Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22
Filtrar
1.
J Diabetes Sci Technol ; : 1932296821995800, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655766

RESUMO

INTRODUCTION: This technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM). METHODS: The development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires. RESULTS: The tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks. Clinicians reported high scores for the usability and usefulness of the tool, making its adoption in routine care promising. CONCLUSIONS: Despite increased use of risk calculators in clinical care, this is the first time that such a tool has been developed in the diabetes area. Further studies are needed to confirm the benefits of using this tool on behavioral and health outcomes in T2DM populations.

2.
Obstet Gynecol ; 137(2): 295-304, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417320

RESUMO

OBJECTIVE: To estimate normal ranges for postpartum maternal vital signs. METHODS: We conducted a multicenter prospective longitudinal cohort study in the United Kingdom. We recruited women before 20 weeks of gestation without significant comorbidities and with accurately dated singleton pregnancies. Women recorded their own blood pressure, heart rate, oxygen saturation and temperature daily for 2 weeks postpartum. Trained midwives measured participants' vital signs including respiratory rate around postpartum days 1, 7, and 14. RESULTS: From August 2012 to September 2016, we screened 4,279 pregnant women; 1,054 met eligibility criteria and chose to take part. Postpartum vital sign data were available for 909 women (86.2%). Median, or 50th centile (3rd-97th centile), systolic and diastolic blood pressures increased from the day of birth: 116 mm Hg (88-147) and 74 mm Hg (59-93) to a maximum median of 121 mm Hg (102-143) and 79 mm Hg (63-94) on days 5 and 6 postpartum, respectively, an increase of 5 mm Hg (95% CI 3-7) and 5 mm Hg (95% CI 4-6), respectively. Median (3rd-97th centile) systolic and diastolic blood pressure returned to 116 mm Hg (98-137) and 75 mm Hg (61-91) by day 14 postpartum. The median (3rd-97th centile) heart rate was highest on the day of birth, 84 beats per minute (bpm) (59-110) decreasing to a minimum of 75 bpm (55-101) 14 days postpartum. Oxygen saturation, respiratory rate, and temperature did not change in the 2 weeks postbirth. Median (3rd-97th centile) day-of-birth oxygen saturation was 96% (93-98). Median (3rd-97th centile) day-of-birth respiratory rate was 15 breaths per minute (10-22). Median (3rd-97th centile) day-of-birth temperature was 36.7°C (35.6-37.6). CONCLUSION: We present widely relevant, postpartum, day-specific reference ranges which may facilitate early detection of abnormal blood pressure, heart rate, respiratory rate, oxygen saturation and temperature during the puerperium. Our findings could inform construction of an evidence-based modified obstetric early warning system to better identify unwell postpartum women. CLINICAL TRIAL REGISTRATION: ISRCTN, 10838017.

3.
Obstet Gynecol ; 135(3): 653-664, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32028507

RESUMO

OBJECTIVE: To estimate normal ranges for maternal vital signs throughout pregnancy, which have not been well defined in a large contemporary population. METHODS: We conducted a three-center, prospective, longitudinal cohort study in the United Kingdom from August 2012 to September 2017. We recruited women at less than 20 weeks of gestation without significant comorbidities with accurately dated singleton pregnancies. We measured participants' blood pressure (BP), heart rate, respiratory rate, oxygen saturation and temperature following standardized operating procedures at 4-6 weekly intervals throughout pregnancy. RESULTS: We screened 4,279 pregnant women, 1,041 met eligibility criteria and chose to take part. Systolic and diastolic BP decreased slightly from 12 weeks of gestation: median or 50th centile (3rd-97th centile) 114 (95-138); 70 (56-87) mm Hg to reach minimums of 113 (95-136); 69 (55-86) mm Hg at 18.6 and 19.2 weeks of gestation, respectively, a change (95% CI) of -1.0 (-2 to 0); -1 (-2 to -1) mm Hg. Systolic and diastolic BP then rose to a maximum median (3rd-97th centile) of 121 (102-144); 78 (62-95) mm Hg at 40 weeks of gestation, a difference (95% CI) of 7 (6-9) and9 (8-10) mm Hg, respectively. The median (3rd-97th centile) heart rate was lowest at 12 weeks of gestation: 82 (63-105) beats per minute (bpm), rising progressively to a maximum of 91 (68-115) bpm at 34.1 weeks. SpO2 decreased from 12 weeks of gestation: median (3-97 centile) 98% (94-99%) to 97% (93-99%) at 40 weeks. The median (3-97 centile) respiratory rate at 12 weeks of gestation was 15 (9-22), which did not change with gestation. The median (3-97 centile) temperature at 12 weeks of gestation was 36.7 (35.6-37.5)°C, decreasing to a minimum of 36.5 (35.3-37.3)°C at 33.4 weeks. CONCLUSION: We present widely relevant, gestation-specific reference ranges for detecting abnormal BP, heart rate, respiratory rate, oxygen saturation and temperature during pregnancy. Our findings refute the existence of a clinically significant BP drop from 12 weeks of gestation. CLINICAL TRIAL REGISTRATION: ISRCTN, ISRCTN10838017.


