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1.
J Craniomaxillofac Surg ; 47(12): 1973-1979, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810844

RESUMO

The Cook-Swartz-Doppler probe is an easy to handle and reliable tool for free flap monitoring. In the head and neck region different confounders can affect the read out. We therefore analyzed the use of the Doppler probe regarding these potential difficulties and to compare the diagnostic accuracy in arterial or venous monitoring of free flaps in the head and neck region. A retrospective study was performed in which all patients were included who underwent free flap surgery in the head and neck region in the Department of Plastic Surgery and the Department of Maxillofacial Surgery of our institution between 2010 and 2018 and were monitored with an implanted Doppler probe. 147 free tissue transfers were included. No significance was found for arterial and venous placement of the Doppler probe for sensitivity (artery 83.3%; vein 84.6%; p = 0.87), specificity (artery 89.2%; vein 96.1%; p = 0.17) and negative predictive value (artery 96.7%; vein 94.2%; p = 0.55). A better positive predictive value for placing the Doppler probe around the artery (82.7%) than the vein (61.1%) was found in our study (p = 0.056). The better positive predictive value in arterial monitoring suggests that this is the more reliable measuring method to assess flap perfusion in the head and neck region.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Monitorização Ambulatorial/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/fisiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Fluxometria por Laser-Doppler/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
2.
BMC Public Health ; 19(1): 1703, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856780

RESUMO

BACKGROUND: Mobility limitations in older adults are associated with poor clinical outcomes including higher mortality and disability rates. A decline in mobility (including physical function and life-space) is detectable and should be discovered as early as possible, as it can still be stabilized or even reversed in early stages by targeted interventions. General practitioners (GPs) would be in the ideal position to monitor the mobility of their older patients. However, easy-to-use and valid instruments for GPs to conduct mobility assessment in the real-life practice setting are missing. Modern technologies such as the global positioning system (GPS) and inertial measurement units (IMUs) - nowadays embedded in every smartphone - could facilitate monitoring of different aspects of mobility in the GP's practice. METHODS: This project's aim is to provide GPs with a novel smartphone application that allows them to quantify their older patients' mobility. The project consists of three parts: development of the GPS- and IMU-based application, evaluation of its validity and reliability (Study 1), and evaluation of its applicability and acceptance (Study 2). In Study 1, participants (target N = 72, aged 65+, ≥2 chronic diseases) will perform a battery of walking tests (varying distances; varying levels of standardization). Besides videotaping and timing (gold standard), a high-end GPS device, a medium-accuracy GPS/IMU logger and three different smartphone models will be used to determine mobility parameters such as gait speed. Furthermore, participants will wear the medium-accuracy GPS/IMU logger and a smartphone for a week to determine their life-space mobility. Participants will be re-assessed after 1 week. In Study 2, participants (target N = 60, aged 65+, ≥2 chronic diseases) will be instructed on how to use the application by themselves. Participants will perform mobility assessments independently at their own homes. Aggregated test results will also be presented to GPs. Acceptance of the application will be assessed among patients and GPs. The application will then be finalized and publicly released. DISCUSSION: If successful, the MOBITEC-GP application will offer health care providers the opportunity to follow their patients' mobility over time and to recognize impending needs (e.g. for targeted exercise) within pre-clinical stages of decline.


Assuntos
Clínicos Gerais , Avaliação Geriátrica/métodos , Aplicativos Móveis , Limitação da Mobilidade , Monitorização Ambulatorial/métodos , Smartphone , Idoso , Feminino , Sistemas de Informação Geográfica , Humanos , Masculino , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Projetos de Pesquisa , Tecnologia
3.
Neurology ; 93(10): 450-458, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477610

