control groups. The 90-day readmission rate was 34% in CiRPM and 47% in weighted controls. In the CiRPM group, 12% of subjects had 2 or more admissions, compared to 37% in the weighted control group. CONCLUSION: This study demonstrates the feasibility of a cirrhosis-specific RPM program. Overall, patient satisfaction and utilization of the CiRPM was high. Future studies are needed to confirm the impact of RPM on the reduction of hospital readmissions in decompensated cirrhosis.


Assuntos
Cirrose Hepática , Satisfação do Paciente , Humanos , Cirrose Hepática/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos de Viabilidade , Idoso , Telemedicina , Monitorização Fisiológica/métodos , Medidas de Resultados Relatados pelo Paciente , Adulto , Readmissão do Paciente/estatística & dados numéricos
2.
Am J Gastroenterol ; 119(5): 982-986, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38240303

RESUMO

INTRODUCTION: Management of hepatic encephalopathy relies on self-titration of lactulose. In this feasibility trial, we assess an artificial intelligence-enabled tool to guide lactulose use through a smartphone application. METHODS: Subjects with hepatic encephalopathy on lactulose captured bowel movement pictures during lead-in and intervention phases. During the intervention phase, daily feedback on lactulose titration was delivered through the application. Goals were determined according to number of bowel movement and Bristol Stool Scale reports. RESULTS: Subjects completed the study with more than 80% satisfaction. In the lead-in phase, less compliant subjects achieved Bristol Stool Scale goal on 62/111 (56%) of days compared with 107/136 (79%) in the intervention phase ( P = 0.041), while the most compliant subjects showed no difference. Severe/recurrent hepatic encephalopathy group achieved Bristol Stool Scale goal on 80/104 (77%) days in the lead-in phase and 90/110 (82%) days in the intervention phase ( P = NS), compared with 89/143 (62%) days and 86/127 (68%) days in the stable group. DISCUSSION: Dieta application is a promising tool for objective Bowel Movement/Bristol Stool Scale tracking for hepatic encephalopathy and may potentially be used to assist with lactulose titration.


Assuntos
Inteligência Artificial , Estudos de Viabilidade , Fezes , Fármacos Gastrointestinais , Encefalopatia Hepática , Lactulose , Aplicativos Móveis , Smartphone , Humanos , Encefalopatia Hepática/tratamento farmacológico , Lactulose/administração & dosagem , Masculino , Feminino , Pessoa de Meia-Idade , Fezes/química , Idoso , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/uso terapêutico
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