Effectiveness of a Smartphone App-Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial.

BACKGROUND: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. OBJECTIVE: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app-based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. METHODS: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. RESULTS: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean -1.3, SD 2.1 vs mean -0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. CONCLUSIONS: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app-based self-care strategies and feedback for patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000.

A smartphone-based teleconsultation system for the management of chronic pressure injuries.

We investigated the accuracy of pressure injury evaluation using tele-devices and examined the concordance between automatically generated recommendations and primary manual recommendations. Caregivers took photos and videos of pressure injuries using smartphones with built-in cameras and uploaded the media to the application. The wound team evaluated the wound using a specially modified version of the Pressure Sore Status Tool. This was compared with the Pressure Sore Status Tool score assessed during the actual examination of the patient. We developed an automatic algorithm for dressing based on the Pressure Sore Status Tool score, checking for consistency between this and the primary manual recommendation. A total of 60 patients diagnosed with pressure injuries were included. The κ coefficients indicated substantial agreement for wound size and total score, and excellent for all other items. We found that the overall concordance rates were statistically significant for all items (p < 0.001). For the primary dressing, the κ coefficient for the concordance rate of automatic algorithm and manual recommendation was 0.771, while that of teleconsultation system and manual recommendation was 0.971. For the secondary dressing, the figures were 0.798 and 0.989, respectively. All values were statistically significant (p < 0.001). We presented strong evidence documenting the utilization of a smartphone, patient-driven system, and demonstrated that the measurements obtained were comparable to the ones obtained by a trained, on-site, wound team. Furthermore, we confirmed agreement between automatically generated recommendations and primary manual recommendations.

4.2 PW, 20 fs Ti:sapphire laser at 0.1 Hz.

We demonstrated the generation of 4.2 PW laser pulses at 0.1 Hz from a chirped-pulse amplification Ti:sapphire laser. The cross-polarized wave generation and the optical parametric chirped-pulse amplification stages were installed for the prevention of the gain narrowing and for the compensation of the spectral narrowing in the amplifiers, obtaining the spectral width of amplified laser pulses of 84 nm (FWHM), and enhancing the temporal contrast. The amplified laser pulses of 112 J after the final booster amplifier were compressed to the pulses with 83 J at 19.4 fs with a shot-to-shot energy stability of 1.5% (RMS). This 4.2 PW laser will be a workhorse for exploring high field science.

A Telescreening Tool to Detect Aphasia in Patients with Stroke.

BACKGROUND: Early identification of patients with stroke-induced aphasia is essential because it is a significant disability affecting daily life and is linked to poor functional outcome after stroke. However, most patients with stroke are unable to undergo aphasia evaluation and detection and therefore remain undiagnosed. The purpose of this study is to develop a valid, reliable mobile aphasia screening test (MAST) for patients in remote locations. MATERIALS AND METHODS: To accomplish this, we enrolled patients with (n=30) and without (n=30) stroke-induced aphasia. A MAST, which adopted the Korean version of the shortened version of the Frenchay Aphasia Screening Test (K-FAST), was designed as an iPad(®) (Apple, Cupertino, CA) application. To validate the MAST, we compared its performance with that of the Korean version of the Western Aphasia Battery (K-WAB) and conventional shortened FAST paper version (K-FAST). We analyzed interrater and internal reliability, using Cronbach's alpha coefficient, and assessed the diagnostic sensitivity, specificity, and power. RESULTS: There was significant correlation between K-FAST and MAST (intraclass correlation coefficient [ICC]=0.995, p<0.001). MAST also had a high correlation with K-WAB (ICC=0.752, p<0.001). Interrater reliability was very high (ICC=0.999, p<0.001). The test had high sensitivity (90.0%) and specificity (73.3%) with an accuracy of 0.930 (95% confidence interval=0.853-1.000). The MAST is a valid and reliable tool for detecting aphasia in patients with stroke. CONCLUSIONS: This telescreening test may overcome the limitations of test administration and may be a convenient and cost-effective alternative to the existing aphasia screening tests for patients with stroke.

Development of the ubiquitous spaced retrieval-based memory advancement and rehabilitation training program.

OBJECTIVE: The Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training (USMART) program was developed by transforming the spaced retrieval-based memory training which consisted of 24 face-to-face sessions into a self-administered program with an iPAD app. The objective of this study was to evaluate the feasibility and efficacy of USMART in elderly subjects with mild cognitive impairment (MCI). METHODS: Feasibility was evaluated by checking the satisfaction of the participants with a 5-point Likert scale. The efficacy of the program on cognitive functions was evaluated by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery before and after USMART. RESULTS: Among the 10 participants, 7 completed both pre- and post-USMART assessments. The overall satisfaction score was 8.0±1.0 out of 10. The mean Word List Memory Test (WLMT) scores significantly increased after USMART training after adjusting for age, educational levels, baseline Mini-Mental Status Examination scores, and the number of training sessions (pre-USMART, 16.0±4.1; post-USMART, 17.9±4.5; p=0.014, RM-ANOVA). The magnitude of the improvements in the WLMT scores significantly correlated with the number of training sessions during 4 weeks (r=0.793; p=0.033). CONCLUSION: USMART was effective in improving memory and was well tolerated by most participants with MCI, suggesting that it may be a convenient and cost-effective alternative for the cognitive rehabilitation of elderly subjects with cognitive impairments. Further studies with large numbers of participants are necessary to examine the relationship between the number of training sessions and the improvements in memory function.