Home Monitoring Of Patients Research Articles

The Feasibility of Measuring Lung Hyperinflation With a Smart Shirt: An in Vitro Study

Home monitoring of patients with chronic obstructive pulmonary disease can increase quality of life and decrease health care costs. Despite the existence of an important relationship between lung hyperinflation (LH) and patient outcomes, LH is often ignored in home monitoring as it difficult to assess at home. A smart shirt containing respiratory inductance plethysmography (RIP, which measures thoracic and abdominal cross-sectional area changes) is a promising tool for home monitoring of LH. This study investigates the feasibility of a smart shirt to monitor LH. We aimed to describe the relationship between temperature and the output, and between the circumference and output of the smart shirt and to correct for temperature dependency. To do so, the smart shirt was applied to a custom-made torso model. Ambient temperature was increased and decreased in 15 tests, while maintaining a constant torso circumference to derive a temperature correction. Additionally, sensor output was monitored with varying circumference. The results revealed a linear relation between temperature and RIP output. Nine of the twelve shirts showed a linear output to changes in circumference. A median temperature drift of -34.7 mL/°C was observed and corrected to a minimum drift of -0.5 mL/°C. In conclusion, RIP is a promising method for measuring LH in home monitoring. Patients will not be falsely diagnosed with LH due to temperature changes. Sensor output can easily be corrected for temperature. Furthermore, the relationship between circumference and output is linear, confirming the ease of implementing the calibration procedure for obtaining lung volumes.

Technical validity and usability of a novel smartphone-connected spirometry device for pediatric patients with asthma and cystic fibrosis.

BackgroundDiagnosis and follow‐up of respiratory diseases traditionally rely on pulmonary function tests (PFTs), which are currently performed in hospitals and require trained personnel. Smartphone‐connected spirometers, like the Air Next spirometer, have been developed to aid in the home monitoring of patients with pulmonary disease. The aim of this study was to investigate the technical validity and usability of the Air Next spirometer in pediatric patients.MethodsDevice variability was tested with a calibrated syringe. About 90 subjects, aged 6 to 16, were included in a prospective cohort study. Fifty‐eight subjects performed conventional spirometry and subsequent Air Next spirometry. The bias and the limits of agreement between the measurements were calculated. Furthermore, subjects used the device for 28 days at home and completed a subject‐satisfaction questionnaire at the end of the study period.ResultsInterdevice variability was 2.8% and intradevice variability was 0.9%. The average difference between the Air Next and conventional spirometry was 40 mL for forced expiratory volume in 1 second (FEV1) and 3 mL for forced vital capacity (FVC). The limits of agreement were −270 mL and +352 mL for FEV1 and −403 mL and +397 mL for FVC. About 45% of FEV1 measurements and 41% of FVC measurements at home were acceptable and reproducible according to American Thoracic Society/European Respiratory Society criteria. Parents scored difficulty, usefulness, and reliability of the device 1.9, 3.5, and 3.8 out of 5, respectively.ConclusionThe Air Next device shows validity for the measurement of FEV1 and FVC in a pediatric patient population.

Introduction

Introduction

A multicenter randomized clinical trial to evaluate the efficacy of telemonitoring in patients with advanced heart and lung chronic failure. Study protocol for the ATLAN_TIC project

BackgroundUsing technologies of information and communication (TICs) is emerging in medical assistance. TICs application for medical assistance is promising. Its applicability in advanced heart and/or respiratory failure is still controversial because studies have shown methodological weakness which could put in danger their conclusions. Our objective is to evaluate efficacy of the application of home monitoring biological parameters in a multi-level model of coordinated clinical care for patients with chronic diseases with advanced heart (HF) and/or respiratory failure (RF) in comparison with conventional clinical care. Method/Design: Multicentric, phase III, randomized, parallel groups, controlled clinical trial. Patients with advanced HF and/or RF were eligible to participate. Patients received medical assistance by a multi-level model of coordinated clinical care with or without home monitoring. Follow up was performed until 180 days after inclusion. Primary efficacy outcome was defined as the percentage of patients with hospitalization/emergency room visits. Secondary efficacy outcomes were hospital admissions, admissions to hospital emergencies and Primary Care Emergencies, number of days of hospital stay, total cost per patient in euros, mortality, change in functional status, quality of life, assistance and technology devices. Intention to treat, as well as per protocol, and incremental cost-effectiveness analysis will be performed. The number of recruits patients per arm is set at 255, a total of 510 patients. DiscussionThis trial could provide some knowledge about the real impact of home monitoring for patients with advanced HF and/or RF within a multi-level model of integrated care.

