Home Monitoring Of Patients Research Articles

Nurses' Experiences With Virtual Consultations and Home-Monitoring in Patients With Cardiac Disease: A Systematic Review and Qualitative Meta-Synthesis ofResults.

To explore how nurses experience facilitators and barriers to the use of video-consultations for home-monitoring of patients with cardiac disease. A systematic literature search in PubMed, CINAHL, Scopus, and Web of Science was undertaken, inclusion criteria were qualitative data published between 2013 and 2023 written in English, Norwegian, Swedish, or Danish. Ten studies were included in the qualitative synthesis conducted as described by Braun and Clarke. From the synthesis, a main theme emerged: Nurses' uncertainty toward telemedicine is a risk toward the use of video-consultations and home-monitoring. The essence of the findings range from nurses' positive experiences to their frustration concerning the implementation process and the lack of technical support for clinicians and patients. Nurses often felt frustration and uncertainty about the quality of delivered care through virtual consultations. Working with technology in caring for patients with cardiac disease, including video-consultations and home-monitoring, nurses experienced a sense of insecurity. Insecurity was identified as a lack of technological knowledge, nurses' feelings of apathy, poorer observation through a video-consultation, and the lack of organizational support.

Feasibility of in-home monitoring for people with glaucoma: the I-TRAC mixed-methods study.

Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma. The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks. Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks. Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks. Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative study that require addressing before progression to a definitive effectiveness trial. The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated. The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated 'cautious optimism' when considering patients' and healthcare professionals' views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial. Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies. This study is registered as Research Registry #6213. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.

Home monitoring of patients with chronic kidney disease.

Home monitoring of patients with chronic kidney disease.

Digital health for remote home monitoring of patients with COVID-19 requiring oxygen: a cohort study and literature review.

The clinical course and outcome of COVID-19 vary widely, from asymptomatic and mild to critical. Elderly patients and patients with comorbidities are at increased risk of respiratory failure and oxygen requirements. Due to the massive surge, the pandemic has created challenges for overwhelmed hospitals. Thus, the original home management of COVID-19 patients requiring oxygen and remote monitoring by a web app and a nurse at home were implemented in our center. We aimed to evaluate the outcome of patients with COVID-19 requiring oxygen who benefited from home remote monitoring management. We performed a retrospective cohort study on all COVID-19 patients requiring oxygen (< 5 L/min) who consulted from October 2020 to April 2021 at our emergency department and were managed with home remote monitoring by a web app and an in-home nurse. We also carried out a literature review of studies on COVID-19 patients requiring oxygen with remote monitoring. We included 300 patients [184 (61.3%) male patients, median age 51 years]. The main comorbidities were cardiovascular disease (n = 117; 39.0%), diabetes mellitus (n = 72; 24.0%), and chronic respiratory disease (n = 32; 10.7%). Among the 28 (9.3%) patients readmitted to the hospital, 6 (1.9%) were hospitalized in the intensive care unit, and 3 (0.9%) died. In the multivariable analysis, risk factors for unplanned hospitalization were chronic respiratory failure (odds ratio (OR) =4.476, 95%CI 1.565-12.80), immunosuppression (OR = 3.736, 95%CI 1.208-11.552), and short delay between symptoms onset and start of telemonitoring (OR = 0.744, 95%CI 0.653-0.847). In the literature review, we identified seven other experiences of remote monitoring management. Mortality rate and unplanned hospitalization were low (maximum 1.9 and 12%, respectively). Our study confirms the safety of home remote monitoring of patients with COVID-19 who require oxygen, as well as our literature review. However, patients with chronic respiratory failure and immunosuppression should be closely monitored.

Effect of angiotensin receptor neprilysin inhibitor on physical activity in patients with heart failure with reduced ejection fraction, monitored by implantable electronic device home monitoring.