Assuntos
Gravidez , Sinais Vitais , Feminino , Humanos , Estudos Longitudinais , Estudos Prospectivos , Valores de Referência
4.
JMIR Mhealth Uhealth ; 8(1): e13756, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31899457

RESUMO

BACKGROUND: The 6-min walk test (6MWT) is a convenient method for assessing functional capacity in patients with cardiopulmonary conditions. It is usually performed in the context of a hospital clinic and thus requires the involvement of hospital staff and facilities, with their associated costs. OBJECTIVE: This study aimed to develop a mobile phone-based system that allows patients to perform the 6MWT in the community. METHODS: We developed 2 algorithms to compute the distance walked during a 6MWT using sensors embedded in a mobile phone. One algorithm makes use of the global positioning system to track the location of the phone when outdoors and hence computes the distance travelled. The other algorithm is meant to be used indoors and exploits the inertial sensors built into the phone to detect U-turns when patients walk back and forth along a corridor of fixed length. We included these algorithms in a mobile phone app, integrated with wireless pulse oximeters and a back-end server. We performed Bland-Altman analysis of the difference between the distances estimated by the phone and by a reference trundle wheel on 49 indoor tests and 30 outdoor tests, with 11 different mobile phones (both Apple iOS and Google Android operating systems). We also assessed usability aspects related to the app in a discussion group with patients and clinicians using a technology acceptance model to guide discussion. RESULTS: The mean difference between the mobile phone-estimated distances and the reference values was -2.013 m (SD 7.84 m) for the indoor algorithm and -0.80 m (SD 18.56 m) for the outdoor algorithm. The absolute maximum difference was, in both cases, below the clinically significant threshold. A total of 2 pulmonary hypertension patients, 1 cardiologist, 2 physiologists, and 1 nurse took part in the discussion group, where issues arising from the use of the 6MWT in hospital were identified. The app was demonstrated to be usable, and the 2 patients were keen to use it in the long term. CONCLUSIONS: The system described in this paper allows patients to perform the 6MWT at a place of their convenience. In addition, the use of pulse oximetry allows more information to be generated about the patient's health status and, possibly, be more relevant to the real-life impact of their condition. Preliminary assessment has shown that the developed 6MWT app is highly accurate and well accepted by its users. Further tests are needed to assess its clinical value.

5.
Sci Data ; 6(1): 24, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975992

RESUMO

Studies have established the importance of physical activity and fitness for long-term cardiovascular health, yet limited data exist on the association between objective, real-world large-scale physical activity patterns, fitness, sleep, and cardiovascular health primarily due to difficulties in collecting such datasets. We present data from the MyHeart Counts Cardiovascular Health Study, wherein participants contributed data via an iPhone application built using Apple's ResearchKit framework and consented to make this data available freely for further research applications. In this smartphone-based study of cardiovascular health, participants recorded daily physical activity, completed health questionnaires, and performed a 6-minute walk fitness test. Data from English-speaking participants aged 18 years or older with a US-registered iPhone who agreed to share their data broadly and who enrolled between the study's launch and the time of the data freeze for this data release (March 10 2015-October 28 2015) are now available for further research. It is anticipated that releasing this large-scale collection of real-world physical activity, fitness, sleep, and cardiovascular health data will enable the research community to work collaboratively towards improving our understanding of the relationship between cardiovascular indicators, lifestyle, and overall health, as well as inform mobile health research best practices.