Home monitoring of patients with hypoplastic left heart syndrome within the interstage period

Home monitoring of patients with hypoplastic left heart syndrome within the interstage period

Evaluation of Home Monitoring for Patients with Cystic Fibrosis: A Feasibility Study

Evaluation of Home Monitoring for Patients with Cystic Fibrosis: A Feasibility Study

Short Health Scale: a valid and reliable measure of quality of life in Dutch speaking patients with inflammatory bowel disease

Objectives: Patient reported outcomes are widely used in today’s clinical practice. The Short Health Scale has been proven to be an easy-to-use and reliable measure to evaluate quality of life in patients with inflammatory bowel disease. We aimed to validate this Short Health Scale in Dutch speaking patients.Methods: A total of 157 Crohn’s disease and ulcerative colitis patients (46% male, median age 39 years) completed the Short Health Scale on a tablet during the outpatient clinic. Validity was assessed by correlating both individual and total Short Health Scale scores with short Inflammatory Bowel Disease Questionnaire dimensions and clinical disease activity. Test-retest reliability was assessed in eight patients in stable remission who completed the Short Health Scale a second time after 4–8 weeks.Results: All Short Health Scale items correlated with corresponding short Inflammatory Bowel Disease Questionnaire dimensions (correlation coefficients ranging from −0.403 to −0.833, all p < .01). Short Health Scale scores increased stepwise with increasing clinical disease activity (all p < .001). The results of the Short Health Scale questionnaire remained stable on repeated measurements in patients in remission (rs between 0.699 and 0.994, all p < .01 except for well-being).Conclusions: The Short health Scale is a rapid and valid instrument for measuring quality of life in Dutch speaking patients with Inflammatory Bowel Disease. Its simplicity and usability make it a good candidate for routine care and suitable for home-monitoring of patients.

Diaphragmatic Neurophysiology and Respiratory Markers in ALS.

The main reason for short survival in amyotrophic lateral sclerosis (ALS) is involvement of respiratory muscles. Severe compromise of diaphragmatic function due to marked loss of motor units causes poor inspiratory strength leading to symptomatic respiratory fatigue, and hypercapnia and hypoxemia, often firstly detected while sleeping supine. Weakness of expiratory muscles leads to cough weakness and poor bronchial clearance, increasing the risk of respiratory infection. Respiratory tests should therefore encompass inspiratory and expiratory function, and include measurements of blood gases during sleep. Non-volitional tests, such as phrenic nerve stimulation, are particularly convenient for investigating respiratory function in patients unable to perform standard respiratory function tests due to poor cooperation or facial weakness. However, SNIP is a sensitive test when patients with bulbar involvement are able to perform the necessary maneuvers. It is likely that central respiratory regulation is disturbed in some ALS patients, but its evaluation is more complex and not regularly implemented. Practical tests should incorporate tolerability, sensitivity, easy application for regular monitoring, and prognostic value. Impending respiratory failure can cause increased circulating inflammatory markers, but molecular assessment of respiratory distress requires further study. In future, home-monitoring of patients with accessible devices should be developed.

