Continuously monitoring the human machine? - A cross-sectional study to assess the acceptance of wearables in Germany.

Background: Wearables have the potential to transform healthcare by enabling early detection and monitoring of chronic diseases. This study aimed to assess wearables' acceptance, usage, and reasons for non-use. Methods: Anonymous questionnaires were used to collect data in Germany on wearable ownership, usage behaviour, acceptance of health monitoring, and willingness to share data. Results: Out of 643 respondents, 550 participants provided wearable acceptance data. The average age was 36.6 years, with 51.3% female and 39.6% residing in rural areas. Overall, 33.8% reported wearing a wearable, primarily smartwatches or fitness wristbands. Men (63.3%) and women (57.8%) expressed willingness to wear a sensor for health monitoring, and 61.5% were open to sharing data with healthcare providers. Concerns included data security, privacy, and perceived lack of need. Conclusion: The study highlights the acceptance and potential of wearables, particularly for health monitoring and data sharing with healthcare providers. Addressing data security and privacy concerns could enhance the adoption of innovative wearables, such as implants, for early detection and monitoring of chronic diseases.

The Effects of Rso2 and PI Monitoring Images on the Treatment of Premature Infants Based on Deep Learning.

In recent years, due to the combined effects of individual behavior, psychological factors, environmental exposure, medical conditions, biological factors, etc., the incidence of preterm birth has gradually increased, so the incidence of various complications of preterm infants has also become higher and higher. This article is aimed at studying the therapeutic effects of preterm infants and proposing the application of rSO2 and PI image monitoring based on deep learning to the treatment of preterm infants. This article introduces deep learning, blood perfusion index, preterm infants, and other related content in detail and conducts experiments on the treatment of rSO2 and PI monitoring images based on deep learning in preterm infants. The experimental results show that the rSO2 and PI monitoring images based on deep learning can provide great help for the treatment of preterm infants and greatly improve the treatment efficiency of preterm infants by at least 15%.

The Relationship Between Continuous Glucose Monitoring and OGTT in Youth and Young Adults With Cystic Fibrosis.

CONTEXT: Early glucose abnormalities in people with cystic fibrosis (PwCF) are commonly detected by continuous glucose monitoring (CGM). Relationships between these CGM abnormalities and oral glucose tolerance testing (OGTT) in PwCF have not been fully characterized. OBJECTIVE: This work aimed to determine the relationship between CGM and common OGTT-derived estimates of ß-cell function, including C-peptide index and oral disposition index (oDI) and to explore whether CGM can be used to screen for OGTT-defined prediabetes and cystic fibrosis-related diabetes (CFRD). METHODS: PwCF not on insulin and healthy controls aged 6 to 25 years were enrolled in a prospective study collecting OGTT and CGM. A subset underwent frequently sampled OGTTs (fsOGTT) with 7-point glucose, insulin, and C-peptide measurements. Pearson correlation coefficient was used to test the association between select CGM and fsOGTT measures. Receiver operating curve (ROC) analysis was applied to CGM variables to determine the cutoff optimizing sensitivity and specificity for detecting prediabetes and CFRD. RESULTS: A total of 120 participants (controls = 35, CF = 85), including 69 with fsOGTTs, were included. CGM coefficient of variation correlated inversely with C-peptide index (Cpeptide30-Cpeptide0/Glucose30-Glucose0) (r = -0.45, P < .001) and oDIcpeptide (C-peptide index)(1/cpep0) (r = -0.48, P < .0001). In PwCF, CGM variables had ROC - areas under the curve ranging from 0.43 to 0.57 for prediabetes and 0.47 to 0.6 for CFRD. CONCLUSION: Greater glycemic variability on CGM correlated with reduced ß-cell function. However, CGM performed poorly at discriminating individuals with and without OGTT-defined CFRD and prediabetes. Prospective studies are now needed to determine how well the different tests predict clinically relevant nonglycemic outcomes in PwCF.

Relationship Between Time in Range, Glycemic Variability, HbA1c, and Complications in Adults With Type 1 Diabetes Mellitus.