Assuntos
Sistema Cardiovascular , Exercício Físico , Sono , Adulto , Glicemia/análise , Pressão Sanguínea , Sistema Cardiovascular/metabolismo , Sistema Cardiovascular/fisiopatologia , Humanos , Smartphone , Inquéritos e Questionários , Telemedicina
6.
Sensors (Basel) ; 18(11)2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30384462

RESUMO

Respiratory rate (RR) is a key parameter used in healthcare for monitoring and predicting patient deterioration. However, continuous and automatic estimation of this parameter from wearable sensors is still a challenging task. Various methods have been proposed to estimate RR from wearable sensors using windowed segments of the data; e.g., often using a minimum of 32 s. Little research has been reported in the literature concerning the instantaneous detection of respiratory rate from such sources. In this paper, we develop and evaluate a method to estimate instantaneous respiratory rate (IRR) from body-worn reflectance photoplethysmography (PPG) sensors. The proposed method relies on a nonlinear time-frequency representation, termed the wavelet synchrosqueezed transform (WSST). We apply the latter to derived modulations of the PPG that arise from the act of breathing.We validate the proposed algorithm using (i) a custom device with a PPG probe placed on various body positions and (ii) a commercial wrist-worn device (WaveletHealth Inc., Mountain View, CA, USA). Comparator reference data were obtained via a thermocouple placed under the nostrils, providing ground-truth information concerning respiration cycles. Tracking instantaneous frequencies was performed in the joint time-frequency spectrum of the (4 Hz re-sampled) respiratory-induced modulation using the WSST, from data obtained from 10 healthy subjects. The estimated instantaneous respiratory rates have shown to be highly correlated with breath-by-breath variations derived from the reference signals. The proposed method produced more accurate results compared to averaged RR obtained using 32 s windows investigated with overlap between successive windows of (i) zero and (ii) 28 s. For a set of five healthy subjects, the averaged similarity between reference RR and instantaneous RR, given by the longest common subsequence (LCSS) algorithm, was calculated as 0.69; this compares with averaged similarity of 0.49 using 32 s windows with 28 s overlap between successive windows. The results provide insight into estimation of IRR and show that upper body positions produced PPG signals from which a better respiration signal was extracted than for other body locations.


Assuntos
Fotopletismografia/métodos , Postura/fisiologia , Taxa Respiratória/fisiologia , Adulto , Algoritmos , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador , Análise de Ondaletas , Dispositivos Eletrônicos Vestíveis
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 4423-4427, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30441333

RESUMO

Step counting from smart-phones allows a wide range of applications related to fitness and health. Estimating steps from phones' accelerometers is challenging because of the multitude of ways a smart-phone can be carried. We focus our work on the windowed peak detection algorithm, which has previously been shown to be accurate and efficient and thus suitable for mobile devices. We explore and optimise further the algorithm and its parameters making use of data collected by three volunteers holding the phone in six different positions. In order to simplify the analysis of the data, we also built a novel device for the detection of the ground truth steps. Over the collected data set, the algorithm reaches 95% average accuracy. We implemented the algorithm for the Android OS and released it as an open source project. A separate dataset was collected with the algorithm running on the smart-phone for further validation. The validation confirms the accuracy of the algorithm in real-time conditions.


Assuntos
Telefone Celular , Corrida , Smartphone , Acelerometria , Algoritmos , Humanos
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 6092-6095, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30441725

RESUMO

Traditional heart failure markers fail to reliably predict heart-failure related hospitalisations and deaths. Multi- sensor patch data can provide an objective insight into activity and sleep patterns of patients and may therefore improve the performance of current risk-quantification algorithms. This work aimed to establish the feasibility of collecting multi-sensor patch data from heart failure patients and to perform an initial analysis of activity and sleep patterns of heart failure patients in relation to disease severity. 13 heart failure patients from the SUPPORT-HF study were provided with chest-worn multisensor patches and asked to wear the devices continuously for up to seven consecutive days. Using a combination of impedance, heart rate and accelerometer data participants' sleep and wakefulness information were extracted and analyzed in relation to self-reported symptom scores. Patch data for eleven patients were of high enough quality to be included in the analysis, accounting for 63 patient days worth of data. The heart failure patients slept for an average of 8.3 hours a night and experienced 2.8 sleep interruptions. Potential differences in sleep angle, heart rate and wake-time activity were found for patients with different heart failure severity. Larger studies are necessary to create a more coherent picture of the potential of activity and sleep as a markers for heart failure deterioration.