RESUMO

OBJECTIVE: We hypothesized that cardiac electrical instability and abnormal autonomic tone result from cumulative cardiac injury sustained in recurrent seizures. We tested this hypothesis by comparing T-wave alternans (TWA) and heart rate variability (HRV), both established markers of sudden cardiac death (SCD) risk, in patients with chronic as compared to newly diagnosed epilepsy. METHODS: In this prospective, observational cohort study, patients (newly diagnosed epilepsy, n = 6, age 41.8 ± 6.8 years; chronic epilepsy, n = 6, age 40.2 ± 5.6 years [p = 0.85]) were monitored either with Holter recorder alone or simultaneously with 14-day Zio XT extended continuous ECG patch monitor. TWA was assessed by Food and Drug Administration-cleared Modified Moving Average analysis; HRV was calculated by rMSSD. RESULTS: TWA levels in chronic epilepsy were significantly higher than in newly diagnosed epilepsy (62 ± 5.4 vs 35 ± 1.3 µV, p < 0.002); the latter did not differ from healthy control adults. In all patients with chronic epilepsy, TWA exceeded the established ≥47-µV TWA cutpoint and rMSSD HRV was inversely related to TWA levels. Patients with chronic epilepsy exhibited elevated TWA levels equivalently on Holter and ECG patch recordings (p = 0.38) with a high correlation (r 2 = 0.99, p < 0.01) across 24 hours. CONCLUSION: Based on the limited number of patients studied, it appears that chronic epilepsy, the common use of sodium channel antagonists, or other factors are associated with higher TWA levels and simultaneously with lower rMSSD HRV, which is suggestive of autonomic dysfunction or higher sympathetic tone. The ECG patch monitor used has equivalent accuracy to Holter monitoring for TWA and HRV and permits longer-term ECG sampling.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Frequência Cardíaca/fisiologia , Adulto , Doença Crônica , Estudos de Coortes , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estudos Prospectivos
4.
Wounds ; 31(8): E49-E53, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31483754

RESUMO

INTRODUCTION: Patient nonadherence to wound care protocols may impact the efficacy of modalities, such as negative pressure wound therapy (NPWT). Recently, a remote therapy monitoring (RTM) system has been devised for use with NPWT for home care patients. OBJECTIVE: Three home care patients receiving NPWT are presented to examine the relationship between patients using the RTM system and Virtual Therapy Specialists (VTS). MATERIALS AND METHODS: Consent was secured from patients with either multiple comorbidities and/or wounds of varying complexity. Wounds were assessed as per their initial presentation, and all patients were discharged home with an RTM-equipped NPWT system to apply continuous subatmospheric pressure to their wound. Dressings were changed every 2 to 3 days. RESULTS: All 3 patients were women (age range, 53-72 years), who presented with the following wound types: recalcitrant abdominal wound, acute wound following ventral hernia repair, and dehisced wound following a hysterectomy. Patient 1 was treated with RTM-equipped NPWT for a duration of 88 days (6 nonadherent vs. 82 adherent days) and was adherent to the therapy 93.2% of the time. Patient 2 was treated with RTM-equipped NPWT for a duration of 57 days (8 nonadherent vs. 49 adherent days) and was adherent to the therapy 86.0% of the time. Patient 3 was treated with RTM-equipped NPWT for a duration of 16 days (2 nonadherent vs. 14 adherent days) and was adherent to the therapy 87.5% of the time. Each patient presented with a barrier to therapy adherence (eg, lack of access to residential clinical support, technical issues, or work demands) that was managed by VTS interactions. CONCLUSIONS: In these 3 cases, RTM-equipped NPWT and the patient-centric exchanges with the VTS through adherence calls helped promote consistent usage of RTM-equipped NPWT to address the patients' therapeutic needs and increase therapy adherence.


Assuntos
Tratamento de Ferimentos com Pressão Negativa/métodos , Cooperação do Paciente , Consulta Remota/métodos , Cicatrização/fisiologia , Técnicas de Fechamento de Ferimentos Abdominais/estatística & dados numéricos , Idoso , Feminino , Hérnia Hiatal/terapia , Herniorrafia/efeitos adversos , Serviços de Assistência Domiciliar , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Assistência Centrada no Paciente/métodos , Deiscência da Ferida Operatória/terapia , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
5.
BMC Cancer ; 19(1): 884, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488084