PURPOSE: Real-time continuous glucose monitoring (RT-CGM) provides information on glycemic variability (GV), time in range (TIR), and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. METHODS: Between September 2014 and January 2017, 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV], and SD) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy, or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. RESULTS: Individuals with microvascular complications were older (P < 0.001), had a longer diabetes duration (P < 0.001), a higher HbA1c (7.8 ± 0.9 vs 7.5 ± 0.9%, P < 0.001), and spent less time in range (60.4 ± 12.2 vs 63.9 ± 13.8%, P = 0.022) compared with those without microvascular complication. Diabetes duration (odds ratio [OR] = 1.12 [1.09-1.15], P < 0.001) and TIR (OR = 0.97 [0.95-0.99], P = 0.005) were independent risk factors for composite microvascular complications, whereas SD and CV were not. Age (OR = 1.08 [1.03-1.14], P = 0.003) and HbA1c (OR = 1.80 [1.02-3.14], P = 0.044) were risk factors for macrovascular complications. TIR (OR = 0.97 [0.95-0.99], P = 0.021) was the only independent risk factor for hospitalizations for hypoglycemia or ketoacidosis. CONCLUSIONS: Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD, and CV were not associated with macrovascular complications.

IoT-Based Smart Health Monitoring System for COVID-19 Patients.

During the ongoing COVID-19 pandemic, Internet of Things- (IoT-) based health monitoring systems are potentially immensely beneficial for COVID-19 patients. This study presents an IoT-based system that is a real-time health monitoring system utilizing the measured values of body temperature, pulse rate, and oxygen saturation of the patients, which are the most important measurements required for critical care. This system has a liquid crystal display (LCD) that shows the measured temperature, pulse rate, and oxygen saturation level and can be easily synchronized with a mobile application for instant access. The proposed IoT-based method uses an Arduino Uno-based system, and it was tested and verified for five human test subjects. The results obtained from the system were promising: the data acquired from the system are stored very quickly. The results obtained from the system were found to be accurate when compared to other commercially available devices. IoT-based tools may potentially be valuable during the COVID-19 pandemic for saving people's lives.

Miniaturized wireless, skin-integrated sensor networks for quantifying full-body movement behaviors and vital signs in infants.

Early identification of atypical infant movement behaviors consistent with underlying neuromotor pathologies can expedite timely enrollment in therapeutic interventions that exploit inherent neuroplasticity to promote recovery. Traditional neuromotor assessments rely on qualitative evaluations performed by specially trained personnel, mostly available in tertiary medical centers or specialized facilities. Such approaches are high in cost, require geographic proximity to advanced healthcare resources, and yield mostly qualitative insight. This paper introduces a simple, low-cost alternative in the form of a technology customized for quantitatively capturing continuous, full-body kinematics of infants during free living conditions at home or in clinical settings while simultaneously recording essential vital signs data. The system consists of a wireless network of small, flexible inertial sensors placed at strategic locations across the body and operated in a wide-bandwidth and time-synchronized fashion. The data serve as the basis for reconstructing three-dimensional motions in avatar form without the need for video recordings and associated privacy concerns, for remote visual assessments by experts. These quantitative measurements can also be presented in graphical format and analyzed with machine-learning techniques, with potential to automate and systematize traditional motor assessments. Clinical implementations with infants at low and at elevated risks for atypical neuromotor development illustrates application of this system in quantitative and semiquantitative assessments of patterns of gross motor skills, along with body temperature, heart rate, and respiratory rate, from long-term and follow-up measurements over a 3-mo period following birth. The engineering aspects are compatible for scaled deployment, with the potential to improve health outcomes for children worldwide via early, pragmatic detection methods.

Cross-sectional assessment of sleep and fatigue in middle-aged Japanese women with primary Sjogren syndrome or rheumatoid arthritis using self-reports and wrist actigraphy.

