Home telemonitoring in smart rurality: results from the HIS2R interreg feasibility pilot study.

AIMS: The Health in Smart Rurality Interreg project aims to assess the feasibility of telemonitoring in rural areas across the Franco-Belgian border among patients affected by heart failure or chronic obstructive pulmonary disease. The objectives were to better understand strengths or barriers to implementing telemonitoring for early detection of potential adverse events, for improving quality of life, communication, and care coordination. METHODS: Using a prospective 6-month observational design, interconnected pads were provided to community-dwelling adults aged over 60 years. The device monitored daily body weight, temperature, cardiac rate, blood pressure, and oxygen saturation. Using predefined warning thresholds, data were analyzed by a nurse case-manager who also provided therapeutic education during their contacts. RESULTS: Out of 87 eligible and screened patients, 21 (24%) were included in the study. At the end of the follow-up, 19 patients (90%) were re-assessed. The rate of hospitalization and mortality was high (32% and 10%, respectively). A total of 644 alerts were recorded (median of 29 alerts/patients) with a high rate of technically-related alerts (TRA) (26%). Out of the 475 non-TRA, 79% and 1% have led to an intervention by the case-manager or the physician, respectively. Therapeutic adjustment was proposed for 12 patients during that period. CONCLUSION: Telemonitoring appears to be a promising solution for the follow-up of patients living far from medical resources. The contribution of a case-manager is of added-value in managing alerts, therapeutic education, and coaching. Many questions remain open such as the improvement of technical aspects and long-term compliance in a real-world setting.

Is the 2000 CDC growth reference appropriate for developing countries?

In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.