Monitoring Of Patients Research Articles

Optimizing laboratory medication safety monitoring in patients with juvenile idiopathic arthritis to advance value-based care.

Most children with juvenile idiopathic arthritis (JIA) are treated with medications that require safety monitoring labs. Recommended testing includes a creatinine level. However, 87.5% of our visits had a basic metabolic panel (BMP) done. The difference in charges for ordering a serum creatinine versus a BMP is $31, and the difference in matched net revenue per unit is $12.09. Our aim was to increase the ordering of a creatinine rather than a BMP in patients with non-systemic JIA needing methotrexate, leflunomide, and/or biologic medication safety lab monitoring in the Rheumatology Clinic from 12.5 to 80% in 8months. We utilized quality improvement tools, incorporated this project in our pre-visit planning process, provided physician education, and made updates to our electronic medical record (EMR) order sets. We tracked the percent of patients with JIA taking the pertinent medications who had a creatinine checked rather than a BMP on a run chart to review performance over time. Our baseline median was 12.5% of visits having a creatinine alone checked instead of a BMP (Fig.1). We had two shifts in our data with a final center line of 99%. There were no unintended consequences noted during our project. Our project optimized medication safety monitoring in patients with JIA by eliminating unnecessary tests to save costs and advance value-based care. Our interventions of education and EMR modifications allowed for standardization of laboratory test ordering. We plan to expand this project to other medications and other diseases to further decrease costs without sacrificing patient safety. Key Points • Most of our patients with JIA that require medication safety monitoring had a basic metabolic panel obtained rather than the recommended serum creatinine. • We significantly increased ordering of a clinically recommended and more cost-effective serum creatinine alone for screening of renal function through quality improvement methodology, physician education, pre-visit planning, and electronic medical record modifications.

VIEWER: an extensible visual analytics framework for enhancing mental healthcare.

A proof-of-concept study aimed at designing and implementing Visual & Interactive Engagement With Electronic Records (VIEWER), a versatile toolkit for visual analytics of clinical data, and systematically evaluating its effectiveness across various clinical applications while gathering feedback for iterative improvements. VIEWER is an open-source and extensible toolkit that employs natural language processing and interactive visualization techniques to facilitate the rapid design, development, and deployment of clinical information retrieval, analysis, and visualization at the point of care. Through an iterative and collaborative participatory design approach, VIEWER was designed and implemented in one of the United Kingdom's largest National Health Services mental health Trusts, where its clinical utility and effectiveness were assessed using both quantitative and qualitative methods. VIEWER provides interactive, problem-focused, and comprehensive views of longitudinal patient data (n = 409870) from a combination of structured clinical data and unstructured clinical notes. Despite a relatively short adoption period and users' initial unfamiliarity, VIEWER significantly improved performance and task completion speed compared to the standard clinical information system. More than 1000 users and partners in the hospital tested and used VIEWER, reporting high satisfaction and expressed strong interest in incorporating VIEWER into their daily practice. VIEWER provides a cost-effective enhancement to the functionalities of standard clinical information systems, with evaluation offering valuable feedback for future improvements. VIEWER was developed to improve data accessibility and representation across various aspects of healthcare delivery, including population health management and patient monitoring. The deployment of VIEWER highlights the benefits of collaborative refinement in optimizing health informatics solutions for enhanced patient care.

Efficacy of Cerebral Oxygen Saturation Monitoring for Perioperative Neurocognitive Disorder in Adult Noncardiac Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Perioperative neurocognitive disorders are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a noninvasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective noncardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making. This study conducted a systematic literature search of databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, from their inception to May 1, 2024. The eligible randomized controlled trials included adult patients undergoing elective noncardiac surgery under general anesthesia who received optimized anesthesia management guided by rSO2 monitoring and those in the control group who received routine anesthesia management under standard monitoring or blinded rSO2 monitoring. The primary outcomes were the incidence of perioperative neurocognitive disorders, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), and Mini-Mental State Examination (MMSE) scores. Secondary outcomes included the incidence of intraoperative cerebral desaturation and length of hospital stay (LOS). The pooled results showed that compared to the control group, optimized anesthesia management guided by intraoperative rSO2 monitoring significantly reduced the incidence of POCD within 7days postoperatively and may reduce the incidence of POCD at 3months and longer periods postoperatively. However, it may not reduce the incidence of POD within 7days or longer periods postoperatively, improve MMSE scores, reduce the incidence of intraoperative cerebral desaturation, or shorten LOS. Given the substantial heterogeneity in the pooled results for MMSE scores within 7days postoperatively and LOS, and the limited number of studies reporting the incidence of POD, POCD, and MMSE scores after 7days postoperatively, the related results should be interpreted with caution. Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale, high-quality studies are needed to confirm the conclusions of this study.