Assuntos
Exercício Físico , Insuficiência Cardíaca , Sono , Frequência Cardíaca , Humanos , Vigília
9.
PLoS One ; 13(8): e0202072, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30096203

RESUMO

BACKGROUND: Though many overweight and obese adults attempt to lose weight without formal support, little is known about the strategies used in self-directed weight loss attempts. We set out to assess cognitive and behavioural strategies for weight loss and their associations with weight change. METHODS: Prospective, web-based cohort study of overweight UK adults (BMI≥25kg/m2) trying to lose weight through behaviour change. Strategy use was assessed using the OxFAB questionnaire and evaluated (1) at the domain level, (2) through exploratory factor analysis, and (3) in a model of strategies deemed a priori to be "essential" to weight management. Associations with weight change at 3 months were tested using linear regression. RESULTS: 486 participants answered all questions; 194 reported weight at baseline and at 3 months (mean weight change -3.3kg (SD 4.1)). Greater weight loss was significantly associated with the motivational support domain (-2.4kg, 95% CI -4.4 to -0.4), dietary impulse control (from factor analysis) (-0.6kg, 95% CI -1.1 to -0.03), and weight loss planning and monitoring (from factor analysis) (-1.3kg, 95% CI -2.0 to -0.5). Higher scores in the model of essential behavioural strategies were significantly associated with greater weight loss (compared to participants using 6 or fewer of the 9 strategies, using 7 or more of the 9 strategies was associated with a 2.13kg greater weight loss (SE 0.58, p<0.001)). CONCLUSIONS: Despite heterogeneity in the strategies employed for weight loss, coherent patterns of behaviours emerged for individual participants, some of which were associated with greater weight loss, including strategies relating to dietary impulse control, weight loss planning and monitoring, motivational support, information seeking and self-monitoring. Trials could test the effect of promoting use of these patterns on weight loss.


Assuntos
Comportamento , Manutenção do Peso Corporal , Cognição , Sobrepeso/psicologia , Adulto , Estudos de Coortes , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Fatores de Tempo , Reino Unido , Perda de Peso
10.
Hypertension ; 72(2): 425-432, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29967037

RESUMO

Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.


Assuntos
Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Autogestão/métodos , Adulto , Feminino , Seguimentos , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Gravidez , Estudos Prospectivos , Resultado do Tratamento
11.
Endocrinol Diabetes Metab ; 1(3): e00022, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30815556

RESUMO

Objectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM). Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention. Results: Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions: This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported.

12.
J Telemed Telecare ; 24(4): 303-316, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28350282

RESUMO

Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping "desired behaviours" into specific system's specifications, borrowing concepts from Fogg's Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.


Assuntos
Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Motivação , Telemedicina/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Autocuidado/métodos , Ativador de Plasminogênio Tipo Uroquinase
13.
BMJ Open ; 7(9): e016034, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28864695

RESUMO

INTRODUCTION: Successive confidential enquiries into maternal deaths in the UK have identified an urgent need to develop a national early warning score (EWS) specifically for pregnant or recently pregnant women to aid more timely recognition, referral and treatment of women who are developing life-threatening complications in pregnancy or the puerperium. Although many local EWS are in use in obstetrics, most have been developed heuristically. No current obstetric EWS has defined the thresholds at which an alert should be triggered using evidence-based normal ranges, nor do they reflect the changing physiology that occurs with gestation during pregnancy. METHODS AND ANALYSIS: An observational cohort study involving 1000 participants across three UK sites in Oxford, London and Newcastle. Pregnant women will be recruited at approximately 14 weeks' gestation and have their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation and temperature) measured at 4 to 6-week intervals during pregnancy. Vital signs recorded during labour and delivery will be extracted from hospital records. After delivery, participants will measure and record their own vital signs daily for 2 weeks. During the antenatal and postnatal periods, vital signs will be recorded on an Android tablet computer through a custom software application and transferred via mobile internet connection to a secure database. The data collected will be used to define reference ranges of vital signs across normal pregnancy, labour and the immediate postnatal period. This will inform the design of an evidence-based obstetric EWS. ETHICS AND DISSEMINATION: The study has been approved by the NRES committee South East Coast-Brighton and Sussex (14/LO/1312) and is registered with the ISRCTN (10838017). All participants will provide written informed consent and can withdraw from the study at any point. All data collected will be managed anonymously. The findings will be disseminated in international peer-reviewed journals and through research conferences.