RESUMO

BACKGROUND: Population-based studies suggest that emergency department visits and hospitalizations are common among patients receiving chemotherapy and that rates in routine practice are higher than expected from clinical trials. Chemotherapy-related toxicities are often predictable and, consequently, acute care visits may be preventable with adequate treatment planning and support between visits to the cancer centre. We will evaluate the impact of proactive telephone-based toxicity management on emergency department visits and hospitalizations in women with early stage breast cancer receiving chemotherapy. METHODS: In this pragmatic covariate constraint-based cluster randomized trial, 20 centres in Ontario, Canada are randomly allocated to either proactive telephone toxicity management (intervention) or routine care (control). The primary outcome is the cluster-level mean number of ED + H visits per patient evaluated using Ontario administrative healthcare data. Participants are all patients with early stage (I-III) breast cancer commencing adjuvant or neo-adjuvant chemotherapy at participating institutions during the intervention period. At least 25 patients at each centre participate in a patient reported outcomes sub-study involving the collection of standardized questionnaires to measure: severity of treatment toxicities, self-care, self-efficacy, quality of life, and coordination of care. Patients participating in the patient reported outcomes (PRO) sub-study are asked to provide written consent to link their PRO data to administrative data. Unit costs will be applied to each per person resource utilized, and a total cost per population and patient will be generated. An incremental cost-effectiveness analysis will be undertaken to compare the incremental costs and outcomes between the intervention and control groups from the health system perspective. DISCUSSION: This study evaluates the effectiveness of a proactive toxicity management intervention in a routine care setting. The use of administrative healthcare data to evaluate the primary outcome enables an evaluation in a real world setting and at a much larger scale than previous studies. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02485678. Registered 30 June 2015.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Monitorização Ambulatorial/métodos , Terapia Neoadjuvante/efeitos adversos , Instituições de Assistência Ambulatorial , Quimioterapia Adjuvante/efeitos adversos , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Estadiamento de Neoplasias , Enfermagem Oncológica/métodos , Ontário , Medidas de Resultados Relatados pelo Paciente , Melhoria de Qualidade , Qualidade de Vida , Tamanho da Amostra , Autocuidado , Autoeficácia , Inquéritos e Questionários , Telefone
6.
Hipertens. riesgo vasc ; 36(3): 137-144, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183953

RESUMO

Introducción y objetivos: El objetivo es cuantificar la validez diagnóstica de la medida de la presión arterial en farmacia comunitaria (PAFC) y establecer los puntos de corte de la presión arterial sistólica (PAS) y de la presión arterial diastólica (PAD) que maximicen la citada validez, usando como patrón de oro la monitorización ambulatoria de la presión arterial (MAPA) de 24 h. Material y métodos: Estudio transversal, con selección consecutiva de pacientes usuarios de la farmacia comunitaria andaluza. Se midió la PAFC y, a continuación, una MAPA de 24 h, con lo que se evaluó la validez diagnóstica de PAFC. También se calculó el área bajo la curva ROC para PAS y PAD, los valores predictivos positivos y negativos para diferentes prevalencias, así como la variación de la sensibilidad y de la especificidad para los distintos puntos de corte de PAS/PAD, lo que sirvió para el cálculo de los puntos de corte óptimos. Resultados: Colaboraron 167 farmacias comunitarias, con 1.170 pacientes, de los que 1.110 aportaron datos válidos. La PAFC presenta una sensibilidad del 60,41% (IC 95%: 56,40-64,29), una especificidad del 79,77% (IC 95%: 76,12-82,99), un valor predictivo positivo de 76,96% (IC 95%: 72,89-80,57) y un valor predictivo negativo de 64,31% (IC 95%: 60,55%-67,90%). Por el método de curva ROC, los puntos de corte óptimos para la PAS y para la PAD son, respectivamente, 134/81mm Hg, puntos donde la sensibilidad y la especificidad se equilibran y se maximiza el índice de Youden. Conclusiones: La sensibilidad es relativamente baja. Para mejorarla se propone bajar el punto de corte de PAS y PAD. El óptimo calculado es 134/81mm Hg. Viene ello a aportar datos sobre la conveniencia de revisar a la baja el actual punto de corte (140/90), como propone la guía de 2017 de ACC/AHA