Swallowing Sound Recognition at Home Using GMM

BackgroundAiming for autonomous living for the people after a stroke is the challenge these days especially for swallowing disorders or dysphagia. The most common cause of dysphagia is stroke. In France, stroke occurs every 4 minutes, which implies 13000 hospitalizations per year. Currently, continuous medical home monitoring of patients is not available. The patient must be hospitalized or visit the medical community for possible follow-up. It is in this context that E-SwallHome (Swallowing & Breathing: Modelling and e-Health at Home) project proposes to develop tools, from hospital care until the patient returns home, which are able to monitor in real time the process of swallowing. MethodThis paper presents a relevant health problem affecting patient recovering from stroke. We propose a frequency acoustical analysis for automatic detection of swallowing process and a non-invasive acoustic based method to differentiate between swallowing sounds and other sounds in normal ambient environment during food intake. ResultThe proposal algorithm for events detection gives a global rate of good detection of 87.31%. Classification of sounds of swallowing and other sounds based on Gaussian Mixture Models (GMM), using the leave-one-out approach according to the small amount of data in our database, gives a good recognition rate of swallowing sounds of 84.57%. ConclusionThe proposal method has great potential to assist in the clinical evaluation using only swallowing sounds, which is a non-invasive technic for swallowing studies.

Telemonitoring in asthma control: a randomized controlled trial

Objective: Telemonitoring seems to be a useful tool for patients’ management. The aim of our project was to test the applicability and potential effects of a 12-month telemonitoring of patients with asthma supported by information and communication technologies. Methods: We included 100 patients with asthma followed in the outpatient pulmonary clinic in a randomized controlled clinical trial. The patients’ data were collected by study questionnaires and lung function tests at the inclusion and at the end of interventional period. In the interventional group, asthma control test (ACT) and peak expiratory flow measurements (PEF) were stimulated to be regularly reported by Short Message Service (SMS). As a response to reported values, the patients automatically received a preformed text or a call from a study nurse in case of detected predefined critical values. Results: The compliance of reporting PEF and ACT values was higher than 80% in 96% of patients. Although we did not detect significant differences in ACT score improvement between the two study groups, we found more prominent improvement of ACT score in the subgroup of patients with two or more exacerbations prior to inclusion in the interventional group, compared to the control group. 40 (78%) patients in the interventional group listed at least one positive effect of telemonitoring on management of asthma. Conclusions: The developed program for home monitoring of patients with asthma was applicable and offered the patients support in managing their disease. Further studies with more selected patients are needed to confirm its usefulness in improving asthma control.

Home Monitoring of Patients with Cystic Fibrosis to Identify and Treat Acute Pulmonary Exacerbations. eICE Study Results.

Individuals with cystic fibrosis (CF) experience frequent acute pulmonary exacerbations, which lead to decreased lung function and reduced quality of life. The goal of this study was to determine if an intervention directed toward early detection of pulmonary exacerbations using home spirometry and symptom monitoring would result in slower decline in lung function than in control subjects. We conducted a multicenter, randomized trial at 14 CF centers with subjects at least 14 years old. The early intervention arm subjects measured home spirometry and symptoms electronically twice per week. Sites were notified if a participant met criteria for an exacerbation and contacted participants to determine if treatment for acute exacerbation was required. Participants in the usual care arm were seen every 3 months and were asked to contact the site if they were concerned about worsening pulmonary symptoms. The primary outcome was the 52-week change in FEV1. Secondary outcomes included time to first exacerbation and subsequent exacerbation, quality of life, and change in weight. A total of 267 patients were randomized, and the study arms were well matched at baseline. There was no significant difference between study arms in 52-week mean change in FEV1 slope (mean slope difference, 0.00 L, 95% confidence interval, -0.07 to 0.07; P = 0.99). The early intervention arm subjects detected exacerbations more frequently than usual care arm subjects (time to first exacerbation hazard ratio, 1.45; 95% confidence interval, 1.09 to 1.93; P = 0.01). Adverse events were not significantly different between treatment arms. An intervention of home monitoring among patients with CF was able to detect more exacerbations than usual care, but this did not result in slower decline in lung function. Clinical trial registered with www.clinicaltrials.gov (NCT01104402).

