Multicomponent Disease Research Articles

Correlation between Central Venous Pressure and Inferior Vena Cava Diameter for Fluid Assessment in Patients with Chronic Obstructive Pulmonary Disease

Abstract Background Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death globally.3 Although COPD primarily affects the lungs, it is now also recognized as a complex multi-component disease characterized by chronic systemic inflammation that frequently coexists with other conditions known as co morbidities. Objective To determine the correlation between central venous pressure (CVP) and the IVC collapsibility index for estimating the fluid status in COPD patients. Patients and Methods After obtaining the approval of the Ain Shams University Ethical Committee and written informed consent, 20 patients aged 21 - 60 years of either sex, admitted in the ICU of Ain Shams teaching hospitals who have a functioning central venous catheter inserted for any clinical indication, were involved in this correlational study. CVP measurements were taken with the patient in the supine position from the zero point and the middle line. Results The current study showed that there was no statically significant correlation Between CVP (cmH2O) and Heart Rate (beat /min), MABP (mmHg), IVCd max (cm) and IVC CI % at Baseline, After PLR test, After Bolus fluid administration, After 3 hours and After 6 hours. Conclusion The measurement of the IVC diameter has a good correlation with CVP and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

Evaluating A Multicomponent Chronic Disease Management Pilot Intervention among Korean Patients with Hypertension and Diabetes.

A local clinic-based chronic disease management intervention including care planning, education about disease management, monitoring, and evaluation of the achievement of objects was introduced in Korea in 2019. We evaluated the effect of the intervention on medication adherence in patients with hypertension and diabetes. In 2019, a one-year retrospective case-control group study design was performed using data from the National Health Insurance Service in Korea. Propensity score matching was used to control for selection bias. Medication adherence, calculated by medication possession rate, was the dependent variable. We conducted multivariate logistic regression analyses to examine the association between participation in the intervention and medication adherence, adjusting for covariates. A control group was set as a reference for participation in the full/partial component intervention. The proportions of participants in the full component intervention in the experimental group were 43.2% and 42.6% for patients with hypertension or diabetes, respectively. Both these groups tended to be more medication adherent than their counterparts (hypertension OR: 1.23, 95% CI 1.03-1.45, diabetes OR: 1.64, 95% CI: 1.24-2.17). Institutionalizing a comprehensive chronic disease management program using multidisciplinary teams in the primary care context is crucial. Also, it is necessary to refine reimbursement payment systems.

Inflammation and comorbidities of chronic obstructive pulmonary disease: The cytokines put on a mask!

ObjectiveChronic obstructive pulmonary disease (COPD) is a well-known complex multicomponent disease characterized by systemic inflammation that frequently coexists with other conditions. We investigated the relationship between some inflammatory markers and complications in COPD patients to explore the possible roles of inflammation in these comorbidities. MethodsThis study used cross-sectional and case-control methods. We included 336 hospitalized COPD patients, 64 healthy controls, and 42 major depression patients and evaluated all participants using the Hamilton Rating Scale. C-reactive protein (CRP), red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were collected and measured in the study population. Statistical methods were used to analyze the association of inflammatory markers with COPD comorbidities. ResultsCor pulmonale and psychological comorbidities (depression and anxiety) were more common in this study on COPD patients. We found that MLR (OR = 2.054, 95 % CI 1.129–3.735, p = 0.018) and RDW (OR = 1.367, 95 % CI 1.178–1.586, p = 0.000) were related to COPD patients complicated with cor pulmonale, while IL-6 (OR = 1.026, 95 % CI 1.001–1.053, p = 0.045) and RDW (OR = 1.280, 95 % CI 1.055–1.552, p = 0.012) were related to depression symptoms. ConclusionMLR, RDW and IL-6 were closely related to cor pulmonale and depression in COPD patients. IL-1 β and IL-6 are closely related to depression in humans.