ABSTRACT: To investigate fatigue, health-related quality of life (HR-QOL), and sleep quality in women with primary Sjogren syndrome (pSS) or rheumatoid arthritis (RA) as compared with healthy controls using self-reports and wrist actigraphy.In this cross-sectional observational study, we evaluated a total of 25 patients (aged 40-75 years) with pSS, 10 with RA, and 17 healthy control subjects living in Japan. The HR-QOL was assessed using the Short Form-36. Fatigue was evaluated using the Short Form-36 vitality score, visual analog scale (VAS) for fatigue, and 2 questionnaire items using scores based on a 4-point Likert scale. Sleep quality was measured using the Japanese version of the Pittsburgh Sleep Quality Index, VAS for sleep quality, and wrist actigraphy for 14 days.Patients with pSS reported severer fatigue and lower HR-QOL than healthy controls, especially in mental health. Based on the Pittsburgh Sleep Quality Index score, 56% of the patients with pSS were poor sleepers, which was higher than healthy controls (29.4%). Furthermore, the patients with pSS scored significantly lower on the VAS for sleep quality than healthy controls (40.5 vs 63.7, P = .001). Although subjective assessments revealed slight sleep disturbances in patients with pSS, wrist actigraphy revealed no differences when compared with healthy controls for total sleep time (421.8 minutes vs 426.5 minutes), sleep efficiency (95.2% vs 96.4%), number of awakenings (1.4 vs 0.9), and wake after sleep onset (22.4 minutes vs 16.1 minutes). Poor subjective sleep quality was associated with enhanced fatigue. However, sleep efficiency, as determined by actigraphy, was not associated with fatigue. Notably, the patients with RA and healthy controls did not differ significantly in terms of fatigue or sleep quality, although patients with RA experienced more nocturnal awakenings than healthy controls (1.7 vs 0.9, P = .04).Patients with pSS experience severe fatigue, poor HR-QOL, and sleep disturbances, which are associated with fatigue. However, wrist actigraphy did not reveal differences in sleep quality, suggesting that it may not be an appropriate measure of sleep in patients with pSS.

Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury: An analysis of the Trauma Quality Improvement Program registry.

BACKGROUND: Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). METHODS: A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. RESULTS: A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. CONCLUSION: Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.

Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement.

OBJECTIVE: Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. DESIGN: Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. SETTING: Patient safety incident reports (10 years, 2005-2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. PARTICIPANTS: Reports describing severe harm/death in acute medical unit were identified. MAIN OUTCOME MEASURES: Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. RESULTS: A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. CONCLUSION: This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.

The accuracy of self-reported physical activity questionnaires varies with sex and body mass index.

BACKGROUND: Factors contributing to the accurate measurement of self-reported physical activity are not well understood in middle-aged adults. We investigated the associations between two self-reported surveys and objectively measured physical activity in middle-aged adults, and the influence of individual and sociodemographic factors on these associations, at different intensities utilizing an observational study design. METHODS: Participants (n = 156) wore a SenseWear Armband™ (SWA) for a continuous seven-day period over the triceps of the left arm, to measure energy expenditure in metabolic equivalents. Participants also completed the Physical Activity Recall questionnaire (PAR) and Active Australia Survey (AAS). Associations were analyzed separately in general linear models for each intensity. The influence of individual and sociodemographic factors was assessed through moderator analyses. RESULTS: The PAR and SWA were significantly positively associated at moderate (ß = 0.68, 95% CI 0.16-1.20), vigorous (ß = 0.36, 95% CI 0.20-0.53), moderate-to-vigorous physical activity (MVPA) (ß = 0.52, 95% CI 0.20-0.83), and total METmins (ß = 0.63, 95% CI 0.35-0.90), the AAS and SWA were associated at all intensities (moderate (ß = 0.41, 95% CI 0.15-0.67), vigorous (ß = 0.32, 95% CI 0.19-0.46), MVPA (ß = 0.42, 95% CI 0.18-0.65) and total METmins (ß = 0.62, 95% CI 0.29-0.96). A significant interaction between the PAR and sex for vigorous-intensity unveiled a weaker association in women. Both surveys tended to under-report physical activity. The largest margins of error were present at light and moderate intensities. For the PAR, participants reported over 20 hours, or 69% less light physical activity than recorded by the SWA per week. For the AAS, participants reported over 7 hours, or 38% less moderate physical activity. Compared to lighter intensities, time spent at a vigorous intensity was overreported by participants with the PAR and AAS by 91 and 43 minutes per week, respectively. The addition of Body Mass Index (BMI) resulted in non-significant interactions between the PAR and SWA for moderate-intensity, and the AAS and SWA for vigorous-intensity; a significant interaction between AAS and BMI indicated that the strength of the association differed by BMI for vigorous-intensity. CONCLUSIONS: The PAR and AAS are not equivalent to the SWA, and sex and BMI may alter the associations between the measures.

Association of kidney function and atrial fibrillation progression to clinical outcomes in patients with cardiac implantable electronic devices.