A Scoping Review of Economic Evaluations Alongside Randomised Controlled Trials of Home Monitoring in Chronic Disease Management.

Many countries have considered telemedicine and home monitoring of patients as a solution to the demographic challenges that health-care systems face. However, reviews of economic evaluations of telemedicine have identified methodological problems in many studies as they do not comply with guidelines. The aim of this study was to examine economic evaluations alongside randomised controlled trials of home monitoring in chronic disease management and hereby to explore the resources included in the programme costs, the types of health-care utilisation that change as a result of home monitoring and discuss the value of economic evaluation alongside randomised controlled trials of home monitoring on the basis of the studies identified. A scoping review of economic evaluations of home monitoring of patients with chronic disease based on randomised controlled trials and including information on the programme costs and the costs of equipment was carried out based on a Medline (PubMed) search. Nine studies met the inclusion criteria. All studies include both costs of equipment and use of staff, but there is large variation in the types of equipment and types of tasks for the staff included in the costs. Equipment costs constituted 16-73% of the total programme costs. In six of the nine studies, home monitoring resulted in a reduction in primary care or emergency contacts. However, in total, home monitoring resulted in increased average costs per patient in six studies and reduced costs in three of the nine studies. The review is limited by the small number of studies found and the restriction to randomised controlled trials, which can be problematic in this area due to lack of blinding of patients and healthcare professionals and the difficulty of implementing organisational changes in hospital departments for the limited period of a trial. Furthermore, our results may be based on assessments of older telemedicine interventions.

Chronic Heart Failure Care Model for home Monitoring of Patients

Chronic heart failure (CHF), often life-threatening, affects over 95,000 Australian and over 23 million people worldwide. Despite advances in modern medicine, patients with CHF are dismally impacted by poor five-year survival rates, poor health related quality of life, and high 30-day readmission rates. To improve the CHF management, an innovative telemonitoring enhanced home care model has been developed. In this enhanced model of care, patients are provided with a wireless (Bluetooth) weight scale and tablet computer to perform daily weight monitoring at home. Measured weight entries are automatically transferred from the scale to the tablet, and subsequently uploaded to a clinical portal. An application monitors uploaded entries in real time to detect missing weight-monitoring events, and abnormal weight changes according to the guidelines, such as rapid weight gains and unintentional weight loss. The detected events are then classified to generate different types of alerts for interventions needed in usual care. To minimise clinical workload, some alerts automatically trigger questionnaires preloaded in the tablet to assist nurses to triage patients. Finally, the generated alerts are distributed to project nurses and/or the MEPACS call centre, integrated in the care model. Nurses and call operators respectively monitor their alerts on a daily basis to provide three levels of interventions: 1) reminder calls to help patients monitor body weight daily, 2) clinical support on the CHF action plan, including emergency calls, and 3) nurse follow-ups to help identify symptoms of acute decompensated heart failure and other health issues for early intervention. Nurses also regularly review risks of alert and patients’ health conditions and engage with the patients and their care teams. To evaluate this care model, a multicentre RCT is being conducted. The trial started in Jan 2015, and is expected to be completed in Dec 2017. Patients with CHF (n=300) will be recruited from Victoria and Western Australia. Patients consented will be randomized to receive either the enhanced care (n=150) or usual care (n=150) for a minimum of 6 months. All the patients will be assessed at baseline, 6-month, and 12-month (if available) points. The aim of the enhanced model of care is to improve adherence (compliance) to the CHF management including daily weight monitoring, as well as health outcomes (health related quality of life, risk factors, functional capacity, frailty, and psychological states), and economic outcomes (risks of hospital readmissions, GP/ED visits, and cost benefits). Effective management of CHF in primary care remains a clinical challenge globally. This project will evaluate the effectiveness of an innovative telemonitoring enhanced home care model to assist patients in managing CHF. The evaluation will provide clinical evidence to integrate telemonitoring innovations to business as usual healthcare services for improvement of CHF care. At present over 80 patients have been recruited for the RCT form a large group of screened patients. Recruitment will continue until mid-2017 to capture close as possible to the trial target of 300 patients. Early results from the trial will be presented including clinical trial protocol, trial design, recruitment, challenges and compliance.

