The effect of tablet computer-based telemonitoring added to an established telephone disease management program on heart failure hospitalizations: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) III Randomized Controlled Trial.

BACKGROUND: Mobile health applications are becoming increasingly common. Prior work has demonstrated reduced heart failure (HF) hospitalizations with HF disease management programs; however, few of these programs have used tablet computer-based technology. METHODS: Participants with a diagnosis of HF and at least 1 high risk feature for hospitalization were randomized to either an established telephone-based disease management program or the same disease management program with the addition of remote monitoring of weight, blood pressure, heart rate and symptoms via a tablet computer for 90 days. The primary endpoint was the number of days hospitalized for HF assessed at 90 days. RESULTS: From August 2014 to April 2019, 212 participants from 3 hospitals in Massachusetts were randomized 3:1 to telemonitoring-based HF disease management (n = 159) or telephone-based HF disease management (n = 53) with 98% of individuals in both study groups completing the 90 days of follow-up. There was no significant difference in the number of days hospitalized for HF between the telemonitoring disease management group (0.88 ± 3.28 days per patient-90 days) and the telephone-based disease management group (1.00 ± 2.97 days per patient-90 days); incidence rate ratio 0.82 (95% confidence interval, 0.43-1.58; P = .442). CONCLUSIONS: The addition of tablet-based telemonitoring to an established HF telephone-based disease management program did not reduce HF hospitalizations; however, study power was limited.

Progression of moderate-to-severe carotid disease.

OBJECTIVE: Our goals were to investigate the degree to which patient demographics, risk factors, laboratory data, and medications influence moderate carotid disease progression among patients with asymptomatic moderate carotid disease and whether such associations are solely based on how progression is defined. In addition, we aimed to establish optimal threshold criteria to categorize patients at high risk of progression. METHODS: In this retrospective study, 621 arteries were evaluated for internal carotid artery (ICA) stenosis between January 1997 and January 2014 and were determined to have moderate (50%-79%) stenosis via color duplex ultrasonography. "Moderate stenosis" was defined as an ICA peak systolic velocity (PSV) ≥120 cm/s and a diastolic ICA velocity <140 cm/s. Kaplan-Meier analysis of the time to progression was conducted using three independent end points: PSV ≥230 cm/s (liberal criterion); ICA/common carotid artery (CCA) ratio ≥4.0 (moderate criterion), and diastolic ICA velocity ≥140 cm/s (strict criterion). Kaplan-Meier survival curves were generated, and multivariate analysis was performed using Cox regression models. Risk stratification criteria were based on optimal sensitivity and specificity generated from receiver operating characteristic (ROC) curve analysis. RESULTS: The overall rate of progression was 28.5%, 21.1%, or 5.1% of study-eligible arteries over 5 years using liberal, moderate, or strict criterion, respectively. Using liberal criterion, multivariate analysis suggested that initial PSV ≥200 cm/s, ICA/CCA ratio ≥3, and male gender were significantly associated with progression. Using the moderate criterion, multivariate analysis revealed that initial PSV ≥200 cm/s, ICA/CCA ratio ≥3, age, and male gender were significantly associated with progression. Using the strict criterion, multivariate analysis revealed that initial PSV ≥200 cm/s was the only statistically significant predictor of progression. No additional patient demographics, comorbidities, initial laboratory values, or medications consistently influenced disease progression across any criteria in our study. ROC analysis suggests PSV ≥165 cm/s is an ideal threshold value for the categorization of high risk patients, as this resulted in an optimal screening sensitivity of nearly 91% and a specificity of 59% over 2 years. CONCLUSIONS: The timing and incidence of carotid disease progression depends on the definition of disease progression. Among all three criteria, only severity of disease at initial presentation reliably predicted progression. Based on the results of our ROC curve analysis, we propose that an initial ICA PSV ≥165 cm/s (sensitivity: 90.7%, specificity: 58.7%) represents a reasonable value for defining high progression risk over a 2-year interval.

Independent learning of the sonographic FAST exam technique using a tablet-based training module.

OBJECTIVE: The aim of this study is to determine if a specific tablet-based training module can be used as an effective tool for independently training novice sonographers in the components of the focused assessment for sonography in trauma (FAST) exam. DESIGN: Participants attended a 15-minute orientation presentation followed by a 2-hour ultrasound scanning workshop where they used a novel tablet-based training module to learn the components of the FAST exam independently. SETTING: This study took place at an accredited United States college of osteopathic medicine. PARTICIPANTS: Thirty-two first-year medical student volunteers without any prior ultrasound training in abdominal scanning. INTERVENTIONS: Training activities included brief didactic training and participation in an independent learning FAST exam workshop. MAIN OUTCOME MEASURES: Participants filled out subjective pre- and post-training self-confidence questionnaires and were objectively assessed and scored on their scanning skills. RESULTS: Comparison of the pre- and post-training subjective questionnaires showed a statistically significant (p < 0.001) increase in participant confidence in performing all components of the FAST exam. During skill evaluation, participants collectively demonstrated correct technique in 366 (82 percent) of the 448 total FAST exam scanning tasks they attempted. CONCLUSIONS: Based on these findings, the authors believe that learning to perform the FAST exam with this digital training module is an effective means of independently acquiring ultrasound skill. Digital ultrasound training modules like this one could have several useful applications, such as serving as an educational resource, or functioning as a point-of-care scanning adjunct to medical professionals in underdeveloped and rural areas where formal ultrasound training is not available.