Attention-guided multiple instance learning for COPD identification: To combine the intensity and morphology

Chronic obstructive pulmonary disease (COPD) is a complex and multi-component respiratory disease. Computed tomography (CT) images can characterize lesions in COPD patients, but the image intensity and morphology of lung components have not been fully exploited. Two datasets (Dataset 1 and 2) comprising a total of 561 subjects were obtained from two centers. A multiple instance learning (MIL) method is proposed for COPD identification. First, randomly selected slices (instances) from CT scans and multi-view 2D snapshots of the 3D airway tree and lung field extracted from CT images are acquired. Then, three attention-guided MIL models (slice-CT, snapshot-airway, and snapshot-lung-field models) are trained. In these models, a deep convolution neural network (CNN) is utilized for feature extraction. Finally, the outputs of the above three MIL models are combined using logistic regression to produce the final prediction. For Dataset 1, the accuracy of the slice-CT MIL model with 20 instances was 88.1%. The backbone of VGG-16 outperformed Alexnet, Resnet18, Resnet26, and Mobilenet_v2 in feature extraction. The snapshot-airway and snapshot-lung-field MIL models achieved accuracies of 89.4% and 90.0%, respectively. After the three models were combined, the accuracy reached 95.8%. The proposed model outperformed several state-of-the-art methods and afforded an accuracy of 83.1% for the external dataset (Dataset 2). The proposed weakly supervised MIL method is feasible for COPD identification. The effective CNN module and attention-guided MIL pooling module contribute to performance enhancement. The morphology information of the airway and lung field is beneficial for identifying COPD.

IDF21-0228 Stakeholder views on the acceptability and sustainability of a multicomponent diabetes care strategy in South Asia

Background: The Cardiovascular Disease Risk Reduction Strategies in South Asia (CARRS) Translational Trial demonstrated the effectiveness of a clinic-based multi-component (non-physician care coordinators [CCs] and decision-support electronic health record [DS-EHR] software) cardiovascular disease (CVD) risk reduction intervention among 1146 diabetes patients across 10 sites in South Asia. Considering that South Asia has the highest worldwide burden of diabetes, the need to implement and sustain quality improvement care models is critical. Previous work examined how intervention characteristics impacted physician’s acceptability of the DS-EHR, yet little is known about what organizational factors enhance or inhibit sustainability of integrated diabetes care in South Asia or it’s perceived acceptability among healthcare users. Aim: To evaluate how organizational features influence sustainability of the CARRS Trial intervention and assess patient’s acceptability of the diabetes care model. Method: As a part of a longitudinal evaluation of the CARRS Trial, in-depth interviews with clinical stakeholders were conducted pre-implementation (physicians, n=19), during late implementation, after 2.5 years of supported intervention (physicians, n=9), and two years post-implementation (CCs, n=3; patients, n=34). Nineteen physicians representing the ten participating study sites were interviewed about their perceptions of utilizing a CC and the DS-EHR to assess changes in perceptions and examine how integration of care components were sustained throughout implementation. Post-implementation interviews with CCs and patients representing five clinics were also conducted to characterize the maintenance of care components and explore patient acceptability of the care model. Verbatim transcriptions were independently coded by two investigators using a codebook developed from the consolidated framework for implementation research (CFIR). A thematic analysis approach was used to identify how organizational features of the implementing clinics may influence intervention sustainability and to describe patients’ acceptance of the intervention. Results: Prior to implementation, physicians were receptive to the care model and perceived it as an opportunity to streamline clinical care processes for patients with diabetes. Recognizing the need to improve the quality of diabetes care in India, physicians felt it was important to leverage available resources to enhance communication with patients and clinic-level tracking of patients’ glycemic control. By late implementation, physicians reported that the intervention was compatible with clinics’ organizational cultures and priorities, but that sustainability would require evidence of effectiveness in preventing CVD events, administrative buy-in, and a fee system that would cover the cost of hiring CCs and maintaining long-term use of the DS-EHR. Pre-existing networks of communication within and across clinics enabled CCs to access additional training support and get feedback that helped them stay motivated. Patients appreciated that the care model optimized their time in clinic and found the CCs helpful in managing their care. Discussion: Efforts to integrate this intervention into routine care in diabetes clinics should focus on enhancing intervention compatibility with clinics’ needs, namely through tailoring the role of CCs and by generating more evidence around the long-term effectiveness of the care model to prevent diabetes complications. These findings indicate that a clinic’s implementation climate and communication system are critical in sustaining intervention implementation, and demonstrate acceptability of the intervention among patients.