Assuntos
Protocolos Clínicos/normas , Cuidados Críticos/métodos , Morte Materna/prevenção & controle , Assistência Perinatal/métodos , Complicações na Gravidez/diagnóstico , Sinais Vitais , Adolescente , Adulto , Pressão Sanguínea , Temperatura Corporal , Estudos de Coortes , Feminino , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade , Oxigênio/metabolismo , Período Pós-Parto , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/fisiopatologia , Valores de Referência , Projetos de Pesquisa , Taxa Respiratória , Reino Unido , Adulto Jovem
14.
Heart Vessels ; 32(4): 408-418, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27730298

RESUMO

Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System). This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity, arrhythmias and adherence to training prescriptions, wirelessly via the internet, to a medical team that provided feedback and adjusted training prescriptions. Exercise capacity was evaluated prior to and 6 months after intervention. 118 patients (58 ± 10 years, 105 men) with CAD referred for CR were randomized (IG: n = 55, CG: n = 63). However, 15 patients (27 %) in the IG and 18 (29 %) in the CG withdrew participation and technical problems prevented a further 21 patients (38 %) in the IG from participating. No training-related complications occurred. For those who completed the study, peak VO2 improved more (p = 0.005) in the IG (1.76 ± 4.1 ml/min/kg) compared to CG (-0.4 ± 2.7 ml/min/kg). A newly designed system for home-based CR appears feasible, safe and improves exercise capacity compared to national CR. Technical problems reflected the complexity of applying remote monitoring solutions at an international level.


Assuntos
Reabilitação Cardíaca/métodos , Doença da Artéria Coronariana/reabilitação , Tolerância ao Exercício , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Smartphone/estatística & dados numéricos , Idoso , Eletrocardiografia Ambulatorial/métodos , Teste de Esforço , Feminino , Alemanha , Frequência Cardíaca , Humanos , Internet/estatística & dados numéricos , Modelos Lineares , Masculino , Consumo de Oxigênio , Estudos Prospectivos , Qualidade de Vida , Espanha , Reino Unido
15.
IEEE J Biomed Health Inform ; 21(1): 218-227, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-26441432

RESUMO

The current institution-based model for healthcare service delivery faces enormous challenges posed by an aging population and the prevalence of chronic diseases. For this reason, pervasive healthcare, i.e., the provision of healthcare services to individuals anytime anywhere, has become a major focus for the research community. In this paper, we map out the current state of pervasive healthcare research by presenting an overview of three emerging areas in personalized health monitoring, namely: 1) mobile phone sensing via in-built or external sensors, 2) self-reporting for manually captured health information, such as symptoms and behaviors, and 3) social sharing of health information within the individual's community. Systems deployed in a real-life setting as well as proofs-of-concept for achieving pervasive health are presented, in order to identify shortcomings and increase our understanding of the requirements for the next generation of pervasive healthcare systems addressing these three areas.


Assuntos
Telefone Celular , Monitorização Fisiológica/instrumentação , Mídias Sociais , Telemedicina/instrumentação , Humanos , Monitorização Fisiológica/métodos , Autorrelato , Inquéritos e Questionários , Telemedicina/métodos
16.
Med Biol Eng Comput ; 53(12): 1285-94, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25564181

RESUMO

Mobile health systems aiming to promote adherence may cost-effectively improve the self-management of chronic diseases like diabetes, enhancing the compliance to the medical prescription, encouraging and stimulating patients to adopt healthy life styles and promoting empowerment. This paper presents a strategy for m-health applications in diabetes self-management that is based on automatic generation of feedback messages. A feedback assistant, representing the core of architecture, delivers dynamic and automatically updated text messages set up on clinical guideline and patient's lifestyle. Based on this strategy, an m-health adherence system was designed, developed and tested in a small-scale exploratory study with T1DM and T2DM patients. The results indicate that the system could be feasible and well accepted and that its usage increased along with adherence to prescriptions during the 4 weeks of the study. A more extensive research is pending to corroborate these outcomes and to establish a clear benefit of the proposed solution.