Cushing's syndrome related to higher rates and earlier onset of cataract: A nationwide retrospective cohort study.

To investigate the risk of cataract in patients with Cushing's syndrome (CS) and evaluate whether disease onset occurs at an earlier age compared to general population. A nationwide retrospective matched-cohort study including individuals diagnosed with endogenous CS from 2000 to 2023. Patients with CS were matched in a 1:5 ratio with a control group individually matched for age, sex, socioeconomic status, and body mass index. The primary outcome was the incidence of cataract and cataract surgery. The Cox proportional hazards model, accounting for death without cataract as a competing risk, was employed to estimate hazard ratio. The study cohort included 609 patients with CS, 65% women and 35% men, and 3018 controls. The average age at CS diagnosis was 48.1 ± 17 years. Follow-up duration was 14.6 years (IQR 9.8-20.2). The source of hypercortisolism was Cushing's disease (CD) in 259 (42.6%) and adrenal CS (aCS) in 206 patients (33.8%). After CS diagnosis, cataract was observed in 171 patients (28.1%), and 771 controls (25.5%). Patients with CS had a 34% higher risk of developing cataract compared to their matched controls (HR = 1.34, 95% CI 1.03-1.75, p = 0.03). Cataract developed earlier in patients with CS compared to controls, with a mean age of onset at 64.7 ± 9.7 versus 67.6 ± 8.4 years, respectively (p = 0.01). A total of 49 (8.05%) patients had undergone cataract surgery after a diagnosis of CS compared to 177 (5.86%) in the control group (p = 0.07). Patients with endogenous CS have an increased likelihood of developing cataracts and they experienced onset at a younger age. Guidelines should include annual cataract monitoring for CS patients, beginning 3-5 years earlier than the current general recommendations.

Short- and long-term glycemic effects of pasireotide in patients with acromegaly: a comprehensive case study with review of literature.

Pasireotide (PAS), a multireceptor somatostatin analog, has been demonstrated to effectively control hormone levels, including those of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), in patients with acromegaly. However, it induces hyperglycemia by inhibiting insulin secretion via somatostatin receptor 5 (SSTR5). Despite the extensive literature on the occurrence of PAS-induced hyperglycemia, there is still no consensus on the optimal first-line treatment for this complication. Herein, we present two cases of acromegaly treated with PAS and highlight its short- and long-term effects on glucose metabolism. In the first case, postprandial hyperglycemia manifested rapidly following the commencement of PAS treatment and was effectively managed with dulaglutide under continuous glucose monitoring (CGM). In the second case, long-term PAS therapy resulted in a dose-dependent glycemic response that was controlled by different GLP-1 receptor agonists (GLP-1RAs), including semaglutide. CGM facilitated the early detection of significant glycemic fluctuations, underscoring the necessity for close monitoring in patients receiving PAS therapy. These cases demonstrate the efficacy of GLP-1RAs in managing PAS-induced hyperglycemia and highlights the value of CGM in early detection and intervention. Our findings suggest that GLP-1RAs, particularly semaglutide, are a valuable treatment option for this condition. Further research is needed to determine the optimal treatment strategy, particularly in East Asian populations, and to establish a clear consensus on the first-line therapy for PAS-induced hyperglycemia.

