Impact of telemedical management on hospitalization and mortality in heart failure patients with diabetes: a post-hoc subgroup analysis of the TIM-HF2 trial.

BACKGROUND: The TIM-HF2 study demonstrated that remote patient management (RPM) in a well-defined heart failure (HF) population reduced the percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death during 1-year follow-up (hazard ratio 0.80) and all-cause mortality alone (HR 0.70). Higher rates of hospital admissions and mortality have been reported in HF patients with diabetes compared with HF patients without diabetes. Therefore, in a post-hoc analysis of the TIM-HF2 study, we investigated the efficacy of RPM in HF patients with diabetes. METHODS: TIM-HF2 study was a randomized, controlled, unmasked (concealed randomization), multicentre trial, performed in Germany between August 2013 and May 2018. HF-Patients in NYHA class II/III who had a HF-related hospital admission within the previous 12 months, irrespective of left ventricular ejection fraction, and were randomized to usual care with or without added RPM and followed for 1 year. The primary endpoint was days lost due to unplanned cardiovascular hospitalization or due to death of any cause. This post-hoc analysis included 707 HF patients with diabetes. RESULTS: In HF patients with diabetes, RPM reduced the percentage of days lost due to cardiovascular hospitalization or death compared with usual care (HR 0.66, 95% CI 0.48-0.90), and the rate of all-cause mortality alone (HR 0.52, 95% CI 0.32-0.85). RPM was also associated with an improvement in quality of life (mean difference in change in global score of Minnesota Living with Heart Failure Questionnaire score (MLHFQ): - 3.4, 95% CI - 6.2 to - 0.6). CONCLUSION: These results support the use of RPM in HF patients with diabetes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01878630.

Improving the Reliability of Water Service Delivery in Rural Kenya through Professionalized Maintenance: A System Dynamics Perspective.

Reliable water service delivery continues to be a complex global issue that is particularly challenging in rural communities. Despite billions of dollars of infrastructure interventions, sustainable water services remain out of reach for millions of people. Professionalized maintenance services have emerged as a service provision strategy to supplement the community-based rural water management approach. This study applies system dynamics modeling to assess the potential impact of scaling up professionalized maintenance services on piped water systems in Kitui County, Kenya. The study results show that over a 10 year simulation, calibrated with 21 months of empirical data and based on a range of key assumptions, delivery of professionalized maintenance services across the county may increase countywide functionality rates from 54% to over 83%, leading to a 67% increase in water production. Furthermore, the increase in preventive maintenance activities and proactive repairs can lead to less frequent major breakdowns and reduction in county government spending on major repairs by over 60%. However, current service fee income from communities accounts for 8% of the total cost of service, necessitating substantial sustained external financing or government subsidies to be financially viable at scale.

Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany.

Additional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) study.

AIMS: Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. METHODS AND RESULTS: The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. CONCLUSION: Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression.

Reducing drought emergencies in the Horn of Africa.

Drought-driven humanitarian emergencies are becoming more frequent in the Horn of Africa where millions of people in this arid region face chronic water and food insecurity. Evidence from the region shows increasing reliance on groundwater supplies, infrastructure and institutional systems in response to decreasing rainfall. Drought emergencies can be mitigated by investing in resilience efforts that make safe water reliably available at strategic groundwater abstraction locations during cycles of water stress. A combination of early warning data, policy reform, asset management and improved rural water supplies and maintenance may enable rapid, responsive, and accountable water governance that is more cost effective than emergency relief and better positioned to absorb and adapt to shocks.

Rainfall and groundwater use in rural Kenya.

This study examines the relationship between rainfall and groundwater use in rural Kenya, using automatically-transmitted hourly data from handpumps (n = 266), daily rainfall records (n = 19), and household survey data (n = 2508). We demonstrate a 34% reduction in groundwater use during the wet season compared to the dry season, suggesting a large shift from improved to unimproved sources in the wet season. By cross-correlating handpump and rainfall time series, we also reveal substantial short-term changes in groundwater pumping observed immediately following heavy rainfall. Further investigation and modelling of this response reveals a 68% reduction in pump use on the day immediately following heavy rain. We then investigate reasons for this behavioural response to rainfall, using survey data to examine the characteristics, concerns and behaviours of households in the area where the reduction in pump use was most marked. In this area rainwater harvesting was widespread and only 6% of households reported handpumps as their sole source of drinking water in the wet season, compared to 86% in the dry season. These findings shed light on the impact increasing rainfall variability may have on the Sustainable Development Goal of "universal and equitable access to safe and affordable drinking water for all". Specifically, we suggest a flaw in the water policy assumption that the provision of improved sources of drinking water-in this case community handpumps-translates to consistent use and the associated health benefits. We note that failure to understand and account for actual water use behaviour may results in adverse public health outcomes and maladapted WASH policy and interventions.