Assessment of finger dexterity through the DIGITS joint tracking web application-An evaluation study with comparison to the nine-hole pegboard test.

BACKGROUND: Hand dexterity is an important clinical marker after hand surgery as it can greatly impact one's ability to perform their day-to-day activities. With the increased focus on remote patient monitoring after hand surgery, new technologies are required to remotely monitor hand dexterity. PURPOSE: The purpose of this study is to identify dexterity outcomes using the web application "DIGITS" and compare these outcomes to the nine-hole-pegboard test (NHPT). STUDY DESIGN: Cross-sectional observational study. METHODS: This was a two-part study with a pilot of our remote dexterity design using DIGITS followed by a validation study comparing DIGITS to a gold-standard metric of dexterity, NHPT. The pilot study recruited 42 healthy subjects between the ages of 18-65 to perform a remote finger tapping exercise using DIGITS. The second part of the study included 50 subjects between the ages of 18-65. Participants completed a demographic questionnaire and then completed three finger tapping sequences for 20 seconds using DIGITS and three trials of the NHPT with each hand. Correlational analyses were done to compare the DIGITS dexterity test with the NHPT. RESULTS: Four outcome measures to assess dexterity were identified, which included (1) total sequences completed in 20 seconds, (2) time to complete 10 sequences, (3) average frequency per sequence, and (3) sequence accuracy. Significant negative correlations were found with the NHPT and total sequences completed in 20 seconds in both dominant and non-dominant hand trials. Additionally, significant negative correlations were found between the NHPT and the time to complete 10 sequences and average frequency in the non-dominant hand trials. CONCLUSIONS: This study shows promising results for the use of DIGITS as a remote measure of hand dexterity. The total number of sequences completed significantly correlates with the NHPT and should be further explored in representative patient populations.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review.

Background: Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM. Methods: Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done. Results: There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments. Conclusions: Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.

Unplanned readmissions after Impella mechanical circulatory support.

BACKGROUND: Early readmissions significantly impact on patient-wellbeing, burden the health-care system, and are important quality metrics. Data on 30-day readmission following Impella mechanical circulatory support (MCS) are unknown. We aimed to assess the rates, causes and clinical outcomes associated with 30-day unplanned readmissions after Impella mechanical circulatory support (MCS). METHODS: Discharged patients who underwent Impella MCS between 2016 and 2019 in the U.S. Nationwide Readmission Database were analyzed. Incidence, causes, and outcomes associated with 30-day unplanned readmissions were assessed. RESULTS: Of 22,055 patients who received Impella MCS, 2685 (12.2%) experienced 30-day readmissions. Cardiac readmissions accounted for 51.7% compared to 48.3% of non-cardiac readmissions, and most (70%) patients were readmitted back to the index hospital. Heart failure was the leading cause of cardiac readmissions accounting for 25% of them, whereas infections were the most common cause among non-cardiac readmissions. Patients who were readmitted were significantly older (median age 71 versus 68 years), more likely to be female (31% versus 26%) and had a shorter length-of-stay (index hospitalization, median 8 versus 9 days) compared to those who were not readmitted. Factors independently associated with 30-day readmissions were chronic renal (aOR: 1.46, 95% CI: 1.35-1.57), pulmonary (aOR: 1.23, 95% CI: 1.15-1.33), and liver disease (aOR: 1.38, 95% CI: 1.17-1.63), anemia (aOR: 1.35, 95% CI: 1.26-1.46), female sex (aOR: 1.21, 95% CI: 1.12-1.30), index admission on weekends (aOR: 1.23, 95% CI: 1.13-1.34), STEMI diagnosis (aOR: 1.16, 95% CI: 1.02-1.31), major adverse event during index hospitalization (aOR: 1.11, 95% CI: 1.00-1.24), prolonged length-of-stay (median 9 vs. 8 days, P < 0.001), and discharge against medical advice (aOR: 2.06, 95% CI: 1.37-3.09). Significantly higher mortality rates were overserved during readmissions to a hospital different than the MCS implanting hospital (12% versus 5.9%, P < 0.001). CONCLUSION: Thirty-day readmissions after Impella MCS are relatively common and relate to sex, baseline comorbidities, presentation, expected primary payer, discharge destination and initial length of hospital stay. Heart failure was the leading cause of cardiac readmissions, whereas infections were the most common cause among non-cardiac readmissions. Most patients were readmitted to the same hospital as their index admission for MCS. Higher mortality rates were observed when patients were readmitted to a different hospital.

Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack.

Background: We examined the frequency and risk factors associated with readmission after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke and/or transient ischemic attack (TIA). Methods: Hospitalizations for LAAC were identified from the US National Readmission Database, 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into those occurring within 0 to 30 days vs within 31 to 180 days. Patients were stratified based on the history of previous stroke and/or TIA. Results: Of 12,901 discharges after LAAC, 28% had previous stroke and/or TIA, and 8.2% had a readmission within 30 days while 18% had a readmission within 31 to 180 days. The rates of in-hospital complications and readmissions at both periods were not significantly different between individuals with vs without previous stroke and/or TIA. Cardiac causes accounted for 28% of readmissions within 30 days and 32% of those within 31 to 180 days, and congestive failure, bleeding, and infections were the most common readmission diagnoses. New stroke and/or TIA accounted for 4% and 6% of the total noncardiac readmissions within 30 days and 31 to 180 days, respectively, and the incidence was higher among those with previous stroke and/or TIA. Female sex and index hospitalization length of stay (LOS) > 1 day were factors independently associated with readmission within 30 days, whereas LOS, diabetes, renal disease, chronic obstructive pulmonary disease, and anemia were among the factors associated with readmissions within 31 to 180 days. Conclusions: Unplanned rehospitalizations were common after LAAC and had similar frequency for patients with vs without previous ischemic stroke and/or TIA. Female sex and index hospitalization LOS > 1 day were among the strongest factors that were independently associated with readmission within 30 days.

Contexte: Nous avons examiné la fréquence et les facteurs de risque des réadmissions consécutives à une fermeture de l'appendice auriculaire gauche (FAOG) chez les patients ayant ou non subi un accident vasculaire cérébral (AVC) ischémique et/ou un accident ischémique transitoire (AIT). Méthodologie: Les hospitalisations pour une FAOG ont été recensées au moyen de la US National Readmission Database (base de données nationale des réadmissions aux États-Unis) pour la période 2016-2018. Le critère d'évaluation principal était la première réadmission non prévue après une FAOG, avec stratification du moment de la réadmission selon que celle-ci était survenue de 0 à 30 jours ou de 31 à 180 jours après l'intervention. Les patients ont été stratifiés en fonction des antécédents d'AVC et/ou d'AIT. Résultats: Parmi les 12 901 patients ayant reçu leur congé de l'hôpital après une FAOG, 28 % avaient des antécédents d'AVC et/ou d'AIT; 8,2 % des patients admissibles ont été réadmis dans les 30 jours et 18 %, entre le 31e et le 180e jour suivant l'intervention. Aucune différence significative n'a été observée entre les patients ayant subi un AVC et/ou un AIT et les patients qui n'en avaient pas subi en ce qui concerne les taux de complications hospitalières et de réadmission durant ces deux périodes. Les causes cardiaques représentaient 28 % des réadmissions dans les 30 jours et 32 % des réadmissions entre le 31e et le 180e jour. L'insuffisance cardiaque congestive, les hémorragies et les infections ont été les causes les plus fréquentes de réadmission. Les nouveaux cas d'AVC et/ou d'AIT ont respectivement été à l'origine de 4 % et de 6 % de l'ensemble des réadmissions de cause non cardiaque dans les 30 jours, et entre le 31e et le 180e jour, et leur fréquence a été plus élevée chez les patients ayant des antécédents d'AVC et/ou d'AIT. Le sexe féminin et une durée d'hospitalisation initiale > 1 jour ont été des facteurs indépendants associés aux réadmissions dans les 30 jours, tandis que la durée de l'hospitalisation, un diabète, une néphropathie, une maladie pulmonaire obstructive chronique et une anémie faisaient partie des facteurs associés aux réadmissions entre le 31e et le 180e jour. Conclusions: Les réhospitalisations non prévues ont été courantes après une FAOG, et leur fréquence a été similaire en présence ou en l'absence d'antécédents d'AVC ischémique et/ou d'AIT. Le sexe féminin et une durée d'hospitalisation initiale > 1 jour ont été les facteurs les plus importants associés aux réadmissions dans les 30 jours.

Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease.

BACKGROUND: Interatrial block (IAB) has been previously shown to predict atrial fibrillation (AF) in cardiac populations. This study sought to evaluate the relationship between IAB and new-onset AF in a population of patients undergoing clinically indicated coronary angiography who received carotid ultrasonography. METHODS: A population of 355 subjects undergoing coronary angiography and carotid ultrasound were retrospectively studied. Common carotid artery (CCA) far-wall intima-media thickness (CIMT), and total carotid plaque area were measured. Coronary artery disease was measured by angiography and IAB by electrocardiograph (ECG). RESULTS: The mean population age was 64.4 years, 70.4% male, mean BMI 29.9 kg/m2. IAB was a predictor of new-onset AF (OR =2.40, 95% CI: 1.33-4.29; P=0.003). There was a significant difference in AF free survival time between patients with IAB and without IAB via Cox proportional hazard analysis [52.9 months (95% CI: 47.1-58.7 months) vs. 62.6 months (95% CI: 58.8-66.5 months); P=0.006]. Patients with IAB had a significantly greater CIMT (0.883±0.193 vs. 0.829±0.192 mm; P=0.013) and a higher prevalence of significant (>70%) right coronary artery lesions than patients without (45.8% vs. 34.4%; P=0.026). Significant predictors of IAB on multivariate analysis were BMI ≥30 kg/m2 (OR =3.14, 95% CI: 1.14-6.71, P=0.003), male sex (OR =1.78, 95% CI: 1.05-3.03, P=0.034), increased mean CIMT (per 0.1 mm increase) (OR =1.75, 95% CI: 1.00-3.07, P=0.050) and increased age (per 10-year increase) (OR =1.46, 95% CI: 1.14-1.88, P=0.003). CONCLUSIONS: IAB is a predictor of new-onset AF in patients with carotid and coronary artery disease. Both carotid and coronary artery disease are associated with a higher prevalence of IAB.

Comparison of the Extent of Coronary Artery Disease in Patients With Versus Without Interatrial Block and Implications for New-Onset Atrial Fibrillation.

Interatrial block (IAB) represents delay or block of conduction between the atria. IAB has been shown to predict the development or recurrence of atrial fibrillation (AF) in various clinical scenarios. Few studies have examined the correlation between coronary artery disease and the prevalence of IAB and its impact on AF. The aim of this study was to determine if specific coronary artery lesions (location and number) are associated with the presence of IAB and development of new-onset AF. Retrospective analysis of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) to our institution. Data were recorded for clinical, echocardiographic, angiographic, electrocardiographic, and outcome variables. Semiautomatic calipers and scanned electrocardiograms at 300 DPI maximized × 8 were used to measure P-wave duration, with a follow-up for a minimum of 1 year. The chi-square and independent-sample t tests were done using IBM SPSS. A total of 322 patients were included in the analysis. Men 72.3%, mean age 65.4 ± 11.9 years, mean ejection fraction of 55.2 ± 12.7% and mean left atrial diameter of 38.7 ± 6 mm. The prevalence of partial IAB was 31.9%, and advanced IAB was 6.5%. Patients with IAB were significantly older (<0.001) and had a greater prevalence of hypertension (0.014). The presence of diffuse coronary artery disease defined as >1 significant coronary artery lesion was associated with IAB (0.026). No specific coronary artery lesion location was found to be associated with IAB nor increased P-wave duration. Patients who developed AF during the follow-up had a significantly higher prevalence of IAB (p = 0.021) and also higher prevalence of diffuse coronary artery disease (p = 0.001). IAB is significantly associated with diffuse coronary artery disease in patients with NSTEMI. IAB is significantly associated with the development of new-onset AF within 12 months after NSTEMI.