Пиоглитазон – забытый сахароснижающий препарат с доказанными кардиопротективными и нефропротективными свойствами

Considering that type 2 diabetes mellitus is a multicomponent disease and is associated with an extremely high risk of macrovascular complications (myocardial infarction, stroke and death from cardiovascular diseases), at present, much attention is paid to the choice of hypoglycemic drugs, given the individual characteristics of the patient. Preference is given to drugs of those classes that have a positive effect on cardiovascular outcomes. Along with relatively new molecules (inhibitors of the sodium-glucose cotransporter type 2 and agonists of glucagon-like peptide-1 receptors), the well-known drug pioglitazone, which belongs to the thiazolidinediones group, has not left the field of attention of researchers. Importantly, the cardioprotective effect of pioglitazone has been confirmed in several large randomized trials that showed a delay in atherosclerosis and a reduced risk of cardiovascular disease (PERISCOPE, CHICAGO, IRIS and PROactive). As an insulin sensitizer, pioglitazone reduces insulin resistance, has a protective effect on pancreatic β-cells, and also has a beneficial effect on components of insulin resistance syndrome (lowers blood pressure, lipid spectrum parameters) and improves the course of non-alcoholic fatty liver disease. There is evidence of possible side effects (weight gain, fluid retention, fractures), but their severity decreases with decreasing dose of the drug.

Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review.

Medication adherence is critical for effective management of hypertension, yet half of patients with hypertension are non-adherent to medications. In this review, we describe and critically evaluate medication adherence interventions published in the past 3years for patients with hypertension. We identified 1593 articles and 163 underwent full review, of which 42 studies met the inclusion criteria. Studies were classified into eight categories: simplification of medication regimen (e.g., fixed dose combination pills); electronic Health (eHealth) tools (e.g., text messaging reminders); behavioral counseling (e.g., motivational interviewing); healthcare system changes (e.g., patient-centered medical home); patient education; multicomponent chronic disease management program; home blood pressure monitoring; and financial incentives. Studies utilizing strategies to simplify medication regimens, eHealth tools, patient education, and behavioral counseling were most likely to report positive findings. Interventions targeting patient behavior were more likely to be associated with improvements in medication adherence compared to those targeting providers or the healthcare system. eHealth tools show promise for augmenting behavioral interventions. A major limitation of included trials was short study duration and use of self-report measures of medication adherence. Future research should explore how complex interventions that utilize a combination of evidence-based strategies and target multiple adherence behaviors (e.g., both day-to-day medication taking and long-term persistence) may be efficacious in improving medication adherence.

Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure.

Chronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first address major and often undiagnosed comorbidities associated with COPD that could have an impact on hospital readmission after an index ICU admission for acute hypercapnic respiratory failure. Some guidance for treatment is discussed. Second, we present predictors of hospital and ICU readmission and discuss various strategies to reduce such events.There is a strong rationale to detect and treat major comorbidities early after index ICU admission for acute hypercapnic respiratory failure. It still remains unclear, however, if a comprehensive and holistic approach to comorbidities in frail patients surviving hypercapnic respiratory failure can efficiently reduce the readmission rate.

Detection and Management of the Female Athlete Triad

The female athlete triad is a disorder seen in physically active females that manifests as three interrelated syndromes that may or may not occur simultaneously.1,2,3 It is a multi-component disease initiated by an energy deficient state (possibly from an eating disorder), bone mineral density abnormalities and menstrual changes.1,2,3 Prevention and early intervention are important in averting permanent debilitating damage. The cornerstone of treatment is creating a positive net energy availability, which requires a multidisciplinary approach comprised of a licensed physician, nutritionist, exercise physiologist, mental health practitioner, athletic trainer, coaches, the athlete and their parents.

KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞINDA DOSE İNDEKSİ KAS FONKSİYON BOZUKLUĞU, GÜNLÜK YAŞAM AKTİVİTELERİ VE YAŞAM KALİTESİ İLE İLİŞKİLİDİR

Purpose: Composite measures have potential to account for many of the facets of disease in chronic obstructive pulmonary disease (COPD). The purpose of this study was to investigate the relationship between the DOSE (Dyspnea, Obstruction, Smoking, Exacerbation) Index which is a multi-component assessment tool and handgrip and respiratory muscle strength, activities of daily living (ADL) and health-related quality of life in patients COPD. Methods: Forty-five patients with COPD (30 males, 15 females, mean FEV1 =50.60±16.00%) were included. The DOSE Index was calculated using the modified Medical Research Council dyspnea scale, obstruction level, smoking status, and exacerbation rate. Inspiratory and expiratory muscle strength (MIP and MEP) was measured using a mouth-pressure device. Handgrip strength was determined using hand dynamometer. Activities of daily living were evaluated using the London Chest Activity of Daily Living Scale (LCADL), and quality of life was assessed using the diseasespecific COPD Assessment Test (CAT). Results: The DOSE Index score was related with handgrip strength (r=-0.388, p=0.009), MIP (r=- 0.323, p=0.033), LCADL-physical activity score (r=0.314, p=0.038), LCADL-leisure activities score (r=0.397, p=0.008), and CAT score (r=0.435, p=0.003). Conclusion: Increased multi-component disease severity is related to decreased handgrip and respiratory muscle strength, physical activity and leisure time activities of daily living, and worse health-related quality of life in COPD patients. The DOSE Index, a simple disease severity assessment tool, is a convenient and practical tool for assessment in pulmonary rehabilitation programs.

Interactions between platelets and leukocytes in pathogenesis of multiple sclerosis

Neurodegenerative diseases are an increasing problem in the modern world. Multiple sclerosis (MS) is a major human demyelinating and degenerative disease of the central nervous system (CNS). There are many reports that point to the significant role of platelet-leukocyte interaction in neurodegenerative diseases and cardiovascular disturbances. Epidemiological studies confirm the high risk of cardiovascular diseases in patients with MS. The pathophysiology mechanisms of this multi-component disease are very complex and involve various types of cells. There is increasing evidence that some co-stimulatory pathways affect the function of inflammatory cells, both in the periphery and in the CNS. Interactions of leukocytes and endothelial cells (ECs) could be significantly modulated in the presence of activated blood platelets. The supposed role of activated platelets in the development of vessel inflammatory response is due to their ability to adhere to inflamed ECs or proteins included in the subendothelial layer of the blood vessel wall, as well as to the ability of platelets to form aggregates with leukocytes. Blood platelets are able to directly activate leukocytes through a receptor-dependent mechanism or, indirectly, by biologically active compounds secreted from their granules. Cell-cell interactions provide critical mechanisms by which platelets link thrombosis, inflammation and related processes, such as diapedesis and leukocyte infiltration, to the affected vessel. Determining the relationship between platelet-leukocyte interactions and the development of neuroinflammation in the course of MS may provide new therapeutic targets in the future.

The Modern Face of Celiac Disease. What Should an Internist Know?

The World Gastroenterology Organization regards celiac disease as a chronic multicomponent autoimmune disease of the predominantly proximal small intestine, which develops with the use of products containing gluten. Celiac disease is difficult to diagnose due to the multisymptomatic course that can change throughout life. Celiac disease is inherited in an autosomal dominant manner with incomplete penetrance. There are new approaches to the treatment of celiac disease, based on some immune pathogenetic links. In particular, the ways of influencing the intraluminal digestion of gluten, the improvement of barrier functions, the effectiveness of immunomodulators are being studied. Patients should be advised to carefully check the contents of the ingredients before purchasing products.

Assessment of cognitive dysfunction, depression, and anxiety in patients with stable chronic obstructive pulmonary disease in relation to serum interleukin-6

Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disease, but its influences on cognitive function and other associated psychological disorders were poorly identified. Systemic inflammation is considered as a key link between these diseases. Aim To assess the cognitive impairment, anxiety, and depression among stable COPD patients using different neuropsychological tests, in relation with serum interleukin-6 (IL-6). Patients and methods A study was conducted upon 100 stable COPD patients and 25 controls. All the participants were subjected to neurological and psychiatric assessment, such as The Generalized Anxiety Disorder-7 scale, Beck Depression Inventory-II scale, and Montreal Cognitive Assessment scale. Serum IL-6 was measured for all participants. Results COPD patients had more frequent anxiety disorders, depression, cognitive dysfunction, and higher serum IL-6 than control group. Visual-spatial/executive and delayed recall domains of cognitive dysfunction were significantly affected in COPD than controls ( P P <0.001). Conclusion Anxiety, depression, and cognitive impairment were significantly more prevalent between COPD patients. Serum IL-6 was a valid predictor for cognitive dysfunction in COPD patients.