Angiotensin receptor neprilysin inhibitor (ARNI) therapy is a cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF), with significant improvement in mortality as well as morbidity and quality of life. However, maximal ARNI doses often result in hypotension. Recent studies with 'real world' experience suggest that lower doses of ARNI are as effective as higher doses.In order to evaluate the symptomatic effect of low-dose ARNI in HFrEF patients, we analyzed physical activity data obtained via home monitoring of patients with cardiac implantable electronic devices (CIEDs). We retrospectively analyzed physical activity data obtained from HFrEF patients with CIED-active home monitoring during the years 2021-2022. Patients with ARNI therapy were further divided into subgroups according to the administered dose. Low-dose ARNI included doses of up to 24/26 mg sacubitril/valsartan daily. Intermediate dose and high dose included doses of 72/78-120/130 mg/day, and 144/156-194/206 mg/day, respectively. A total of 122 patients had home monitoring-compatible CIEDs and HFrEF during the study period. Sixty-four of these patients were treated with ARNI. Administration of low-dose ARNI resulted in a 20% increase in daily activity when compared with patients without ARNI treatment ( P = 0.038). Change in physical activity of patients in the intermediate-dose and high-dose groups was not significant. Younger patients, patients with cardiac resynchronization therapy, and patients without diabetes mellitus were more physically active. Low-dose ARNI had a beneficial effect on physical activity in HFrEF patients. MH via CIED provided real-life objective data for patients' follow-up.

Enhancing Home Monitoring of Patients With Heart Failure: Primary Care Experience With an Autonomous Foot-Measuring Device

In recent years, telemonitoring solutions have gained prominence for monitoring patients at home. However, patient and clinician enthusiasm, as well as adherence rates, have been inconsistent. This article presents a primary care evaluation of an autonomous foot-measuring home device, designed to monitor physiological changes in medium to high-risk chronic heart failure patients at risk of decompensation. The Heartfelt device garnered positive reception among the 13 participating patients. Remarkably, in 77% of cases (10 patients), the device captured and transmitted patient data on more than half of the days each month, while only 8% (one patient) managed to provide equivalent daily measurements using weighing scales. These results indicate that the Heartfelt device holds promise as an effective telemonitoring solution for patients who face adherence challenges with traditional telemonitoring systems, and self-management checks more generally. By adopting this technology, healthcare providers may be better equipped to proactively manage chronic heart failure patients and improve overall patient outcomes.

Care4U: Integrated healthcare systems based on blockchain

During the COVID-19 crisis, the need to stay at home has increased dramatically. In addition, the number of sick people, especially elderly persons, has increased exponentially. In such a scenario, home monitoring of patients can ensure remote healthcare at home using advanced technologies such as the Internet of Medical Things (IoMT). The IoMT can monitor and transmit sensitive health data; however, it may be vulnerable to various attacks. In this paper, an efficient healthcare security system is proposed for IoMT applications. In the proposed system, the medical sensors can transmit sensed encrypted health data via a mobile application to the doctor for privacy. Then, three consortium blockchains are constructed for load balancing of transactions and reducing transaction latency. They store the credentials of system entities, doctors' prescriptions and recommendations according to the data transmitted via mobile applications, and the medical treatment process. Besides, cancelable biometrics are used for providing authentication and increasing the security of the proposed medical system. The investigational results show that the proposed system outperforms existing work where the proposed model consumed less processing time by values of 18%, 22%, and 40%, and less energy for processing a 200 ​KB file by values of 9%, 13%, and 17%. Finally, the proposed model consumed less memory usage by values of 7%, 7%, and 18.75%. From these results, it is clear that the proposed system gives a very reliable and secure performance for efficiently securing medical applications.

A Wearable Multi-Sensor Array Enables the Recording of Heart Sounds in Homecare.

The home monitoring of patients affected by chronic heart failure (CHF) is of key importance in preventing acute episodes. Nevertheless, no wearable technological solution exists to date. A possibility could be offered by Cardiac Time Intervals extracted from simultaneous recordings of electrocardiographic (ECG) and phonocardiographic (PCG) signals. Nevertheless, the recording of a good-quality PCG signal requires accurate positioning of the stethoscope over the chest, which is unfeasible for a naïve user as the patient. In this work, we propose a solution based on multi-source PCG. We designed a flexible multi-sensor array to enable the recording of heart sounds by inexperienced users. The multi-sensor array is based on a flexible Printed Circuit Board mounting 48 microphones with a high spatial resolution, three electrodes to record an ECG and a Magneto-Inertial Measurement Unit. We validated the usability over a sample population of 42 inexperienced volunteers and found that all subjects could record signals of good to excellent quality. Moreover, we found that the multi-sensor array is suitable for use on a wide population of at-risk patients regardless of their body characteristics. Based on the promising findings of this study, we believe that the described device could enable the home monitoring of CHF patients soon.