Introduction and objectives: The aim of this study is to determine the diagnostic validity of blood pressure measurement in the community pharmacy (CPBP), and to set the cut-off points in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in order to maximise the aforementioned validity, using 24 hour ambulatory blood pressure monitoring (ABPM) as the reference method. Material and methods: A cross-sectional study with consecutive selection of patient users of the community pharmacy in Andalusia. The CPBP was measured, followed by 24-hour ABPM, which assessed the diagnostic validity of the CPBP. The AUC of the ROC curve was also calculated for SBP and DBP, along with the positive and negative predictive values, for different prevalences and the variation of sensitivity and specificity for the different cut-off points for SBP/DBP. Results: A total of 167 community pharmacy participated with 1,170 patients, of which 1,110 were valid. The CPBP showed a sensitivity of 60.41% (95% CI: 56.40-64.29), and a specificity of the 79.77% (95% CI: 76.12-82.99), a positive predictive values of 76.96% (95% CI: 72.89-80.57), and a negative predictive values of 64.31% (95% CI: 60.55%-67.90%). By using the ROC curve method, the optimal cut-off points are 134/81mm Hg, the point where the sensitivity and specificity and are balanced and the Youden index is maximised. Conclusions: The sensitivity is relatively low. To improve it tends to lower the cut-off points of SBP and DBP. The calculated optimum is 134/81mm Hg. This provides data on the desirability to review the current cut-off points (140/90), as proposed by the ACC/AHA 2017


Assuntos
Humanos , Pressão Arterial/fisiologia , Farmácias/organização & administração , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estudos Transversais , Sensibilidade e Especificidade , Intervalos de Confiança , Curva ROC
7.
Comput Methods Programs Biomed ; 178: 47-58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416562

RESUMO

BACKGROUND: Sepsis-associated cardiac arrest is a common issue with the low survival rate. Early prediction of cardiac arrest can provide the time required for intervening and preventing its onset in order to reduce mortality. Several studies have been conducted to predict cardiac arrest using machine learning. However, no previous research has used machine learning for predicting cardiac arrest in adult sepsis patients. Moreover, the potential of some techniques, including ensemble algorithms, has not yet been addressed in improving the prediction outcomes. It is required to find methods for generating high-performance predictions with sufficient time lapse before the arrest. In this regard, various variables and parameters should also been examined. OBJECTIVE: The aim was to use machine learning in order to propose a cardiac arrest prediction model for adult patients with sepsis. It is required to predict the arrest several hours before the incidence with high efficiency. The other goal was to investigate the effect of the time series dynamics of vital signs on the prediction of cardiac arrest. METHOD: 30 h clinical data of every sepsis patients were extracted from Mimic III database (79 cases, 4532 controls). Three datasets (multivariate, time series and combined) were created. Various machine learning models for six time groups were trained on these datasets. The models included classical techniques (SVM, decision tree, logistic regression, KNN, GaussianNB) and ensemble methods (gradient Boosting, XGBoost, random forest, balanced bagging classifier and stacking). Proper solutions were proposed to address the challenges of missing values, imbalanced classes of data and irregularity of time series. RESULTS: The best results were obtained using a stacking algorithm and multivariate dataset (accuracy = 0.76, precision = 0.19, sensitivity = 0.77, f1-score = 0.31, AUC= 0.82). The proposed model predicts the arrest incidence of up to six hours earlier with the accuracy and sensitivity over 70%. CONCLUSION: We illustrated that machine learning techniques, especially ensemble algorithms have high potentials to be used in prognostic systems for sepsis patients. The proposed model, in comparison with the exiting warning systems including APACHE II and MEWS, significantly improved the evaluation criteria. According to the results, the time series dynamics of vital signs are of great importance in the prediction of cardiac arrest incidence in sepsis patients.


Assuntos
Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Aprendizado de Máquina , Monitorização Ambulatorial/métodos , Sepse/complicações , APACHE , Adolescente , Adulto , Algoritmos , Estudos de Casos e Controles , Árvores de Decisões , Registros Eletrônicos de Saúde , Feminino , Parada Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distribuição Normal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Sepse/fisiopatologia , Índice de Gravidade de Doença , Sinais Vitais , Adulto Jovem
8.
Int J Med Inform ; 130: 103928, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31434042

RESUMO

BACKGROUND: Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly. OBJECTIVES: The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis. RESULTS: Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance. CONCLUSIONS: Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Monitorização Ambulatorial/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Humanos , Monitorização Ambulatorial/instrumentação
9.
J Therm Biol ; 84: 121-128, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31466744