Exploring the general practitioners’ perception of the inter-professional care of rheumatoid arthritis patients (GEPRA—II): a qualitative interview study

BackgroundA lack of medication adherence among patients with rheumatoid arthritis (RA) has been reported. Inter-professional collaborations seem essential for an optimal therapeutic management of patients. The aim of this study was to analyse the barriers and facilitators of general practitioners (GPs) for the implementation of collaborative support programmes in RA.MethodsA qualitative semi-structured study using face-to-face or telephone interviews was conducted. Eligible participants included French GPs referring patients with RA. Interviews were audio-recorded and then transcribed. Data were analysed using Braun and Clarke’s thematic analysis framework with Nvivo®12 software.ResultsNineteen GPs were interviewed between August 2019 and February 2020. Five themes were identified in the care of their patients with RA. GPs reported being mainly involved in diagnosis and orientation, and frequently asked for pain management and explanation/reformulation of previously given information. They perceived their patients to be adherent to their treatments, although they frequently identified reasons for non-adherence. Regarding their perception of the community-hospital relationship, they sometimes considered it insufficient and expected more immediate interactions. Additionally, most interviewed GPs had no expectation regarding increased collaborations with community pharmacists (CPs) and several GPs were motivated to be more involved in a patient support programme. However, barriers were identified: lack of time and training, and insufficient payment.ConclusionsThe implementation of a collaborative patient support programme in RA should be developed taking into account the barriers and facilitators identified by GPs who appeared to be aware of the causes of potential non-adherence, and were particularly interested in receiving more information about the therapeutic monitoring of patients by hospital professionals.

Systolic blood pressure response during exercise testing in symptomatic severe aortic stenosis

AimsExercise testing remains underused in patients with aortic stenosis (AS), partly due to concerns about an exercise-induced drop in systolic blood pressure (SBP). We aimed to study the SBP response...

Circulating tumour DNA in earlystage and locally advanced NSCLC: ready for clinical implementation?

Circulating tumour DNA (ctDNA) can be released by cancer cells into biological fluids through apoptosis, necrosis or active release. In patients with non-small-cell lung cancer (NSCLC), ctDNA levels correlate with clinical and pathological factors, including histology, tumour size and proliferative status. Currently, ctDNA analysis is recommended for molecular profiling in patients with advanced-stage NSCLC. In this Review, we summarize the increasing evidence suggesting that ctDNA has potential clinical applications in the management of patients with earlystage and locally advanced NSCLC. In those with earlystage NSCLC, detection of ctDNA before and/or after surgery is associated with a greater risk of disease recurrence. Longitudinal monitoring after surgery can further increase the prognostic value of ctDNA testing and enables detection of disease recurrence earlier than the assessment of clinical or radiological progression. In patients with locally advanced NSCLC, the detection of ctDNA after chemoradiotherapy is also associated with a greater risk of disease progression. Owing to the limited number of patients enrolled and the different technologies used for ctDNA testing in most of the clinical studies performed thus far, their results are not sufficient to currently support the routine clinical use of ctDNA monitoring in patients with earlystage or locally advanced NSCLC. Therefore, we discuss the need for interventional studies to provide evidence for implementing ctDNA testing in this setting.

Federally qualified health center patients’ experiences with remote patient monitoring as part of telehealth services for self-measured blood pressure monitoring

BackgroundRemote patient monitoring (RPM) for hypertension management has become increasingly popular, demonstrating benefits for both clinics and patients. However, patient engagement in self-measured blood pressure (SMBP) monitoring remains low despite healthcare providers’ efforts. This study aimed to assess adherence and acceptance of RPM for SMBP among Texas Federally Qualified Health Center patients.MethodsParticipants enrolled in the SMBP monitoring program were recruited at three health centers. Data was collected from patient health records, and a questionnaire assessed hypertension self-management, technology acceptance, intentions, and attitudes toward SMBP. Thematic analysis was conducted for open-ended responses that followed each item, and multivariate linear regression assessed associations between psychosocial factors and SMBP use.ResultsThe sample (n = 47) was 64% female, 89% Hispanic/Latino, and 75% uninsured. Participants used RPM for SMBP an average of 46 days and 72 times within the first 120 days (~ 4 months). Age and behavioral intention were significantly positively associated with more days of SMBP use. Three themes emerged from open-ended data: perceived ease of learning and using mobile patient portal for SMBP, perceived benefits of using mobile patient portal for SMBP, and intentions to continue using the mobile patient portal for SMBP.ConclusionsParticipants found RPM for SMBP acceptable and easy to use. Use varied over time, with intention to use RPM for SMBP and older age linked to more days of use. RPM can enhance patient experience by providing additional information to the provider, prompting self-management discussions, and empowering patients to better control their BP.