346 Evaluation of home monitoring for patients with cystic fibrosis a feasibility study

346 Evaluation of home monitoring for patients with cystic fibrosis a feasibility study

EPS6.9 Validation of lung monitor for home monitoring of patients with cystic fibrosis. A feasibility study

EPS6.9 Validation of lung monitor for home monitoring of patients with cystic fibrosis. A feasibility study

The future of telemedicine for the management of heart failure patients: a Consensus Document of the Italian Association of Hospital Cardiologists (A.N.M.C.O), the Italian Society of Cardiology (S.I.C.) and the Italian Society for Telemedicine and eHealth (Digital S.I.T.).

Telemedicine applied to heart failure patients is a tool for recording and providing remote transmission, storage and interpretation of cardiovascular parameters and/or useful diagnostic images to allow for intensive home monitoring of patients with advanced heart failure, or during the vulnerable post-acute phase, to improve patient’s prognosis and quality of life.Recently, several meta-analyses have shown that telemedicine-supported care pathways are not only effective but also economically advantageous. Benefits seem to be substantial, with a 30–35% reduction in mortality and 15–20% decrease in hospitalizations. Patients implanted with cardiac devices can also benefit from an integrated remote clinical management since all modern devices can transmit technical and diagnostic data. However, telemedicine may provide benefits to heart failure patients only as part of a shared and integrated multi-disciplinary and multi-professional ‘chronic care model’. Moreover, the future development of remote telemonitoring programs in Italy will require the primary use of products certified as medical devices, validated organizational solutions as well as legislative and administrative adoption of new care methods and the widespread growth of clinical care competence to remotely manage the complexity of chronicity.Through this consensus document, Italian Cardiology reaffirms its willingness to contribute promoting a new phase of qualitative assessment, standardization of processes and testing of telemedicine-based care models in heart failure.By recognizing the relevance of telemedicine for the care of non-hospitalized patients with heart failure, its strategic importance for the design of innovative models of care, and the many challenges and opportunities it raises, ANMCO and SIC through this document report a consensus on the main directions for its widespread and sustainable clinical implementation

Development and Feasibility Study of a Telemedicine Tool for All Patients with IBD

Tight control of disease activity, medication side effects, and adherence are crucial to prevent disease complications and improve quality of life in patients with inflammatory bowel disease (IBD). The chronic nature and increasing incidence of IBD demand health care innovations to guarantee future high-quality care. Previous research proved that integrated care by telemedicine can improve outcomes of chronic diseases. Currently available IBD telemedicine tools focus on specific patient subgroups. Therefore, we aimed to (1) develop a telemedicine system suitable for all patients with IBD in everyday practice and (2) to test this system's feasibility. With a structured iterative process between patients, dietitians, IBD nurse-specialists, and gastroenterologists, myIBDcoach was developed. During 3 months, myIBDcoach's feasibility was tested by 30 consecutive outpatients with IBD of 3 hospitals. Thereafter, patients and health care providers completed a questionnaire covering satisfaction, accessibility, and experiences with myIBDcoach. MyIBDcoach enables continuous home-monitoring of patients with IBD and optimizes disease knowledge and communication between patients and health care providers. Besides disease activity, medication adherence, and side effects, myIBDcoach monitors malnutrition, smoking, quality of life, fatigue, life-events, work participation, stress, and anxiety and depression and provides e-learnings for patient empowerment. Patients graded the system with a mean of 7.8 of 10, and 93% would recommend myIBDcoach to other patients. We developed myIBDcoach, which enables integrated care for all patients with IBD, regardless of disease severity or medication use. The feasibility study showed high satisfaction and compliance of patients and health care providers. To study myIBDcoach's efficacy, a multicenter randomized controlled trial has been initiated.