RESUMO

The monitoring of body temperature is important for the diagnosis of the physiological state of the animal, being dependent on available methods and their applicability within production systems. This work evaluated techniques to monitor the body temperature of beef cattle kept on pasture and their ability to predict internal temperature. Twenty-three adult bovine females were monitored for six months, and collection data carried out in eleven campaigns (D0-D10) twelve days apart. During collections, the surface temperatures of ear base (ET, oC) and ocular globe (OGT, oC) were measured by infrared thermography, and the subcutaneous temperature (ST, oC) was measured with the use of transponder containing an implantable microchip. Rectal temperature (RT, oC) was considered as a reference for body temperature. Temperature and Humidity Index (THI), Black Globe Temperature and Humidity Index (BGHI) and Radiant Heat Load (RHL, W/m2) were calculated. ET (33.32 ±â€¯0.12 °C), ST (36.10 ±â€¯0.07 °C), OGT (37.40 ±â€¯0.06 °C) and RT (38.83 ±â€¯0.03 °C) differed significantly (P˂0.05). There was positive correlation of RT with OGT (r = 0.392), ET (r = 0.264) and ST (r = 0.236) (P˂0.05). Considering the bioclimatic indicators, the highest magnitude correlations were observed between ET and THI (r = 0.71), ET and BGHI (r = 0.65), and ET and RHL (r = 0.48). The use of microchip represented a practical method, but with limited predictability. On the other hand, infrared thermography proved to be safe and non-invasive, presenting greater precision for inference of internal body temperature. ET was more influenced by meteorological conditions.


Assuntos
Temperatura Corporal , Bovinos/fisiologia , Termografia/métodos , Animais , Fazendas , Feminino , Umidade , Raios Infravermelhos , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Temperatura Ambiente
10.
Int J Technol Assess Health Care ; 35(4): 334-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345279

RESUMO

OBJECTIVES: We sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations. METHODS: A narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus. RESULTS: Two hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods. CONCLUSIONS: Our review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.


Assuntos
Monitorização Ambulatorial/métodos , Monitorização Ambulatorial/normas , Sinais Vitais , Idoso , Idoso de 80 Anos ou mais , Automonitorização da Glicemia/normas , Confiabilidade dos Dados , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
11.
Biosensors (Basel) ; 9(3)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31336678

RESUMO

We conducted a pilot study to evaluate the accuracy of a custom built non-contactpressure-sensitive device in diagnosing obstructive sleep apnea (OSA) severity as an alternative toin-laboratory polysomnography (PSG) and a Type 3 in-home sleep apnea test (HSAT). Fourteenpatients completed PSG sleep studies for one night with simultaneous recording from ourload-cell-based sensing device in the bed. Subjects subsequently installed pressure sensors in theirbed at home and recorded signals for up to four nights. Machine learning models were optimized toclassify sleep apnea severity using a standardized American Academy of Sleep Medicine (AASM)scoring of the gold standard studies as reference. On a per-night basis, our model reached a correctOSA detection rate of 82.9% (sensitivity = 88.9%, specificity = 76.5%), and OSA severity classificationaccuracy of 74.3% (61.5% and 81.8% correctly classified in-clinic and in-home tests, respectively).There was no difference in Apnea Hypopnea Index (AHI) estimation when subjects wore HSATsensors versus load cells (LCs) only (p-value = 0.62). Our in-home diagnostic system providesan unobtrusive method for detecting OSA with high sensitivity and may potentially be used forlong-term monitoring of breathing during sleep. Further research is needed to address the lowerspecificity resulting from using the highest AHI from repeated samples.


Assuntos
Técnicas Biossensoriais , Serviços de Assistência Domiciliar , Monitorização Ambulatorial/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Análise de Variância , Automação , Análise de Dados , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação
12.
Curr Gastroenterol Rep ; 21(8): 37, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31289922