Predicting the Progression from Asymptomatic to Symptomatic Multiple Myeloma and Stage Classification Using Gene Expression Data.

The accurate staging of multiple myeloma (MM) is essential for optimizing treatment strategies, while predicting the progression of asymptomatic patients, also referred to as monoclonal gammopathy of undetermined significance (MGUS), to symptomatic MM remains a significant challenge due to limited data. This study aimed to develop machine learning models to enhance MM staging accuracy and stratify asymptomatic patients by their risk of progression. We utilized gene expression microarray datasets to develop machine learning models, combined with various data transformations. For multiple myeloma staging, models were trained on a single dataset and validated across five independent datasets, with performance evaluated using multiclass area under the curve (AUC) metrics. To predict progression in asymptomatic patients, we employed two approaches: (1) training models on a dataset comprising asymptomatic patients who either progressed or remained stable without progressing to multiple myeloma, and (2) training models on multiple datasets combining asymptomatic and multiple myeloma samples and then testing their ability to distinguish between asymptomatic and asymptomatic that progressed. We performed feature selection and enrichment analyses to identify key signaling pathways underlying disease stages and progression. Multiple myeloma staging models demonstrated high efficacy, with ElasticNet achieving consistent multiclass AUC values of 0.9 across datasets and transformations, demonstrating robust generalizability. For asymptomatic progression, both modeling approaches yielded similar results, with AUC values exceeding 0.8 across datasets and algorithms (ElasticNet, Boosting, and Support Vector Machines), underscoring their potential in identifying progression risk. Enrichment analyses revealed key pathways, including PI3K-Akt, MAPK, Wnt, and mTOR, as central to MM pathogenesis. To the best of our knowledge, this is the first study to utilize gene expression datasets for classifying patients across different stages of multiple myeloma and to integrate multiple myeloma with asymptomatic cases to predict disease progression, offering a novel methodology with potential clinical applications in patient monitoring and early intervention.

Telehomecare Monitoring for Patients Receiving Anticancer Oral Therapy: Protocol for a Mixed Methods Evaluability Study.

Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes. This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation. This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings. Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025. This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients. DERR1-10.2196/63099.

Assessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.

Fluids are given with the purpose of increasing cardiac output (CO), but approximately only 50% of critically ill patients are fluid responders. Since the effect of a fluid bolus is time-sensitive, it diminuish within few hours, following the initial fluid resuscitation. Several functional hemodynamic tests (FHTs), consisting of maneuvers affecting heart-lung interactions, have been conceived to discriminate fluid responders from non-responders. Three main variables affect the reliability of FHTs in predicting fluid responsiveness: (1) tidal volume; (2) spontaneous breathing activity; (3) cardiac arrythmias. Most FTHs have been validated in sedated or even paralyzed ICU patients, since, historically, controlled mechanical ventilation with high tidal volumes was the preferred mode of ventilatory support. The transition to contemporary methods of invasive mechanical ventilation with spontaneous breathing activity impacts heart-lung interactions by modifying intrathoracic pressure, tidal volumes and transvascular pressure in lung capillaries. These alterations and the heterogeneity in respiratory mechanics (that is present both in healthy and injured lungs) subsequently influence venous return and cardiac output. Cardiac arrythmias are frequently present in critically ill patients, especially atrial fibrillation, and intuitively impact on FHTs. This is due to the random CO fluctuations. Finally, the presence of continuous CO monitoring in ICU patients is not standard and the assessment of fluid responsiveness with surrogate methods is clinically useful, but also challenging. In this review we provide an algorithm for the use of FHTs in different subgroups of ICU patients, according to ventilatory setting, cardiac rhythm and the availability of continuous hemodynamic monitoring.

Remote patient monitoring in heart failure: Acomprehensive meta-analysis of effective programme components for hospitalization and mortality reduction.