Determining the Value of Home Monitoring of Patients With Age-Related Macular Degeneration

Determining the Value of Home Monitoring of Patients With Age-Related Macular Degeneration

Review of high quality economic evaluations of telemedicine

Introduction: Telemedicine has been suggested as solution to the demographic challenges that the health care sector in many European countries are facing. The basis of this suggestion is reviews of studies of tele- medicine interventions, and these reviews often find that telemedicine is able to reduce the costs per patient. However, a large proportion of the economic studies of telemedicine suffering from methodological weaknesses making them inadequate for drawing conclusions about the economic potential of telemedicine solutions. The objective of this study was therefore to examine the results from high quality economic evaluation of home monitoring for patients with chronic diseases in order to identify the true costs of tele-medicine applications.Methods: High quality economic evaluations are here defined as economic evaluations based on randomised controlled trials that include description of data collection, mean use of resources per patient, prices and costs in accordance with the Drummond et al. (2005) guideline for economic evaluation. Economic evaluations published before August 2010 was collected from a systematic review of telemedicine studies by Wootton (2012). Economic evaluations published after August 2010 was identified by a systematic literature search in the PubMed database. Inclusion criteria were economic evaluation of telemedicine based on randomized controlled trials. The results with regard to the estimated costs per patient were synthetized qualitatively and quantitatively by meta-analyses.Results: 26 economic evaluations were found by Wootton et al. (2012) and in the Pubmed search 58 studies were identified. Of these nine economic evaluations of high quality of home monitoring for patients with chronic diseases were identified. Six of the nine studies (67%) found higher costs when telemedicine in used, and meta-analysis showed a statistical significant increase in total costs per patient of DKK 907 (p value = 0.04). No clear tendency was observed with regard to the types of costs that was reduced or increased when a telemedicine intervention was introduced. However, meta-analysis showed significant cost savings for emergency department visits of DKK 121 per patient (p value = 0.02). Investment costs were found to comprise 41 to 65% of the total intervention costs.Discussion: This review is focusing on the estimated costs from high quality economic evaluations of home monitoring for patients with chronic diseases. The study shows that telemedicine is often associated with higher costs per patient, mainly because of high costs of investment in telemedicine devices. This indicates that more attention should be given to costs and price of the telemedicine devices.Notice that the study was not designed to address questions of cost-effectiveness as only the cost side was studied. Thus, studies showing an increase in the costs per patient can still be describing a cost-effective technology if the intervention is effective. In addition the definition of high quality economic evaluations can be discussed.The literature search identified relatively few studies of high quality indicating a continuing need for more and better economic evaluations of telemedicine based on randomized controlled trials - not to forget the need for clear and transparent reporting of results. A concluding point to be noted is that statements of the economic potential of telemedicine must be based on methodological sound studies.

Pulse Wave Detection Magnetoelastic Sensing Device Based on Nanocrystalline Microwires for the Indirect Diagnosis of Paroxysmal Rhythm Disorders

The results on a new magnetoelastic sensing device for monitoring the pulse wave characteristics are reported. The main application area for this device is the indirect diagnosis of paroxysmal rhythm disorders. The proposed device is employing a novel nanocrystalline microwire with enhanced soft magnetic properties, obtained after accurate post-processing treatments. It has a high sensitivity to detect the pulse wave, being at the same time small and autonomous (battery operated). It also has a large internal memory for data storage and Internet connectivity options. The information processed and stored by the device is extremely useful for healthcare professionals and for patients with cardiac arrhythmias. The monitoring of the main parameters of the pulse wave, such as frequency, regularity, and signal amplitude, allows one to differentiate a regular arrhythmia from an irregular one. Online transmission of the recorded pulse wave information is helpful for telediagnosis and for home monitoring of patients with paroxysmal rhythm disorders.