RESUMO

PURPOSE OF REVIEW: Here, we discuss how esophageal motor testing plays important roles in patients with suspected gastroesophageal reflux disease (GERD). In addition to guiding appropriate placement of catheters for ambulatory reflux monitoring, esophageal high-resolution manometry (HRM) rules out confounding diagnoses, such as achalasia spectrum disorders, that can present with symptoms similar to that of GERD, but are managed very differently. RECENT FINDINGS: HRM performed with impedance in the post-prandial setting (PP-HRIM) can assess for rumination syndrome or supragastric belching, which should be directed towards behavioral interventions. The recent GERD Classification of Motor Function recommends a hierarchical approach, focusing on (1) the esophagogastric junction (EGJ), (2) the esophageal body, and (3) esophageal contraction reserve, which can be assessed with provocative maneuvers at HRM, such as multiple rapid swallows (MRS). This approach can inform the appropriate tailoring of antireflux surgery. Novel esophageal motility metrics, such as the EGJ-contractile integral from HRM, or post-reflux swallow-induced peristaltic wave indices from 24-h pH-impedance monitoring, may also assist with GERD diagnosis. Assessment of esophageal motor function can contribute in a significant manner to the care of patients with suspected GERD, particularly when esophageal symptoms do not improve with antisecretory therapy, and/or when surgical or endoscopic antireflux therapies are under consideration.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Diagnóstico Diferencial , Acalasia Esofágica/diagnóstico , Junção Esofagogástrica/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/cirurgia , Humanos , Manometria/métodos , Monitorização Ambulatorial/métodos , Peristaltismo/fisiologia , /diagnóstico
13.
Handb Clin Neurol ; 160: 161-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277845

RESUMO

Ambulatory electroencephalography (aEEG) is a technique of continuous EEG recording while ensuring maximum mobility of the patient in a more naturalistic setting. The initial technological drawbacks of aEEG have been circumvented by incorporating digital and computer technology. Some of the current devices provide the facility of synchronous video recording. Low cost, convenience, higher diagnostic yield, and the ability to capture circadian patterns are the main advantages of aEEG. It is a useful tool in the diagnosis of epilepsy and nonepileptic paroxysmal disorders. Ambulatory EEG is superior to routine EEG in capturing interictal epileptiform abnormalities particularly in relation to natural sleep. However, the use of aEEG in presurgical workup is still unclear and more research is needed. At present, the place of EEG in the decision making for antiepileptic drug withdrawal is unclear and aEEG is an ideal tool to study this research question. Well-designed studies are needed to evaluate the use of aEEG in the assessment of response to antiepileptic therapy and occupational safety. Ambulatory EEG is an underutilized tool and more research is needed to expand the horizon of its applications in clinical practice.


Assuntos
Eletroencefalografia/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Monitorização Ambulatorial/métodos , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Ritmo Circadiano/fisiologia , Eletroencefalografia/efeitos dos fármacos , Epilepsia/tratamento farmacológico , Humanos
14.
J Stroke Cerebrovasc Dis ; 28(8): 2337-2342, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31182266

RESUMO

INTRODUCTION: Monitoring of acute ischaemic stroke patients during thrombolysis or thrombectomy is based mostly on frequent physical examinations, since no objective measurement of cerebrovascular haemodynamics is available in routine clinical practice. Near-infrared spectroscopy (NIRS) is a bed-side, noninvasive assessment tool that could help monitor these patients and potentially guide therapeutic interventions. Our goal in this pilot study was to investigate whether NIRS is a suitable method to monitor leptomeningeal collateral circulation via changes in cortical oxygen saturation in the first 24 hours of acute ischaemic stroke. PATIENTS AND METHODS: Our study included 5 patients with acute anterior circulation infarcts. All patients received thrombolytic therapy and 1 had thrombectomy. 24-hour continuous NIRS monitoring was performed on all participants. RESULTS: We aimed to give a detailed description of each NIRS recording and explain how the observed findings could correlate with changes in anterior watershed territory collateral circulation and clinical outcome. CONCLUSION: Our pilot study supports the use of NIRS monitoring in acute ischaemic stroke. We believe that this technique could provide real-time information on the dynamic changes of leptomeningeal collateral circulation and help monitor the effects of thrombolysis and thrombectomy.