Methods of non-invasive remote patient monitoring (RPM) for heart failure (HF) remain diverse. Understanding factors that influence the effectiveness of RPM on HF-related and all-cause hospitalizations, mortality, and emergency department visits is crucial for developing successful RPM interventions. This meta-analysis aims to synthesize and compare existing literature on RPM components that impact HF-related and all-cause hospitalizations, mortality and emergency department visits in HF patients. A systematic search of electronic databases (PubMed, EMBASE, CENTRAL) identified randomized controlled trials from January 2012 to June 2023, comparing non-invasive RPM interventions for HF with usual care. A random-effects meta-analysis assessed outcomes, and additional analyses identified effective RPM components. A total of 41 studies with 16 312 patients (mean follow-up: 9.88 ± 6.37 months) were included. RPM was associated with lower mortality risk (pooled odds ratio [OR] 0.81 95% confidence interval [CI] 0.69-0.95; I2 = 0.39) and reduced first HF hospitalization risk (pooled OR 0.78, 95% CI: 0.70-0.87; I2 = 0.21) compared to usual care. RPM interventions with a self-management module (p < 0.001) and education module (p = 0.028) significantly lowered HF-related hospitalizations. Video calls during RPM interventions further reduced HF-related (p = 0.047) and all-cause hospitalizations (p < 0.001). This meta-analysis confirms the efficacy of RPM in reducing HF-related hospitalizations and mortality. Effective components include self-management, education modules, and video communication. However, heterogeneity among interventions challenges the overall evaluation. Modernizing RPM with advanced technologies like non-invasive sensors, artificial intelligence, and cardiac telerehabilitation could enhance its potential.

Patient-Reported Outcome Measures in Patients with Diabetes Mellitus: Findings from the Diabetes Landeck Cohort.

Maintaining and optimizing quality of life (QoL) is a central issue and one of the most important goals in therapy for patients with chronic diseases, such as diabetes mellitus (DM). Despite its importance, there is little data on the QoL of patients with DM in Austria. The objective of this study was to extend an established population-based cohort, the Diabetes-Landeck cohort, by including patient-reported outcomes. We performed a survey on quality of life (QoL) and treatment satisfaction in patients from the Diabetes-Landeck cohort using the EQ-5D-5L, the problem areas in diabetes survey (PAID), and the diabetes treatment satisfaction questionnaire (DTSQ). Mean sum scores were calculated and compared between patient characteristic subgroups. In total 58 patients were recruited, with a mean age of 63 years and a mean hemoglobin A1c (HbA1c) of 7.1%. The mean sum score of EQ-5D-5L was 92 (SD=10.6), and that of DTSQ and PAID were 32.2 (SD=6.6) and 10.8 (SD=11.6), respectively. Patients with obesity (body mass index ≥ 30 kg/m2) showed a statistically significant decreased mean sum score of EQ-5D-5L and a statistically significant increased mean sum score of DTSQ. Patients with HbA1c ≥7.5% showed a statistically significant decreased mean sum score of DTSQ. We observed patient-reported outcomes significantly associated with obesity and HbA1c, which could be used for targeted patient monitoring. Limited by small sample size and questions in generalizability, we strongly suggest the rollout of a larger study.

Current status of nanofat in the management of knee osteoarthritis: A systematic review.

Osteoarthritis (OA) is a prevalent joint disorder requiring innovative treatment approaches. To evaluate the use of nanofat, a specialized form of adipose tissue-derived cells, in the treatment of OA, by examining its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes. A comprehensive review of preclinical studies, clinical trials, and in vitro investigations was conducted. The included studies provided insights into the potential role of nanofat in OA treatment, addressing its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes. Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA. Local adverse events were limited to the injection site, such as localized pain and inflammation, and resolved within a few days to weeks. Systemic adverse events were rare, and no significant long-term complications were observed. Mechanistically, nanofat was found to enhance chondrocyte proliferation, reduce inflammation, and promote angiogenesis, thereby contributing to its therapeutic effects. Nanofat therapy holds promise as a therapeutic option for managing OA, providing pain relief, functional improvement, and potential tissue regeneration. The safety profile of nanofat treatment appears favorable, but long-term data are still limited. Standardized protocols, larger randomized controlled trials, longer follow-up periods, and cost-effectiveness evaluations are warranted to establish optimal protocols, comparative effectiveness, and long-term outcomes. Despite current limitations, nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment, with careful patient selection and monitoring.

Ganciclovir Resistance-Linked Mutations in the HCMV UL97 Gene: Sanger Sequencing Analysis in Samples from Transplant Recipients at a Tertiary Hospital in Southern Brazil.