Surgical treatment of wound defects in fulminant purpura

Fulminant purpura (FP) is an acute rapidly progressing syndrome of disseminated intravascular coagulation, it is accompanied by specific skin manifestations and characterized by extremely high lethality in the absence of adequate timely treatment. This multicomponent disease requires a multidisciplinary approach to its treatment and the phasing of surgical interventions. We have accumulated experience in successful treatment of three patients with fulminant purpura of different etiologies from 2014 to the present time. This article provides an example of the complex treatment of a three-year-old girl with fulminant purpura of both hips that was connected with the deficiency of protein C and the expression after acute respiratory illness.

Multiple Sclerosis: New Aspects of Immunopathogenesis.

SUMMARY – Multiple sclerosis (MS) is a multicomponent disease characterized by inflammation, neurodegeneration, and cancellation of the central nervous system recovery mechanisms. The cause of MS is still unknown, but it is undeniable that genetic, environmental and immune factors are involved in the etiopathogenesis of this complex and heterogeneous disease. From the aspect of immunopathogenesis, until recently the opinion prevailed that autoreactive T lymphocytes played a major role, the activation of which is a key step in MS. The knowledge of the effector and regulatory roles of B cells supports a new concept of MS immunopathogenesis that is based on the highly complex interaction of T and B cells, with B cells actively participating in cellular immunity by directing the intensity and quality of cellular immune response. The mechanisms of B cell activity in MS immunopathogenesis are multiple and include antigen presentation and T cell costimulation, cytokine secretion, antibody synthesis, and formation of ectopic lymphoid B cell aggregates in the intrameningeal spaces. The importance of B cells has been confirmed by modern therapeutic options for the treatment of MS.

Evaluation of Thyroid Functions in Patients with Multiple Sclerosis Before and after Treatment with Interferon Beta

Background: Multiple sclerosis (MS) is a multi-component disease characterized by inflammation, neurodegeneration and failure of central nervous system (CNS) repair mechanisms. Autoimmune thyroid disease is a frequently studied disorder in MS, most studies have focused primarily on the increased prevalence of thyroid dysfunction and anti-thyroid antibodies (ATAs) in MS patients compared with a control population.Objectives: To investigate the effect of treatment with interferon beta on thyroid functions and autoimmune thyroid markers in patients with multiple sclerosis.Subjects and Methods: This prospective study was conducted on 100 subjects recruited from the inpatient and outpatient clinic of Internal Medicine department and Neurology Unit of Ain Shams University Hospitals. They were divided into group 1, which included 50 patients newly diagnosed with multiple sclerosis according to Macdonald’s criteria 2010 and group 2, which included 50, age and sex matched healthy volunteers. All participants were exposed before and 6 months after treatment with interferon beta to Expanded disability status scale (EDSS), which is a method of quantifying disability in multiple sclerosis, Free T4, Free T3 and TSH, Anti thyroid peroxidase (anti- TPO) and anti-thyroglobulin (anti TG) antibodies, MRI brain and neck ultrasonography.Results: Anti thyroid peroxidase antibody levels were significantly higher in the drug naive patients group after treatment with interferon beta (29.660 ± 28.755 IU/ml) in comparison to their baseline values (17.580 ± 4.982 IU/ml) (p-value=0.004). Anti-thyroglobulin antibody levels were significantly higher too after treatment with interferon beta (33.920 ± 32.553 IU/ml) in comparison to baseline values (24.560 ± 20.101 IU/ml) (p- value=0.01).Conclusion: IFN-β therapy has a strong impact on the auto-immune thyroid markers status and levels in drug naive MS patients causing increase in both anti TPO and anti TG positivity statues and numerical values.