Continuous Monitoring of Vital Signs After Hospital Discharge: A Feasibility Study

Introduction Increasing demand for inpatient beds limits capacity and poses a challenge to the healthcare system. Early discharge may be one solution to solve this problem, and continuous vital sign monitoring at home could safely facilitate this goal. We aimed to document feasibility of continuous home monitoring in patients after hospital discharge. Methods Patients were eligible for inclusion if they were admitted with acute medical disease and scheduled for discharge. They wore three wireless vital sign sensors for four days at home: a chest patch measuring heart rate and respiratory rate, a pulse oximeter, and a blood pressure (BP) monitor. Patients with ≥6 hours monitoring time after discharge were included in the analysis. Primary outcome was percentage of maximum monitoring time of heart rate and respiratory rate. Results Monitoring was initiated in 80 patients, and 69 patients (86%) had ≥6 hours monitoring time after discharge. The chest patch, pulse oximeter, and BP monitor collected data for 88%, 60%, and 32% of the monitored time, respectively. Oxygen desaturation &lt;88% was observed in 92% of the patients and lasted for 6.3% (interquartile range [IQR] 0.9%–22.0%) of total monitoring time. Desaturation below 85% was observed in 83% of the patients and lasted 4.2% [IQR 0.4%–9.4%] of total monitoring time. 61% had tachypnea (&gt;24/minute); tachycardia (&gt;130/minute) lasting ≥30 minutes was observed in 28% of the patients. Conclusions Continuous monitoring of vital signs was feasible at home with a high degree of valid monitoring time. Oxygen desaturation was commonly observed.

Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study.

Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction. Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was €54 (US $1=€0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19.

P405 Adherence in the use of digital technology for home monitoring in patients with cystic fibrosis

Evidence for using telehealth in Cystic Fibrosis (CF) is growing rapidly. A study evaluating digital technologies in the management of CF adults showed an improvement in patients’ quality of life. The behavior of CF patients and their adherence regarding these new approaches need further investigations. The aim was to assess patient’s adherence of using the NuvoAir Home platform as part of a virtual model of care.

Performance of a Smart Device over 12-Months for Home Monitoring of Patients with Intermediate Age-Related Macular Degeneration.

To determine the 12-month compliance with and retention of home monitoring (HM) with Melbourne Rapid Fields (MRFh) for patients with intermediate age-related macular degeneration (iAMD) and compare visual acuity (VA) and retinal sensitivity (RS) results to clinical measures. Participants were recruited to a 12-month HM study with weekly testing of vision with MRFh. Inclusion criteria were a diagnosis of iAMD, understand English instructions, VA ≥ 20/40, and access to an iPad. Supervised in-clinic testing of high contrast VA (HVA, ETDRS), low-luminance VA (LLVA, ETDRS with ND2 filter), and RS (Macular Integrity Assessment, MAIA, and MRF in-clinic, MRFc) was conducted every 6-months. A total of 54 participants (67 ± 6.8 years) were enrolled. Compliance to weekly HM was 61% and study retention at 12-months was 50% of those with uptake (n = 46). No difference was observed between MRFc and MRFh across all RS and VA outcomes (p > 0.05). MRFh RS was higher than MAIA (29.1 vs. 27.1 dB, p < 0.001). MRFh HVA was not different from ETDRS (p = 0.08), but LLVA was 9 letters better (81.5 vs. 72.4 letters, p < 0.001). Over 12-months, MRFh yields a moderate level of compliance with (61%) and retention (50%) of weekly testing. Further studies are required to assess the ability of MRFh to detect early progression to nAMD.

Glaucoma and Telemedicine.

Teleglaucoma is the future, but there is a need for clearer regulation by government agencies and medical entities, as well as for studies to further demonstrate the cost-effectiveness and safety of teleglaucoma strategies at a global scale. The coronavirus disease 2019 pandemic drastically impacted global health, forcing institutions to provide alternative models of safe and reliable health care. In this context, telemedicine has been successfully used to overcome distance barriers and improve access to medical services. Teleglaucoma is the application of telemedicine to screen and monitor glaucoma, a chronic and progressive optic neuropathy. Teleglaucoma screening aims to detect the disease at an earlier stage, especially in high-risk populations and underserved areas, also identifying patients who require more urgent treatment. Teleglaucoma monitoring seeks to provide remote management through virtual clinics, where classic in-person visits are replaced by synchronous data collection (clinical measurements) performed by non-ophthalmologists and asynchronous review (decision-making) by ophthalmologists. This may be employed for low-risk patients with early disease, improving health care logistics, reducing the number of face-to-face consultations, and saving time and costs. New technologies may also allow home monitoring of patients in teleglaucoma programs, with the addition of artificial intelligence methods, which are expected to increase the accuracy of remote glaucoma screening/monitoring and support clinical decision-making. However, for the incorporation of teleglaucoma into clinical practice, a complex system for collection, transfer, flow, and interpretation of data is still necessary, in addition to clearer regulatory markers by government agencies and medical entities.