BACKGROUND: Kidney function may promote progression of AF. OBJECTIVE: We evaluated the association of kidney function to AF progression and resultant clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS: We performed a retrospective cohort study using national clinical data from the Veterans Health Administration linked to CIED data from the Carelink® remote monitoring data warehouse (Medtronic Inc, Mounds View, MN). All devices had atrial leads and at least 75% of remote monitoring transmission coverage. Patients were included at the date of the first AF episode lasting ≥6 minutes, and followed until the occurrence of persistent AF in the first year, defined as ≥7 consecutive days with continuous AF. We used Cox regression analyses with persistent AF as a time-varying covariate to examine the association to stroke, myocardial infarction, heart failure and death. RESULTS: Of, 10,323 eligible patients, 1,771 had a first CIED-detected AF (mean age 69 ± 10 years, 1.2% female). In the first year 355 (20%) developed persistent AF. Kidney function was not associated with persistent AF after multivariable adjustment including CHA2DS2-VASc variables and prior medications. Only higher age increased the risk (HR: 1.37 per 10 years; 95% CI:1.22-1.54). Persistent AF was associated to higher risk of heart failure (HR: 2.27; 95% CI: 1.88-2.74) and death (HR: 1.60; 95% CI: 1.30-1.96), but not stroke (HR: 1.28; 95% CI: 0.62-2.62) or myocardial infarction (HR: 1.43; 95% CI: 0.91-2.25). CONCLUSION: Kidney function was not associated to AF progression, whereas higher age was. Preventing AF progression could reduce the risk of heart failure and death.

Lockdown, slow down: impact of the COVID-19 pandemic on physical activity-an observational study.

AIMS: In response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study. METHODS: This study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of 'stay at home' lockdown measures in the form of 'minutes active per day' (min/day). RESULTS: Data were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001). CONCLUSIONS: In a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures. TRIAL REGISTRATION NUMBER: NCT04177199.

Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS.

Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = - 0.60; p = 0.001) and within-subjects correlation (r = - 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.

Utilization of partograph and its associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia.

BACKGROUND: Partographs should be used universally to monitor the mother and fetus's conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian. METHODS: An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used. RESULT: The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization. CONCLUSIONS: The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it.

The Promise of Remote Patient Monitoring: Lessons Learned During the COVID-19 Surge in New York City.

The coronavirus pandemic catalyzed a digital health transformation, placing renewed focus on using remote monitoring technologies to care for patients outside of hospitals. At NewYork-Presbyterian, the authors expanded remote monitoring infrastructure and developed a COVID-19 Hypoxia Monitoring program-a critical means through which discharged COVID-19 patients were followed and assessed, enabling the organization to maximize inpatient capacity at a time of acute bed shortage. The pandemic tested existing remote monitoring efforts, revealing numerous operating challenges including device management, centralized escalation protocols, and health equity concerns. The continuation of these programs required addressing these concerns while expanding monitoring efforts in ambulatory and transitions of care settings. Building on these experiences, this article offers insights and strategies for implementing remote monitoring programs at scale and improving the sustainability of these efforts. As virtual care becomes a patient expectation, the authors hope hospitals recognize the promise that remote monitoring holds in reenvisioning health care delivery.

Testicular cancer follow-up costs in Germany from 2000 to 2015.

PURPOSE: Advances in testicular cancer screening and therapy increased 10-year survival to 97% despite a rising incidence; eventually expanding the population of survivors requiring follow-up. We analyzed 10-year follow-up costs after testicular cancer treatment in Germany during 2000, 2008, and 2015. METHODS: Testicular cancer follow-up guidelines were extracted from the European Association of Urology. Per patient costs were estimated with a micro-costing approach considering direct and indirect medical expenses derived from expert interviews, literature research, and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. Cost progression was compared across cancer histology, stage, stakeholders, resource use, and follow-up years. RESULTS: Mean 10-year follow-up costs per patient for stage I seminomatous germ-cell tumors (SGCT) on surveillance declined from EUR 11,995 in 2000 to EUR 4,430 in 2015 (p < 0.001). Advanced SGCT spending shrank from EUR 13,866 to EUR 9,724 (p < 0.001). In contrast, expenditure for stage II SGCT increased from EUR 7,159 to EUR 9,724 (p < 0.001). While insurers covered 32% of costs in 2000, only 13% of costs were reimbursed in 2015 (p < 0.001). 70% of SGCT follow-up resources were consumed by medical imaging (x-ray, CT, ultrasound, FDG-PET). Spending was unevenly distributed across follow-up years (years 1-2: 50%, years 3-5: 39%, years 5-10: 11%). CONCLUSIONS: The increasing prevalence of testicular cancer survivors caused German statutory insurers to cut per patient cost by up to 80% by budgeting services and decreasing reimbursement rates. The economic burden was gradually redistributed to patients and providers.