Assuntos
Infarto Encefálico/diagnóstico , Infarto Encefálico/terapia , Fibrinolíticos/administração & dosagem , Monitorização Ambulatorial/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos , Espectroscopia de Luz Próxima ao Infravermelho , Trombectomia , Terapia Trombolítica/métodos , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/sangue , Infarto Encefálico/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Imagem de Difusão por Ressonância Magnética , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Cardiol Young ; 29(5): 660-666, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31142394

RESUMO

INTRODUCTION: Interstage mortality causes are often unknown in infants with shunt-dependent univentricular defects. For 2 years, screening catheterisation was encouraged before neonatal discharge to determine if routine evaluation improved interstage outcomes. METHODS: Retrospective single-centre review of home monitoring programme from December, 2010 to June, 2012. Composite scores were created for physical examination/echocardiography risk factors; catheterisation risk factors; and interstage adverse events. Composite scores were compared between usual care and screening catheterisation groups. The ability of each risk factor composite to predict interstage adverse events, individually and in combination, was assessed with sensitivity, specificity, and receiver operating characteristic curves. RESULTS: There were 27 usual care and 32 screening catheterisation patients. There were no significant differences between groups except rates of catheterisation before discharge (29.6 versus 100%, p < 0.001). Usual care patients who underwent catheterisation for clinical indications had higher intervention rates (37.5 versus 3.1%, p = 0.004). Physical examination/echocardiography risk factor frequency was similar, but usual care patients with catheterisation had a higher catheterisation risk factor frequency. Interstage adverse event frequency was similar (48.2 versus 53.1%, p = 0.7). For interstage adverse event prediction, sensitivity for the physical examination/echocardiography, catheterisation, and either risk factor composites was 53.3, 72, and 80%, respectively; specificity was 59, 60, and 48%. The area under the receiver operating characteristic curve was 0.56, 0.66, and 0.64. CONCLUSION: Screening catheterisation evaluation offered slightly increased sensitivity and specificity, but no difference in interstage adverse event frequency. Given this small advantage versus known risks, screening catheterisations are no longer encouraged.


Assuntos
Cateterismo/efeitos adversos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood , Alta do Paciente , Ecocardiografia , Feminino , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Ambulatorial/métodos , Cuidados Paliativos/métodos , Philadelphia , Complicações Pós-Operatórias/etiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
J Med Syst ; 43(7): 207, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144129

RESUMO

This paper presents comprehensive insights into mobile patient monitoring systems (MPMSs) from evaluation and benchmarking aspects on the basis of two critical directions. The current evaluation criteria of MPMSs based on the architectural components of MPMSs and possible solutions are discussed. This review highlights four serious issues, namely, multiple evaluation criteria, criterion importance, unmeasurable criteria and data variation, in MPMS benchmarking. Multicriteria decision-making (MCDM) analysis techniques are proposed as effective solutions to solve these issues from a methodological aspect. This methodological aspect involves a framework for benchmarking MPMSs on the basis of MCDM to rank available MPMSs and select a suitable one. The benchmarking framework is discussed in four steps. Firstly, pre-processing and identification procedures are presented. Secondly, the procedure of weight calculation based on the best-worst method (BWM) is described. Thirdly, the development of a benchmark framework by using the VIKOR method is introduced. Lastly, the proposed framework is validated.


Assuntos
Monitorização Ambulatorial/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis , Técnicas de Apoio para a Decisão , Demência/epidemiologia , Retroalimentação , Humanos , Monitorização Ambulatorial/instrumentação , Transferência de Pacientes/métodos , Reprodutibilidade dos Testes , Telemedicina/instrumentação , Triagem/métodos
17.
Neurology ; 92(24): e2743-e2753, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31092626

RESUMO

OBJECTIVE: To facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus. METHODS: Adults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included. RESULTS: Ictal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84-0.99, 0.71-0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85-0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81-0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54-1.00, 0.64-0.88). CONCLUSION: Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Medições dos Movimentos Oculares , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Monitorização Ambulatorial/métodos , Nistagmo Patológico/diagnóstico , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/complicações , Feminino , Humanos , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Nistagmo Patológico/etiologia , Vertigem/complicações , Vertigem/diagnóstico
18.
Blood Press ; 28(4): 250-257, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31056948