Point-of-care self-testing for measuring total white blood cells and C-reactive protein – a pilot study for future home-monitoring of patients during antibiotic treatment at home

Background During home treatment with antibiotics, patients’ laboratory results of total white blood cell count (WBC) with neutrophil counts and C-reactive protein (CRP) are drawn and monitored at the hospital. The aim of the study was to examine the feasibility and analytical accuracy of hospitalized patients 18 years or older self-testing using two point-of-care tests (POCT). Methods The pilot study included 41 hospitalized patients. A subjective judgment of the patients’ ability to conduct the self-testing was made along with a comparison of the POCT measurements of WBC, neutrophil counts and CRP with standard laboratory measurements. Correlation between the POCTs and laboratorial values was assessed by coefficient of determination and the level of agreement between the means was assessed by Bland Altman test. Results Of the 38 patients conducting self-testing, 78% were men and the mean age was 61.8 years. 28 patients (73.7%) successfully performed self-testing on the first try while, 10 (26.3%) ‘HemoCue WBC DIFF’ measurements showed an error code. All the patients successfully performed the ‘QuickRead go CRP’ self-test. Comparison of the ‘HemoCue WBC DIFF’ results with the laboratory results of WBC and neutrophil counts showed good agreement. On the other hand, ‘QuickRead go CRP’ results showed a small but significant systematic disagreement compared to the laboratory results. Conclusion Our results showed that the POCTs can be used by some patients and factors influencing the patient participation included psychological and physical limitations. Both POCTs appeared to have an acceptable clinical level of accuracy.

International Collaboration to Develop a Remote Monitoring Web App for COVID-19 Patients in Armenia: Design and Development With Agile Methodology.

COVID-19 has led to over 500 million cases and 6.2 million deaths around the world. Low- and middle-income countries (LMICs) like Armenia face unique infrastructure, financial, and capacity challenges that in many cases result in worse outcomes. Health care facilities across Armenia experienced a shortage of resources, including hospital beds and oxygen, which was further exacerbated by the war with neighboring Azerbaijan. Without a framework for home-based care, health care facilities were severely strained by COVID-19 patients who had prolonged oxygen requirements but were otherwise clinically stable. This paper describes our approach to establishing an international collaboration to develop a web app to support home monitoring of patients with COVID-19 with persistent oxygen requirements. The app was developed using a rapid, coordinated, and collaborative approach involving an international group of clinicians, developers, and collaborators. Health screening, monitoring, and discharge forms were developed into a lightweight OpenMRS web app and customized for the local Armenian context. The software was designed and developed over 2 months using human-centered design and agile sprints. Once live, 5087 patient records were created for 439 unique patients. This project suggests a promising framework for designing and implementing remote monitoring programs in LMICs, despite pandemic and geopolitical challenges.

A life-threatening arrhythmia detection method based on pulse rate variability analysis and decision tree.

Extreme bradycardia (EB), extreme tachycardia (ET), ventricular tachycardia (VT), and ventricular flutter (VF) are the four types of life-threatening arrhythmias, which are symptoms of cardiovascular diseases. Therefore, in this study, a method of life-threatening arrhythmia recognition is proposed based on pulse rate variability (PRV). First, noise and interference are wiped out from the arterial blood pressure (ABP), and the PRV signal is extracted. Then, 19 features are extracted from the PRV signal, and 15 features with highly important and significant variation were selected by random forest (RF). Finally, the back-propagation neural network (BPNN), extreme learning machine (ELM), and decision tree (DT) are used to build, train, and test classifiers to detect life-threatening arrhythmias. The experimental data are obtained from the MIMIC/Fantasia and the 2015 Physiology Net/CinC Challenge databases. The experimental results show that the DT classifier has the best average performance with accuracy and kappa coefficient (kappa) of 98.76 ± 0.08% and 97.59 ± 0.15%, which are higher than those of the BPNN (accuracy = 94.85 ± 1.33% and kappa = 89.95 ± 2.62%) and ELM (accuracy = 95.05 ± 0.14% and kappa = 90.28 ± 0.28%) classifiers. The proposed method shows better performance in identifying four life-threatening arrhythmias compared to existing methods and has potential to be used for home monitoring of patients with life-threatening arrhythmias.

Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

BackgroundProvision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic.MethodsA descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews.ResultsAll 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data.ConclusionRapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Impact of Omicron surge in community setting in greater Paris area

IntroductionThe SARS-CoV-2 Omicron variant of concern (VOC) was first identified in South Africa during November 2021, and has now become the dominant variant in Europe and worldwide. However, as the number of Omicron COVID-19 cases increased rapidly in South Africa, the rate of hospitalization due to Omicron infections seemed lower than that of Delta infections.The Greater Paris area has experienced five COVID-19 surges. We aimed to assess the impact and clinical severity of patients infected during the Omicron surge compared with the previous surges in community setting in this area.Matériels et méthodesWe performed a cohort study including adult patients, with confirmed COVID-19 diagnosis (RT-PCR or antigen), managed from 9 March 2020 until 11 January 2022 with Covidom, a telesurveillance solution for home monitoring of patients with COVID-19 in the greater Paris area. When included, the patients completed on a daily basis self-administered questionnaires until 10 to 30 days according to symptom course. According to predefined thresholds, questionnaires could generate 2 types of alerts: orange alert (mild priority), and red alert (top priority alert). Outcome was recorded: unplanned hospitalization (including in intensive care unit), contact with national emergency number, or admission to Emergency department.RésultatsOverall, 225,248 patients were included in the study, including 72,394 from the last surge, which is more numerous compared to the previous surges. Patients included during the Delta and Omicron waves were younger (mean age 35.6 ± 13.0 and 38.4 ± 13.0 versus maximum 44.5 ± 14.5 years in surge 1; p<0.001). Significantly fewer patients with comorbidities were included in surge 5 (p<0.001), and the proportion presenting with respiratory signs was lower (49.8% in surge 5 vs maximum 86.5% in surge 1; p<0.001). During surge 5, while the number of patients included was high compared to previous surges, the rate of orange and red alerts was significantly lower (p<0.0001), as the number of hospitalizations, national emergency contact and emergency unit requirement (p<0.0001).ConclusionThese data confirm that the Omicron surge is highly significant considering the number of cases but presents with a low rate of severe presentation and worsening.Aucun lien d'intérêt

Effectiveness of remote home monitoring for patients with Chronic Obstructive Pulmonary Disease (COPD): systematic review

BackgroundAlthough remote home monitoring (RHM) has the capacity to prevent exacerbations in patients with chronic obstructive pulmonary disease (COPD), evidence regarding its effectiveness remains unclear. The objective of this study was to determine the effectiveness of RHM in patients with COPD.MethodsA systematic review of the scholarly literature published within the last 10 years was conducted using internationally recognized guidelines. Search strategies were applied to several electronic databases and clinical trial registries through March 2020 to identify studies comparing RHM to ‘no remote home monitoring’ (no RHM) or comparing RHM with provider’s feedback to RHM without feedback. To critically appraise the included randomized studies, the Cochrane Collaboration risk of bias tool (ROB) was used. The quality of included non-randomized interventional and comparative observational studies was evaluated using the ACROBAT-NRSI tool from the Cochrane Collaboration. The quality of evidence relating to key outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) on the following: health-related quality of life (HRQoL), patient experience and number of exacerbations, number of emergency room (ER) visits, COPD-related hospital admissions, and adherence as the proportion of patients who completed the study. Three independent reviewers assessed methodologic quality and reviewed the studies.ResultsSeventeen randomized controlled trials (RCTs) and two comparative observational studies were included in the review. The primary finding of this systematic review is that a considerable amount of evidence relating to the efficacy/effectiveness of RHM exists, but its quality is low. Although RHM is safe, it does not appear to improve HRQoL (regardless of the type of RHM), lung function or self-efficacy, or to reduce depression, anxiety, or healthcare resource utilization. The inclusion of regular feedback from providers may reduce COPD-related hospital admissions. Though adherence RHM remains unclear, both patient and provider satisfaction were high with the intervention.ConclusionsAlthough a considerable amount of evidence to the effectiveness of RHM exists, due to heterogeneity of care settings and the low-quality evidence, they should be interpreted with caution.

Remote Home Monitoring of Patients with Cancer During the COVID-19 Pandemic

Remote Home Monitoring of Patients with Cancer During the COVID-19 Pandemic