A deep learning-based medication behavior monitoring system.

The internet of things (IoT) and deep learning are emerging technologies in diverse research fields, including the provision of IT services in medical domains. In the COVID-19 era, intelligent medication behavior monitoring systems for stable patient monitoring are further required, because many patients cannot easily visit hospitals. Several previous studies made use of wearable devices to detect medication behaviors of patients. However, the wearable devices cause inconvenience while equipping the devices. In addition, they suffer from inconsistency problems due to errors of measured values. We devise a medication behavior monitoring system that uses the IoT and deep learning to avoid sensing errors and improve user experiences by effectively detecting various activities of patients. Based on the real-time operation of our proposed IoT device, the proposed solution processes captured images of patents via OpenPose to check medication situations. The proposed system identifies medication status on time by using a human activity recognition scheme and provides various notifications to patients' mobile devices. To support reliable communication between our system and doctors, we employ MQTT protocol with periodic data transmissions. Thus, the measured information of patient's medication status is transmitted to the doctors so that they can periodically perform remote treatments. Experimental results show that all medication behaviors are accurately detected and notified to the doctor efficiently, improving the accuracy of monitoring the patient's medication behavior.

Correlation between skin temperature in the lower limbs and biochemical marker, performance data, and clinical recovery scales.

The aim of this study was to evaluate the correlation between tools commonly used in the detection of physiological changes, such as clinical complaints, a biochemical marker of muscle injury, and performance data during official matches, with infrared thermography, which has been commonly used in the possible tracking of musculoskeletal injuries in athletes. Twenty-two athletes from a professional soccer club (age 27.7 ± 3.93 years; BMI 24.35 ± 1.80 kg/cm2) were followed during the season of a national championship, totaling 19 matches with an interval of 7 days between matches. At each match, the athletes used a Global Positioning System (GPS) device to collect performance data. Forty-eight hours after each match, every athlete's perception of recovery, fatigue, and pain was documented. Blood was collected for creatine kinase (CK) analysis, and infrared thermography was applied. Only athletes who presented pain above 4 in either limb were included for thermographic analysis. Each thermographic image was divided into 14 regions of interest. For statistical analysis, we included only the images that showed differences ≥ 1° C. Data normality was verified by the Kolmogorov-Smirnov test with Dallal-Wilkinson-Lilliefors correction. We used the Pearson correlation coefficient to verify the correlation between infrared thermography and the biochemical marker, performance data, and clinical recovery scales. No correlation was observed between mean skin temperature and blood CK levels, pain level, perception of recovery, and fatigue perception (r <0.2, p>0.05). Thus, infrared thermography did not correlate with CK level, pain, fatigue perception, or recovery, nor with performance variables within the field.

Self-Monitoring via Digital Health in Weight Loss Interventions: A Systematic Review Among Adults with Overweight or Obesity.

OBJECTIVE: Self-monitoring is a core component of behavioral obesity treatment, but it is unknown how digital health has been used for self-monitoring, what engagement rates are achieved in these interventions, and how self-monitoring and weight loss are related. METHODS: This systematic review examined digital self-monitoring in behavioral weight loss interventions among adults with overweight or obesity. Six databases (PubMed, Embase, Scopus, PsycInfo, CINAHL, and ProQuest Dissertations & Theses) were searched for randomized controlled trials with interventions ≥ 12 weeks, weight outcomes ≥ 6 months, and outcomes on self-monitoring engagement and their relationship to weight loss. RESULTS: Thirty-nine studies from 2009 to 2019 met inclusion criteria. Among the 67 interventions with digital self-monitoring, weight was tracked in 72% of them, diet in 81%, and physical activity in 82%. Websites were the most common self-monitoring modality, followed by mobile applications, wearables, electronic scales, and, finally, text messaging. Few interventions had digital self-monitoring engagement rates ≥ 75% of days. Rates were higher in digital- than in paper-based arms in 21 out of 34 comparisons and lower in just 2. Interventions with counseling had similar rates to standalone interventions. Greater digital self-monitoring was linked to weight loss in 74% of occurrences. CONCLUSIONS: Self-monitoring via digital health is consistently associated with weight loss in behavioral obesity treatment.

Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study.

BACKGROUND: Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. OBJECTIVES: To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. DESIGN AND METHODS: We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. RESULTS: During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. CONCLUSION: Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.