Background/Objectives: Human cytomegalovirus (HCMV) DNAemia remains a significant concern for transplant recipients, largely due to mutations in the viral genome that may lead to antiviral-resistant strains. Mutations in the UL97 gene are frequently associated with resistance to ganciclovir (GCV), highlighting the importance of early mutation detection to effectively manage viremia. This study aimed to optimize a Sanger sequencing protocol for analyzing GCV resistance-linked mutations in the HCMV UL97 gene from plasma samples of transplant patients treated at Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. Methods: A nested-PCR approach combined with a touchdown PCR method was employed to enhance the sensitivity and specificity of the sequencing analysis. Results: The study sample included various transplants, encompassing solid organ and bone marrow recipients. Among 16 sequenced samples, 8 exhibited nucleotide substitutions resulting in amino acid changes. Notably, the A594V and C603W mutations, associated with GCV resistance, were identified in four samples. Additionally, three mutations with unknown phenotypic impact (P509L, A628T, and H662Y) and two viral polymorphisms (N510S and D605E) were detected. Furthermore, double peaks in the Sanger electropherograms, indicative of mixed viral populations of HCMV were observed in seven samples. Conclusions: The optimized Sanger sequencing protocol provides a cost-effective solution for detecting GCV resistance mutations in HCMV UL97 among transplant recipients. This approach could improve the understanding of HCMV strain dynamics and serve as a valuable tool for long-term patient monitoring, particularly within resource-constrained settings such as the public health systems of middle-income countries.

Enhancing Real-Time Patient Monitoring in Intensive Care Units with Deep Learning and the Internet of Things.

The demand for intensive care units (ICUs) is steadily increasing, yet there is a relative shortage of medical staff to meet this need. Intensive care work is inherently heavy and stressful, highlighting the importance of optimizing these units' working conditions and processes. Such optimization is crucial for enhancing work efficiency and elevating the level of diagnosis and treatment provided in ICUs. The intelligent ICU concept represents a novel ward management model that has emerged through advancements in modern science and technology. This includes communication technology, the Internet of Things (IoT), artificial intelligence (AI), robotics, and big data analytics. By leveraging these technologies, the intelligent ICU aims to significantly reduce potential risks associated with human error and improve patient monitoring and treatment outcomes. Deep learning (DL) and IoT technologies have huge potential to revolutionize the surveillance of patients in the ICUs due to the critical and complex nature of their conditions. This article provides an overview of the most recent research and applications of linical data for critically ill patients, with a focus on the execution of AI. In the ICU, seamless and continuous monitoring is critical, as even little delays in patient care decision-making can result in irreparable repercussions or death. This article looks at how modern technologies like DL and the IoT can improve patient monitoring, clinical results, and ICU processes. Furthermore, it investigates the function of wearable and advanced health sensors coupled with IoT networking systems, which enable the secure connection and analysis of various forms of patient data for predictive and remote analysis by medical professionals. By assessing existing patient monitoring systems, outlining the roles of DL and IoT, and analyzing the benefits and limitations of their integration, this study hopes to shed light on the future of ICU patient care and identify opportunities for further research.

A IMPORTÂNCIA DO CUIDADO FARMACÊUTICO NO TRATAMENTO DA DIABETES MELLITUS TIPO I EM CRIANÇAS E ADOLESCENTES

Introduction: Childhood and adolescence are the typical periods of onset of type 1 diabetes mellitus (DM1), marked by hyperglycemia and diabetic ketoacidosis. This autoimmune disease is characterized by the infiltration and destruction of insulin-secreting cells in the islets of Langerhans by lymphocytes. The fundamental role of pharmaceutical professionals in the care of patients with DM1 is essential, their involvement encompassing the management of blood glucose levels, the recommendation of appropriate dosage regimens, the recommendation of lifestyle changes and the selection of medications based on individual needs, safety, cost and efficacy. Objective: The aim of this study was to highlight the importance of the pharmacist’s role in controlling and monitoring DM in children and adolescents.. Methodology: This was a literature review carried out using materials published in databases between 2019 and 2024. Results: The pharmacist, as a qualified professional with experience in handling and managing medicines, plays a crucial role in monitoring patients with DM. Final considerations: In addition to handling medications and monitoring treatment, pharmacists provide essential guidance on the proper use of insulin and other medications, ensuring the safety and effectiveness of treatment.

