A cloud-based home health care information sharing system to connect patients with home healthcare staff -A case report of a study in a mountainous region.

We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

Incidence and outcome of out-of-hospital cardiac arrest with public-access defibrillation. A descriptive epidemiological study in a large urban community.

BACKGROUND: Detailed characteristics of those who experience an out-of-hospital cardiac arrest (OHCA) with public-access defibrillation (PAD) are unknown. METHODS AND RESULTS: A prospective, population-based observational study involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from July 1, 2004 through December 31, 2008 in Osaka City. We extracted data for OHCA patients shocked by a public-access automated external defibrillator (AED) and evaluated the patients' and rescuers' characteristics. The main outcome measure was neurologically favorable 1-month survival. During the study period, 10,375 OHCA patients were registered and of 908 patients suffering ventricular fibrillation arrest, 53 (6%) received public-access AED shocks by lay-rescuers, with the proportion increasing from 0% in 2004 to 11% in 2008 (P for trend<0.001). Railway stations (34%) were the places where PAD shocks were most frequently delivered, followed by nursing homes (11%), medical facilities (9%), and fitness facilities (7%). In 57% of cases, the subject received public-access AED shocks delivered by non-medical persons, including employees of railway companies (13%), school teachers (6%), employees of fitness facilities (6%), and security guards (6%). The proportion of neurologically favorable 1-month survival tended to increase from 0% in 2005 to 58% in 2008 (P for trend=0.081). CONCLUSIONS: Railway stations are the most common places where shocks by public-access AEDs were delivered in large urban communities of Japan, and among lay-rescuers railway station workers use AEDs more frequently.

[Investigation of polypharmacy in late-stage elderly patients visiting a community hospital outpatient unit].

UNLABELLED: background & aim: Elderly patients often suffer comorbidity, which leads to polypharmacy (≥ 6 concurrent medications). The extent of polypharmacy in very elderly patients in university hospitals has been reported, but not in community hospital outpatient units. We investigated polypharmacy in late-stage elderly patients at an outpatient unit of a community hospital. METHODS: The study group comprised 159 patients who visited a community hospital during 6 consecutive days. We analyzed the number of consultations and the changeless prescriptions for the past three months or more in the medical records of these patients. RESULTS: Patients took up to 15 types of medication (average 6.5 ± 3.5) and up to 36 tablets (average 12.4 ± 7.8 tablets/day) at the time of survey. Over 9 months, 76.1% of patients had multiple consultations. A total of 57.9% of patients received polypharmacy. Antihypertensive drugs were prescribed to 20.3% of patients. Inappropriate prescription accounted for 4.8% of a total of 1,031 prescriptions. CONCLUSION: A larger number of very elderly patients was receiving polypharmacy and multiple consultations in outpatient units of a community hospital than has been previously reported in university hospitals. It is important to prescribe appropriately for very elderly patients in teams which include pharmacists and nurses as well as doctors.

Pharmacist-physician collaborative care for outpatients with left ventricular assist devices using a cloud-based home medical management information-sharing system: a case report.

BACKGROUND: The standard anticoagulation therapy for patients implanted with left ventricular assist devices (LVADs) includes warfarin therapy. We developed a cloud-based home medical management information-sharing system named as LVAD@home. The LVAD@home system is an application designed to be used on iPad tablet computers. This system enables the sharing of daily information between a patient and care providers in real time. In this study, we reported cases of outpatients with LVADs using this system to manage anticoagulation therapy. CASE PRESENTATION: The patient, a man in his 40s with end-stage heart failure owing to non-ischemic dilated cardiomyopathy, underwent LVAD implantation and warfarin was started on postoperative day 1. He started to use LVAD@home to manage warfarin therapy after discharge (postoperative day 47). He sent his data to care providers daily. By using this system, the pharmacist observed his signs of reduced dietary intake 179 days after discharge, and after consulting the physician, told the patient to change the timing of the next measurement earlier than usual. On the next day, the prothrombin time-international normalized ratio increased from 2.0 to 3.0, and thus the dose was decreased by 0.5 mg. Four patients used this system to monitor warfarin therapy from October 2015 to March 2018. In these patients, the time in therapeutic range was 90.1 ± 1.3, which was higher than that observed in previous studies. Additionally, there were no thromboembolic events or bleeding events. CONCLUSIONS: The cloud-based home management system can be applied to share real-time patient information of factors, including dietary intake that interact with warfarin. It can help to improve long-term anticoagulation outcomes in patients implanted with LVAD.

A cloud-based home management system for patients with a left ventricular assist device: a case report.

Since implantable left ventricular assist devices (LVAD) with smaller configurations became available for bridge-to-transplant or even destination therapy in patients with end-stage heart failure, an increasing number of patients with these devices are receiving home medical management. However, these patients may be anxious about potential complications such as pump failure, thromboembolism, and infections that may occur during home management. To provide a sense of security during home management of patients with LVAD and to establish an ideal shared-care system, we developed a patient-centered cloud-based home management system for patients with LVAD. In this case report, we describe this system and report a trial of it in a 64-year-old patient with an LVAD.