NMR-based lipoprotein analysis for patients with severe hypercholesterolemia undergoing lipoprotein apheresis or PCSK9-inhibitor therapy (NAPALI-Study).

Taking into account the discordance between low-density lipoprotein cholesterol (LDL-C) and LDL particle (LDL-P) number, cardiovascular risk more closely correlates with LDL-P in patients. The aim of our study was to evaluate the number of lipid particles in patients with severe hypercholesterolemia treated with different lipid-lowering regimens. Four groups of patients differing with respect to lipid-lowering therapy were recruited from hypercholesterolemic outpatients and lipoprotein apheresis (LA) facilities, and were treated with statins alone (group A), with statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (PCSK9i) (group B), with statins and LA (group C), or with statins, PCSK9i, and LA (group D). Cholesterol, triglycerides, LDL-C, high-density lipoprotein cholesterol (HDL-C), LDL-P number and size, HDL-P number and size were determined using nuclear magnetic resonance spectroscopy. The lowest LDL-P number was achieved at the end of LA sessions in combination with statins or in combination with statins and a monoclonal PCSK9i (median; 25th and 75th percentile) (group C: 244 nmoL/L: 237, 244, P < 0.05; group D: 244 nmoL/L: 99, 307, P < 0.05). Comparing LDL-P number at the start of LA (group C: 978 nmoL/L: 728, 1404; group D: 954 nmoL/L: 677, 1521) to the other patient groups (groups A and B), the lowest LDL-P number was measured in patients treated with PCSK9i and a statin (group B): LDL-P (762 nmoL/L: 604, 1043, P < 0.05), large LDL-P (472 nmoL/L: 296, 574, P < 0.05), and small LDL-P (342 nmoL/L: 152, 494, P < 0.05). Very low-density lipoprotein and HDL particle sizes remained approximately the same in all groups. LA in combination with statins or in combination with statins and PCSK9i most reduced LDL-P numbers in hypercholesterolemic patients.

[Advancing therapy-oriented telemedicine- Does Europe have an answer?]. / Therapie-orientierte Telemedizin - hat Europa eine Antwort?

Despite a large number of existing telemedical applications as well as numerous issues in the current implementations, the desire for intensified integration of IT solutions for the health sector is unanimous amongst all actors involved (patients, practitioners, software and hardware developers, insurers, services, etc.). This reflects the state of digital systems in use in medicine today which have yet to arrive in the 21st century and operate well below the technologically possible. Telemedica/ methods remain mainly associated to flagship projects with often limited mid- or long termimpact on patient care practicesror scientific research. Supraregional or national standards are far from being defined. The register EUSTAR under patronage of the ESH is designed to fill gaps in the current IT solutions by utilization of the innovative software system SCITIM 0 to enable broad application of telemedicine and thereby provide evidence for its scientific and economical feasibility. For this the utilization of interventional decentralised telemonitoring (idTM 0 } is suitable as it preserves clear and direct patient practitioner bonds and communication. The fundamental measure of idTM 0 - to judge the quality of the te/emedica/ application by the medical quality of the consequent actions -is rarely considered by the majority of smaller projects where other tetemedical applications and methods are established.

Telemedicine: interventional decentralised blood pressure telemonitoring (idTBPM).

Telemedicine comprises different methods of bridging a spatial distance between doctor, medical and care services and patients. These include mere data transmissions as well as alarm functionalities, consultations and therapy recommendations. A special form of telemedicine application is the interventional decentralised telemonitoring (idTM). Here the patient-practitioner relationship forms the basis for therapy control and optimisation using telemetrical medical data. To identify areas of indication of idTM, a detailed definition of transferred parameters, alarm conditions and intervention algorithms is required as a well as cost efficiency and feasibility studies. The quality of the telemedical application is determined by the medical quality of the derived actions.

[Interventional decentralized telemonitoring: possible indications and perspectives of a new method in telemedicine]. / Interventionelles dezentrales Telemonitoring: Mögliche Indikationen und Perspektiven einer neuen Methode in der Telemedizin.

Telemedicine comprises different concepts aiming to close a spatial distance between practitioner, medical staff and patient. Its functionality can include mere data transmission but extend as well to triggering alarms or enable consultation and therapy suggestions. A special form of telemedicinal application is interventional decentralized telemonitoring. Here practitioner-patient communication is characterized by telemedicinal data collection driven therapy-control and -optimization. To identify feasible indications for the employment of telemonitoring a detailed definition of communicated parameters, alarm rules and algorithms of intervention are required as well as a benefit-cost analysis. The quality of the telemedical application is determined by the medical quality of the resulting actions.

La télémédecine comprend différents concepts visant à supprimer la distance spatiale entre le praticien, le personnel médical et le patient. C'est une fonctionnalité qui peut inclure une simple transmission de données, mais s'étendre aussi bien au déclenchement d'alarmes ou permettre une consultation et des suggestions thérapeutiques. Une forme particulière d'application de la télémedicinal est la télésurveillance décentralisée interventionnelle. Ici, la communication médecin-patient est caractérisée par la collecte de données qui permettent du contrôler et d'optimiser le traitement. Pour identifier les indications possibles de la télésurveillance une définition détaillée des paramètres communiqués, les règles d'alarme et des algorithmes d'intervention sont nécessaires, ainsi qu'une analyse coûts-bénéfices. La qualité de l'application de la télémédecine est déterminée par la qualité médicale des actions qui en découlent.