RESUMO

Objective: Advanced technology allows non-invasive monitoring of the 24-h brachial and central hemodynamics simultaneously. However, related reproducibility data was limited in White patients. We therefore explored if the novel measurements would be reproducible in Chinese. Methods: From February 2017 to January 2018, 152 untreated patients who were suspected of hypertension and referred for ambulatory blood pressure (BP) monitoring were recruited. Ambulatory BP monitoring was repeated within one month (median, 12.5 days) using the Mobil-O-Graph monitors (IEM, Germany). Reproducibility was assessed as the intra-class correlation coefficient (ICC), coefficient of variation (CV), and repeatability coefficient (RC). Results: The 152 participants (average age, 58.6 years) included 54 men and 98 women. The first and second means of the ambulatory brachial and central BPs, pulse wave velocity (PWV), augmentation pressure, augmentation index (AIx) and AIx at a heart rate of 75 beats per minute (AIx@75) were all similar (p ≥ 0.065), except that the repeated daytime and 24-h brachial and central systolic BPs and pulse pressure slightly differed by approximately 1-2 mmHg (p ≤ 0.011). ICC ranged from 0.70 to 0.94 for all ambulatory BPs and ≥0.91 for the arterial measurements. CV was in the range from 5.0% to 10.3% for all BPs and PWV measurements, and from 15.5% to 22.3% for AIx and AIx@75. RC expressed as percentages of maximal variation was <15% for the PWVs and ranged from 25.5% to 54.7% for BPs, AIx and AIx@75. Conclusions: The 24-h ambulatory brachial and central BPs and arterial measurements were reproducible within a short time period in Chinese, and could therefore be used in clinical practice and research settings.


Assuntos
Hemodinâmica , Monitorização Ambulatorial/métodos , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Velocidade do Fluxo Sanguíneo , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Artéria Braquial/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
19.
BMC Neurol ; 19(1): 71, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029123

RESUMO

BACKGROUND: Parkinson's disease is a complex neurological disorder characterized by a variety of motor- as well as non-motor symptoms. Video-based technology (using continuous home monitoring) may bridge the gap between the fragmented in-clinic observations and the need for a comprehensive understanding of the progression and fluctuation of disease symptoms. However, continuous monitoring can be intrusive, raising questions about feasibility as well as potential privacy violation. METHODS: We used a grounded theory approach in which we performed semi-structured interviews to explore the opinion of Parkinson's patients on home-based video recording used for vision-based movement analysis. RESULTS: Saturation was reached after sixteen interviews. Three first-level themes were identified that specify the conditions required to perform continuous video monitoring: Camera recording (e.g. being able to turn off the camera), privacy protection (e.g. patient's behaviour, patient's consent, camera location) and perceived motivation (e.g. contributing to science or clinical practice). CONCLUSION: Our findings show that Parkinson patients' perception of continuous, home-based video recording is positive, when a number of requirements are taken into account. This knowledge will enable us to start using this technology in future research and clinical practice in order to better understand the disease and to objectify outcomes in the patients' own homes.


Assuntos
Monitorização Ambulatorial/métodos , Doença de Parkinson , Telemedicina/métodos , Gravação em Vídeo , Idoso , Feminino , Humanos , Masculino , Pesquisa Qualitativa
20.
Nat Rev Urol ; 16(5): 291-301, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30936468

RESUMO

Urodynamic studies are a key component of the clinical evaluation of lower urinary tract dysfunction and include filling cystometry, pressure-flow studies, uroflowmetry, urethral function tests and electromyography. However, pitfalls of traditional urodynamics include physical and emotional discomfort, artificial test conditions with catheters and rapid retrograde filling of the bladder, which result in variable diagnostic accuracy. Ambulatory urodynamic monitoring (AUM) uses physiological anterograde filling and, therefore, offers a longer and more physiologically relevant evaluation. However, AUM methods rely on traditional catheters and pressure transducers and do not measure volume continuously, which is required to provide context for pressure changes. Novel telemetric AUM (TAUM) methods that use wireless, catheter-free, battery-powered devices to monitor bladder pressure and volume while patients carry out their daily activities are currently being investigated. TAUM devices under current development are innovating in the areas of remote monitoring, rechargeable energy sources, device deployment and retrieval and materials engineering to provide increased diagnostic accuracy and improved comfort for patients with incontinence or voiding dysfunction. These devices hold promise for improving the diagnosis and management of patients with lower urinary tract disorders.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Monitorização Ambulatorial , Urodinâmica , Desenho de Equipamento , Previsões , Humanos , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Monitorização Ambulatorial/tendências
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