Use of digital health kits to reduce readmission after cardiac surgery.

BACKGROUND: Unintended rehospitalizations after surgical procedures represent a large percentage of readmissions and have been associated with increased morbidity and cost of care. Beginning in 2017, Medicare will expand diagnostic categories subject to financial penalties for excess postoperative readmissions to include coronary revascularization procedures. Arrhythmias and pulmonary complications comprise the largest categories for readmission after cardiac surgery. Technologic advances in remote monitoring have led to the use of web-based digital health kits (DHK) aimed at reducing readmissions and improving postoperative outcomes. The present study was performed to determine the added benefit of incorporating DHK's into a formal readmissions reduction program (RRP) in preventing 30-d readmissions and to evaluate patient and provider satisfaction with the use of these devices. MATERIALS AND METHODS: This was a prospective study of all adult patients who underwent cardiac surgery at our institution from March 2014 to June 2015. During the study period, 443 adult patients (mean age, 65 ± 14, 33% female) were identified and participated in the formal RRP, 27 of whom also received a DHK after discharge (416 control group). In addition to providing a live video link to a provider specializing in cardiac surgery, the DHK also allowed for automatic daily transmission of weight, oxygen saturation, heart rate, and blood pressure. Patients also completed a daily health survey targeting symptoms concerning for heart failure, poor wound healing, poor ambulation, and nonadherence to medications. Abnormal vitals or survey responses triggered automatic notifications to the healthcare team. Satisfaction surveys were administered to participants and members of the healthcare team. Pearson χ(2) test and the Welch's t-test were used to assess statistical differences in baseline characteristics and outcome variables. RESULTS: During the study period, the readmission rate for the DHK and control groups were similar (7.4% versus 9.9%, P = 0.65). The use of DHKs led to 1649 alerts and 144 interventions, with the highest number of alerts occurring during d 5-9. The majority of alerts (64%) were prompted by abnormal biometric measurements, and a significant correlation was noted between abnormal biometrics and required intervention (r = 0.62, P < 0.001). No correlation was seen between alerts because of health survey responses (r = 0.07, P = 0.71) or missed check-ins (r = 0.06, P = 0.76) and required interventions. Poststudy satisfaction surveys showed an overall satisfaction rating of 4.9 ± 0.5 for DHK patients and 4.9 ± 0.2 for members of the care team (scale 1-5, 5 = agree). CONCLUSIONS: In our study, adding DHKs to a formal RRP was not associated with a significant decrease in 30-d readmission rates. We also found that notifications because of abnormal biometric measures were significantly correlated with required interventions. In contrast, notifications due to abnormal health survey responses were not associated with increased interventions. Both patients and members of the healthcare team were highly satisfied with this technology. DHKs appear to extend care beyond the inpatient period and provide a portal for telemonitoring of surgical patients. However, this modality is highly resource intensive and may not significantly reduce readmissions. Further studies are warranted to evaluate the efficacy of such kits in reducing readmissions and costs of care.

Zinc(II)-Sterol Hydrazone Complex as a Potent Anti-Leishmania Agent: Synthesis, Characterization, and Insight into Its Mechanism of Antiparasitic Action.

Searching for new alternatives for treating leishmaniasis, we present the synthesis, characterization, and biological evaluation against Leishmania amazonensis of the new ZnCl2(H3)2 complex. H3 is 22-hydrazone-imidazoline-2-yl-chol-5-ene-3ß-ol, a well-known bioactive molecule functioning as a sterol Δ24-sterol methyl transferase (24-SMT) inhibitor. The ZnCl2(H3)2 complex was characterized by infrared, UV-vis, molar conductance measurements, elemental analysis, mass spectrometry, and NMR experiments. The biological results showed that the free ligand H3 and ZnCl2(H3)2 significantly inhibited the growth of promastigotes and intracellular amastigotes. The IC50 values found for H3 and ZnCl2(H3)2 were 5.2 µM and 2.5 µM for promastigotes, and 543 nM and 32 nM for intracellular amastigotes, respectively. Thus, the ZnCl2(H3)2 complex proved to be seventeen times more potent than the free ligand H3 against the intracellular amastigote, the clinically relevant stage. Furthermore, cytotoxicity assays and determination of selectivity index (SI) revealed that ZnCl2(H3)2 (CC50 = 5 µΜ, SI = 156) is more selective than H3 (CC50 = 10 µΜ, SI = 20). Furthermore, as H3 is a specific inhibitor of the 24-SMT, free sterol analysis was performed. The results showed that H3 was not only able to induce depletion of endogenous parasite sterols (episterol and 5-dehydroepisterol) and their replacement by 24-desalkyl sterols (cholesta-5,7,24-trien-3ß-ol and cholesta-7,24-dien-3ß-ol) but also its zinc derivative resulting in a loss of cell viability. Using electron microscopy, studies on the fine ultrastructure of the parasites showed significant differences between the control cells and parasites treated with H3 and ZnCl2(H3)2. The inhibitors induced membrane wrinkle, mitochondrial injury, and abnormal chromatin condensation changes that are more intense in the cells treated with ZnCl2(H3)2.