Real-world ePRO use and clinical outcomes using electronic patient-reported symptom monitoring for patients with advanced non-small-cell lung cancer receiving first-line pembrolizumab.

Aim: This ambispective observational study assessed the impact of Noona, an electronic patient-reported outcomes (ePRO) platform, for patients with non-small cell lung cancer (NSCLC) treated in a community oncology setting. Methods: Adults with advanced NSCLC, ECOG performance status of 0-2, who received first-line (1L) pembrolizumab (monotherapy or with chemotherapy) were eligible. Those initiating pembrolizumab from 1 July 2017 to 30 June 2019, identified retrospectively (historical cohort), were compared with those initiating pembrolizumab from 1 October 2019 to 30 September 2021 who were prospectively offered Noona (standard of care [SoC] cohort). The Kaplan-Meier method and Cox proportional hazards models were used to compare pembrolizumab real-world time on treatment (rwToT; primary outcome measure) and rw time to next treatment or death (rwTTNTD) between historical and SoC cohorts. Healthcare resource use (HCRU) was compared using generalized linear models with Poisson distribution. Analyses were repeated to compare outcomes in the SoC cohort between Noona users (created a profile and used any function ≥one-time during 1L therapy) and nonusers with >42days on 1L pembrolizumab. Data cutoff was 30 June 2020 and 30 September 2022 for historical and SoC cohorts, respectively. Results: Median pembrolizumab rwToT was 4.4months (95% CI: 3.9-5.1) in the historical cohort (n=448) versus 4.1months (95% CI: 3.3-4.8) in the SoC cohort (n=462; adjusted hazard ratio [aHR], 0.9; 95% CI: 0.8-1.0; p=0.14 vs historical cohort). In the SoC cohort, 147 of 341 eligible patients (43%) established a Noona profile; 122/341 (36%) were Noona users. Median rwToT was 6.4months (95% CI: 5.1-7.4) and 6.9months (95% CI: 5.6-7.6) among Noona users and Noona nonusers (n=219), respectively (aHR, 1.1; 95% CI: 0.8-1.4; p=0.95 vs Noona users). The rwTTNTD and HCRU were comparable in historical versus SoC cohorts and for Noona users versus nonusers. During the first year after establishing a Noona profile, 92 of 147 patients (63%) used the platform; monthly use was 32-42%, and checking laboratory results was the most used function overall (by 52% of the 147). Conclusion: Notwithstanding the null findings of this study, positive results of ePRO use in clinical trials and observational studies support the treatment-related symptom monitoring and survival benefits of ePRO utilization.

Blood coagulation monitoring of patients with mechanical heart valve visiting Imam

BackgroundThe lacking proper regulation of International Normalized Ratio (INR) as the main problem in patients with mechanical valve replacement surgery poses the risk of thrombosis and embolism on the one hand and the risk of bleeding on the other. For this reason, the correct monitoring of INR via the Time in Therapeutic Range (TTR) is needed. The present study aimed to explore the blood coagulation monitoring of patients with mechanical heart valve in Imam Ali Hospital of Kermanshah in 2021.MethodIn the present cross-sectional study, the research population consisted of 139 patients, who underwent mechanical heart valve replacement. Information on patients’ demographic variables, health records, comorbidities, and medications was collected using a checklist. During the monthly follow-up, INR and thrombotic and bleeding events were recorded through calls made to patients. Then the TTR was estimated based on Rosendahl’s model and compared with the standard rate to test the relationship with hemorrhagic and thrombotic events in SPSS21.ResultsThe mean and standard deviation of patients’ age was 58.25 ± 10.16 years. Among 139 patients with mechanical heart valves, 55 (39.6%) were male and 84 (60.4%) were female. Ninety-one patients (65.5%) had primary-school education, 22 (15.8%) middle school education, 17 (12.2%) high school education and 9 (6.5%) had a university degree. Chi-square test results showed a positive and significant difference between the blood coagulation monitoring of patients with mechanical heart valves and sex, education, blood pressure, captopril drug and the number of visits and follow-up (p ≥ 0.05).ConclusionThe present study showed that TTR was lower than normal in the target population. Therefore, it is necessary to closely monitor patients’ blood coagulation for the appropriate therapeutic dose according to patients’ sex, education, blood pressure, captopril drug and the number of visits and follow-up.