Adults with congenital heart disease: ready for mobile health?

PURPOSE: Mobile health (mHealth) could improve the outcome of grown-up patients with congenital heart disease (GUCH) and reduce their emergency care utilisation. Inappropriate use of mHealth, however, can lead to data overload for professionals and unnecessary data collection for patients, increasing the burden for both. We aimed to determine the clinical characteristics of patients with high emergency care utilisation and to test whether these patients were willing to start using mHealth. METHODS: Clinical characteristics and emergency care utilisation of consecutive GUCH patients who visited one of the two participating cardiologists at the outpatient clinic of the Academic Medical Centre in Amsterdam were studied retrospectively. All patients were approached to fill in an mHealth questionnaire. A frequency of three or more emergency visits in 5 years was defined as high emergency care utilisation. RESULTS: In total, 202 consecutive GUCH patients who visited one of the two participating cardiologists were studied. Median age was 41 years, 47% were male, and 51% were symptomatic. In the previous 5 years, 134 emergency visits were identified. Of all patients, 8% had high emergency care utilisation. High emergency care utilisation was associated with patients being symptomatic, using antiarrhythmic drugs or diuretics. In total, 75% of all patients with high emergency care utilisation were willing to start using mHealth. CONCLUSION: GUCH patients who are symptomatic, those on antiarrhythmic drug therapy and those on diuretics are suitable candidates for enrolment in future mHealth initiatives because of both high care utilisation and high motivation to start using mHealth.

First real-world experience with mobile health telemonitoring in adult patients with congenital heart disease.

BACKGROUND: Arrhythmias and heart failure are common and invalidating sequelae in adult patients with congenital heart disease (CHD). Mobile health (m-Health) enables daily monitoring and a timely response that might prevent deterioration. We present an observational prospective registry to evaluate feasibility of an m­Health telemonitoring program for managing arrhythmia, heart failure and blood pressure in symptomatic adults with CHD. METHODS: Symptomatic adult patients with CHD are enrolled in an m­Health telemonitoring program, which evaluates single-lead ECG, blood pressure and weight measurements. In case of symptoms extra measurements could be performed. Data are collected by mobile apps, matched with individualised thresholds. Patients are contacted if thresholds were exceeded or if arrhythmias were found, for treatment adjustments or reassurance. Data on emergency care utilisation, hospitalisation and patient-reported outcome measures are used to assess quality of life and self-management. RESULTS: 129 symptomatic CHD patients were invited to participate, 55 participated. Reasons for refusing consent included too time consuming to participate in research (30) and to monitor vital signs (14). At baseline 22 patients were in New York Heart Association class ≥ II heart failure, 43 patients had palpitations or documented arrhythmias, and 8 had hypertension. Mean follow-up was 3.0 months, one patient dropped out, and adherence was 97%. CONCLUSION: The first results indicate that this program is feasible with high adherence.

[Dementia and technology. A study of technology interventions in the healthcare for dementia patients and their caregivers]. / Dementie en technologie. Een studie naar de toepassingen van techniek in de zorg voor mensen met dementie en hun mantelzorgers.

PURPOSE: To explore the possibilities for IT interventions in care of older persons with dementia. METHOD: Inventory of international and national studies on implemented technology interventions for the care of persons with dementia and their caregivers. Three categories of technology are distinguished: (1) help with symptoms of dementia (2) social contact and company for the patient, and (3) health monitoring and safety. RESULTS: Eighteen international and eight national studies are included. The first results of the effects of technology interventions for patients with dementia look promising. Evidence exists for significant improvements as to the quality of life and effects on behaviour (such as less falling). The caregivers and healthcare professionals are satisfied with the usability of the technology. The purchase and user costs, however, are often too high. The labour satisfaction of healthcare professionals in relation to the use of technology has rarely been studied. CONCLUSION: Although technology can improve the ability to cope with certain consequences of dementia, the effects of technology for dementia patients, caregivers and healthcare professionals has not yet been extensively studied. Further research may focus on effects of technology for people with dementia and their caregivers as to their quality of life, feeling of safety and work satisfaction, respectively.

[Cord blood stem cells. Legal basics and problems]. / Neonatale Stammzellen. Rechtliche Grundlagen und Probleme.

With regard to the great social importance and ethical acceptance of cord blood stem cell research, this article is devoted to basic legal questions concerning the use of umbilical cord blood. The original legal status of the cord blood was analyzed with the result that the cord blood belongs to the child, and thus the child can claim certain personal rights regarding the cord blood. Since the newborn itself is not able to take part in legal transactions, its parents have to ensure that its personal and financial concerns are protected, as they are its legal representatives. The parents can decide together what shall happen to the cord blood because of their parental custody. They have to give their consent to the donation of the cord blood as well as to the collection of personal data of the child. The duty to obtain permission for the production of stem cell preparations derives from the German drug law. Maternity clinics and cord blood banks need this permission and those blood banks that stock up on cord blood stem cell preparations for indefinite recipients have to obtain an additional authorization because these preparations are prefabricated drugs.

Postoperative intrathecal patient-controlled analgesia with bupivacaine, sufentanil or a mixture of both.

In a randomised double-blind study, 45 patients, scheduled for major orthopaedic surgery under continuous spinal anaesthesia, received for relief of postoperative pain patient-controlled analgesia with either sufentanil 2 micrograms.ml-1, bupivacaine 0.0625% or a mixture of both by the intrathecal route. The mean (SD) consumption of sufentanil and bupivacaine during the first 12 h was 65.5 (27.1) micrograms and 18.2 (4.8) mg, respectively. Combining bupivacaine and sufentanil reduced the consumption of both to approximately 40% as compared to the administration of each component separately. Pain relief was very good in all subjects, although this was obtained faster with the combined regimen. Moreover, more patients in this group remained completely painfree during the entire observation period (p < 0.05). The incidence of hypotension was low and not significantly different when the plain bupivacaine group was compared with the two other groups. Nausea and vomiting were significantly more frequently observed in both groups treated with sufentanil. Motor block was not a major problem and was noticed during the first 2 h of treatment only. Tachyphylaxis did not occur. It was concluded that the groups receiving plain bupivacaine and sufentanil alone experienced pain relief of good quality. The use of a mixture, however, accelerated the onset of analgesia, improved the analgesic quality and reduced the doses for both components by 60% but at the expense of a higher incidence of nausea and vomiting.