Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis.

BACKGROUND: Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. OBJECTIVE: This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. METHODS: Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. RESULTS: Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. CONCLUSIONS: This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.

Telemedicine for Acute Conditions During COVID-19: A Nationwide Survey Using Crowdsourcing.

Background: COVID-19 has resulted in a rapid and significant adoption of telemedicine for acute conditions. Understanding whether patient demand will last after the pandemic helps providers and payers make informed decisions about whether to continue adopting telemedicine. Objective: We examine user experience as well as process and patient outcomes of using telemedicine for acute conditions during COVID-19 and assess how patient outcomes are affected by waiting times and demographics. Materials and Methods: A survey was conducted via Amazon Mechanical Turk during June 17-29, 2020. Inclusion criteria were: (1) ≥18 years old, (2) residing in the United States, (3) used telemedicine for acute conditions after January, and 4) a human intelligence task approval rate of >95%. Process outcomes included patient waiting time with patient outcomes being satisfaction and future use intention. Bivariate analysis and regressions of the data were performed. Results: On average, respondents reported appointment wait time of 2.76 days and virtual office wait time of 19.44 min. Overall, respondents reported moderate satisfaction (mean 5.08-5.35 of 7) and future use intention (mean 5.10-5.32 of 7). Over 72% of the respondents were satisfied and had future use intention. Females, heavier internet users, and those on the higher/lower ends of the education spectrum reported better patient outcomes. Patients "visiting" a doctor experiencing eye problems, vis-à-vis other ailments, reported lower satisfaction and intention. Waiting time negatively associates with satisfaction. Conclusions: Given the satisfactory outcomes, the high demand for telemedicine may continue after the COVID-19 pandemic. However, whether providers will continue to offer telemedicine visits may require more evidence.

Timing and Causes of Common Pediatric Readmissions.

OBJECTIVE: To evaluate and compare readmission causes and timing within the first 30 days after hospitalization for 3 acute and 3 chronic common pediatric conditions. STUDY DESIGN: Data from the 2013 to 2014 Nationwide Readmissions Database were used to examine the daily percentage of readmissions occurring on days 1-30 and the leading causes of readmission after hospitalization for 3 acute (appendicitis, bronchiolitis/croup, and gastroenteritis) and 3 chronic (asthma, epilepsy, and sickle cell) conditions for patients aged 1-17 years (n = 2 753 488). Data were analyzed using Cox proportional hazards regression. RESULTS: The 30-day readmission rates ranged from 2.6% (SE, 0.1) after hospitalizations for appendectomy to 19.1% (SE, 0.5) after hospitalizations for sickle cell anemia. More than 50% of 30-day readmissions after acute conditions occurred within 15 days after discharge, whereas readmissions after chronic conditions occurred more uniformly throughout the 30 days after discharge. Higher numbers of patient comorbidities were associated with increased risk of readmission at days 1-7, 8-15, and 16-30 after discharge for all conditions examined. Most 30-day readmissions after chronic conditions were for the same diagnosis or closely related conditions as the index admission (67% for asthma, 65% for seizure disorder, and 82% for sickle cell anemia) in contrast with 50% or fewer readmissions after acute conditions (46% for appendectomy, 47% for bronchiolitis/croup, and 19% for gastroenteritis). CONCLUSIONS: The timing and causes of pediatric readmissions vary greatly across pediatric conditions. To be effective, strategies for reducing readmissions need to account for the index diagnosis to better target the highest risk period and causes for readmission.

Prevention of ferroptosis in acute scenarios: an in vitro study with classic and novel anti-ferroptotic compounds.

Ferroptosis, an iron-dependent form of cell death, has critical roles in diverse pathologies. Data on the temporal events mediating the prevention of ferroptosis are lacking. Focused on temporal aspects of cytotoxicity/protection, we investigated the effects of classic (Fer-1) and novel [2,6-di-tert-butyl-4-(2-thienylthio)phenol (C1) and 2,6-di-tert-butyl-4-(2-thienylselano)phenol (C2)] anti-ferroptotic agents against RSL3-, BSO- or glutamate-induced ferroptosis in cultured HT22 neuronal cell line, comparing their effects with those of the antioxidants trolox, ebselen and probucol. Glutamate (5 mM), BSO (25 µM) and RSL3 (50 nM) decreased approximately 40% of cell viability at 24 h. At these concentrations, none of these agents changed cell viability at 6 h after treatments; RSL3 increased lipoperoxidation from 6 h, although BSO and glutamate only did so at 12 h after treatments. At similar conditions, BSO and glutamate (but not RSL3) decreased GSH levels at 6 h after treatments. Fer-1, C1 and C2 exhibited similar protective effects against glutamate-, BSO- and RSL3-cytotoxicity, but this protection was limited when the protective agents were delivered to cells at time-points characterized by increased lipoperoxidation (but not glutathione depletion). Compared to Fer-1, C1 and C2, the anti-ferroptotic effects of trolox, ebselen and probucol were minor. Cytoprotective effects were not associated with direct antioxidant efficacies. These results indicate that the temporal window is central in affecting the efficacies of anti-ferroptotic drugs in acute scenarios; ferroptosis prevention is improbable when significant rates of lipoperoxidation were already achieved. C1 and C2 displayed remarkable cytoprotective effects, representing a promising new class of compounds to treat ferroptosis-related pathologies.

Is the Renin-Angiotensin-Aldosterone System Good for the Kidney in Acute Settings?

The renin-angiotensin-aldosterone system (RAAS) plays a major role in the regulation of blood pressure, renal hemodynamic, myocardial contractility via an enzymatic cascade leading to the synthesis of angiotensin 2. The activation of the RAAS system after acute kidney injury triggers renal inflammation and fibrotic process with long-term damaging consequences. To date, there is still a debate on the benefits of RAAS for the kidney in acute settings. Effects of RAAS antagonists are variable in chronic or acute conditions. The aim of this review is to discuss the renal and systemic effects of the RAAS, and its modulation, in acute situations.

Factors affecting dental diseases presenting at the University of Ghana Hospital.

Dental diseases are common in man and range from a toothache to cancers of the head and neck. Dental conditions can affect our capacity to function effectively in areas such as smiling, chewing and speaking. The objective of this study was to describe the main types of dental conditions presenting at the University Hospital between January 2006 and December 2011 and to determine factors associated with the top five diagnosed conditions as well as the acute and chronic conditions. A retrospective review of all 5012 clinical records of dental patients visiting the dental unit within the period stated was carried out. A total of 4196 records which passed the inclusion/exclusion criteria were analysed. Most of the patients who presented were adults. The top 5 dental conditions were apical periodontitis (50.4 %), reversible pulpitis (23.3 %), Gingivitis (11.4 %), Periodontitis (6.2 %) and Halitosis/bad breadth (8.8 %). The top 5 conditions constituted over 75 % of the cases seen. About 84 % of the presentation was acute whilst 16 % was chronic. For the entire dataset and also the top five conditions, approximately 53.0 % were males and 47.0 %. Males outnumbered females on all occasions except for halitosis and most patients presented within 1 month of experiencing symptoms of dental disease. Some significant association was found between the presence of multiple chronic conditions and reversible/irreversible pulpitis. The main dental conditions presenting at the University Hospital during the stated period (i.e. between January 2006 and December 2011) were: apical periodontitis (50.4 %), reversible pulpitis (23.3 %), gingivitis (11.4 %), periodontitis (6.2 %) and halitosis/bad breadth (8.8 %).