Assuntos
Diabetes Mellitus/terapia , Cooperação do Paciente/estatística & dados numéricos , Telemedicina/métodos , Envio de Mensagens de Texto , Humanos , Smartphone
17.
Sensors (Basel) ; 14(4): 7277-311, 2014 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-24763209

RESUMO

Ambient assisted living (AAL) is a complex field, where different technologies are integrated to offer solutions for the benefit of different stakeholders. Several evaluation techniques are commonly applied that tackle specific aspects of AAL; however, holistic evaluation approaches are lacking when addressing the needs of both developers and end-users. Living labs have been often used as real-life test and experimentation environments for co-designing AAL technologies and validating them with relevant stakeholders. During the last five years, we have been evaluating AAL systems and services in the framework of various research projects. This paper presents the lessons learned in this experience and proposes a set of harmonized guidelines to conduct evaluations in living labs.


Assuntos
Moradias Assistidas , Interface Usuário-Computador , Humanos , Desenvolvimento de Programas , Software
18.
Artigo em Inglês | MEDLINE | ID: mdl-24111353

RESUMO

Cardiovascular Diseases are the most prevalent and serious chronic conditions existing nowadays. They are the primary cause of death in the world and generate enormous expenditures to the health systems. Tele-monitoring and personal health systems have proven to be good options for tackling this situation; however they are still lacking many functionalities. It is necessary to find solutions that allow health professionals to follow up patients more closely and efficiently, while reducing the non-adherence of patients to the treatment regime. HeartCycle research project (partially funded by the European Commission) has developed a personal health system for cardiovascular diseases management with the aim to address this problem. This paper describes the Patient Loop of this solution, including the different components, the adopted user interaction, and the implemented patients' education and coaching strategy.


Assuntos
Educação de Pacientes como Assunto , Telemedicina , Interface Usuário-Computador , Humanos , Inquéritos e Questionários
19.
IEEE Trans Biomed Eng ; 60(1): 216-20, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22955869

RESUMO

One of the major problems related to cancer treatment is its recurrence. Without knowing in advance how likely the cancer will relapse, clinical practice usually recommends adjuvant treatments that have strong side effects. A way to optimize treatments is to predict the recurrence probability by analyzing a set of bio-markers. The NeoMark European project has identified a set of preliminary bio-markers for the case of oral cancer by collecting a large series of data from genomic, imaging, and clinical evidence. This heterogeneous set of data needs a proper representation in order to be stored, computed, and communicated efficiently. Ontologies are often considered the proper mean to integrate biomedical data, for their high level of formality and for the need of interoperable, universally accepted models. This paper presents the NeoMark system and how an ontology has been designed to integrate all its heterogeneous data. The system has been validated in a pilot in which data will populate the ontology and will be made public for further research.


Assuntos
Biomarcadores Tumorais/análise , Biologia Computacional/métodos , Modelos Estatísticos , Neoplasias Bucais/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Diagnóstico por Computador , Humanos , Neoplasias Bucais/genética , Neoplasias Bucais/metabolismo , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/metabolismo , Reprodutibilidade dos Testes
20.
Stud Health Technol Inform ; 177: 296-303, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22942070

RESUMO

The Ambient Assisted Living domain is a fast growing area with many new technological artefacts and services developed. Most of the systems developed address end-users' needs. Yet, they have not achieved a large market penetration. The work presented here argues that this is primarily due to not sufficiently addressing the quality requirements posed by the health care organizations. Satisfying quality requirements requires a standardized and easily accessible framework for measuring quality. We present the initial steps towards such a framework by building on relevant ISO standards.


Assuntos
Moradias Assistidas/normas , Diagnóstico por Computador/normas , Serviços de Assistência Domiciliar/normas , Monitorização Ambulatorial/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Telemedicina/normas , Terapia Assistida por Computador/normas , Ecossistema , Europa (Continente)
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...