Cushing’s syndrome in an infant

Endogenous hypercorticism in infants occurs extremely rare. The causes of Cushing’s syndrome in early childhood include space-occupying lesions and bilateral hyperplasia of the adrenal glands. ACTH-independent hypercorticism due to bilateral nodular hyperplasia of the adrenal glands in children in the first months of life is most often associated with McCune-Albright-Braitsev syndrome. This syndrome is a rare disease caused by hyperfunction of the stimulatory G-protein alpha-subunit due to somatic mutations in the GNAS gene. The McCune-Albright-Braitsev syndrome is a multicomponent disease, the clinical manifestations of which include café-au-lait spots, fibrous dysplasia, and different types of endocrine hyperfunction, among which hypercorticism is one of the rare cases. The clinical picture of Cushing’s syndrome manifested in early childhood is characterized by some peculiarities that can delay the correct diagnosis: the first manifestations include low weight and height at birth, physical retarfation in the absence of a redistribution of subcutaneous fat typical of Cushing’s syndrome, psychomotor retardation, and complications caused by immunodeficiency and hypertension. We present a case of ACTH-independent hypercorticism in an infant.

Peripheral neuropathy in stable chronic obstructive pulmonary disease: Is the phrenic nerve more affected compared with other peripheral nerves?

Background Chronic obstructive pulmonary disease (COPD) is a multicomponent disease with extrapulmonary manifestation. Peripheral nerve affection may be one of the results or mechanism of COPD. Objective The aim of this study was to evaluate peripheral neuropathy in patients with stable COPD and whether these changes are more or less marked in the phrenic nerve when compared with other peripheral nerves. Patients and methods Eighty patients with COPD and 60 healthy individuals as a control group were included. All were subjected to the following: (i) full history taking; (ii) clinical and neurological examination; (iii) chest radiography; (iv) high-resol ution computed tomography scanning of the chest; (v) arterial blood gases analysis at room air; and (vi) spirometric tests. Results There was a statistically significant increase in smoking packs/year, respiratory rate, hemoglobin, and white blood cells in the COPD group. There was a significant decrease in oxygen saturation, pH, arterial oxygen tension, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, and forced vital capacity% in the study group when compared with the control group, whereas there was a significant increase in CO2 tension in the COPD group. There was a significant increase in the distal latency of all nerves and a significant decrease in the amplitude and conduction velocity of all nerves, except the amplitude of the phrenic nerve in the COPD group. The difference for phrenic nerve amplitude was statistically nonsignificant. In the COPD group, abnormal motor activity in the median, ulnar, common peroneal, and phrenic nerves of 30, 22.5, 35, and 22.5%, respectively, was reported, whereas abnormal sensory activity in the median, ulnar, and sural nerves of 30.0, 27.5, and 42.5%, respectively, was reported. Finally, we found a statistically significant increase in nerve abnormalities with increased severity of the disease. Conclusion COPD had a significant affection on peripheral nerves, either motor or sensory. In addition, COPD had a significant affection on the phrenic nerve and muscle of the diaphragm. However, this affection of the phrenic nerve was confined to grades III and IV and was the least affection of studied nerves.

Feasibility of interactive biking exercise system for telemanagement in elderly.

Inexpensive cycling equipment is widely available for home exercise however its use is hampered by lack of tools supporting real-time monitoring of cycling exercise in elderly and coordination with a clinical care team. To address these barriers, we developed a low-cost mobile system aimed at facilitating safe and effective home-based cycling exercise. The system used a miniature wireless 3-axis accelerometer that transmitted the cycling acceleration data to a tablet PC that was integrated with a multi-component disease management system. An exercise dashboard was presented to a patient allowing real-time graphical visualization of exercise progress. The system was programmed to alert patients when exercise intensity exceeded the levels recommended by the patient care providers and to exchange information with a central server. The feasibility of the system was assessed by testing the accuracy of cycling speed monitoring and reliability of alerts generated by the system. Our results demonstrated high validity of the system both for upper and lower extremity exercise monitoring as well as reliable data transmission between home unit and central server.

Why act early in COPD?

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