Remote Programming Research Articles

Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study.

Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood. This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey. A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients' attitudes toward the 2 different programming methods. A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources. Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions-burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients.

Feasibility and safety of remote programming in postoperative follow-up of cardiovascular implantable electronic devices

Objective: To explore the feasibility and safety of remote programming technology based on 5G cloud technology support platform in postoperative follow-up of cardiovascular implantable electronic devices(CIED). Methods: This study was a multicenter cross-sectional study. CIED patients from 12 hospitals lacking full-time follow-up specialists in Sichuan Province were enrolled from June 2021 to October 2021. All patients' devices received remote inspecting and programming by the follow-up specialist of the remote follow-up center of the Third People's Hospital of Chengdu through 5G cloud technology support platform. The baseline data, device alarm events, device reprogramming events, adverse reactions and satisfaction questionnaire survey results were collected. Results: A total of 195 CIED implantation patients were included, with an age of (72.5±11.3) years, including 103 males (52.6%). All patients completed remote inspecting and programming successfully, with a duration of (5.8±4.0) min. Ninety-one patients' CIED were reprogrammed, with a total of 104 parameter adjustments. No abnormal communication or adverse events occurred. The satisfaction questionnaire showed that 97.9%(191/195) of the patients trusted or relatively trusted remote follow-up and 86.7%(169/195) of the patients were willing to choose remote follow-up mode for device management. Conclusion: The remote programming based on 5G cloud technology support platform may be feasible and safe for postoperative follow-up of CIED patients.

Motor improvement of remote programming in patients with Parkinson's disease after deep brain stimulation: a 1-year follow-up.

Remote programming (RP) is an emerging technology that enables the adjustment of implantable pulse generators (IPGs) via the Internet for people with Parkinson's disease (PwPD) who have undergone deep brain stimulation (DBS). Previous studies have not comprehensively explored the effectiveness of RP in managing motor symptoms, often omitting assessments such as the rigidity and retropulsion tests during the follow-up. This study evaluates the comprehensive improvements in motor performance and the potential cost benefits of RP for PwPD with DBS. A retrospective analysis was conducted on two groups of patients-those who received RP and those who received standard programming (SP). Clinical outcomes including motor improvement, quality of life, and daily levodopa dosage were compared between the groups during a 12 (± 3)-month in-clinic follow-up. A total of 44 patients were included in the study, with 18 in the RP group and 26 in the SP group. No significant differences were observed in the frequency of programming sessions or clinical outcomes between the groups (p > 0.05). However, the RP group experienced significantly lower costs per programming session than the SP group (p < 0.05), despite patients in the former group living further from our center (p < 0.05). Our findings suggest that RP could significantly reduce the costs of programming for PwPD with DBS, especially without compromising the effectiveness of treatment across all motor symptoms in the short term.

Cochlear Implant Remote Assist: Clinical and Real-World Evaluation

Objectives To develop and evaluate Cochlear™ Remote Assist (RA), a smartphone-based cochlear implant (CI) teleaudiology solution. The development phase aimed to identify the minimum features needed to remotely address most issues typically experienced by CI recipients. The clinical evaluation phase assessed ease of use, call clarity, system latency, and CI recipient feedback. Design The development phase involved mixed methods research with experienced CI clinicians. The clinical evaluation phase involved a prospective single-site clinical study and real-world use across 16 clinics. Study sample CI clinicians (N = 23), CI recipients in a clinical study (N = 15 adults) and real-world data (N = 57 CI recipients). Results The minimum feature set required for remote programming in RA, combined with sending replacements by post, should enable the clinician to address 80% of the issues typically seen in CI follow-up sessions. Most recipients completed the RA primary tasks without prior training and gave positive ratings for usefulness, ease of use, effectiveness, reliability, and satisfaction on the Telehealth Usability Questionnaire. System latency was reported to be acceptable. Conclusion RA is designed to help clinicians address a significant proportion of issues typically encountered by CI recipients. Clinical study and real-world evaluation confirm RA’s ease of use, call quality, and responsiveness.

Easy Development of Industry 4.0 Remote Labs

Acquiring hands-on skills is nowadays key for engineers in the context of Industry 4.0. However, it is not always possible to achieve this in person. Therefore, it is essential to be able to conduct skill acquisition from a remote location. To support the development of remote labs for experimentation, this work proposes the development of an open Industry 4.0 remote platform that can be easily configured and scaled to develop new remote labs for IoT (Internet of Things), cybersecurity, perception systems, robotics, AI (artificial intelligence), etc. Over time, these capabilities will enable the development of sustainable Industry 4.0 remote labs. These labs will coexist on the same Industry 4.0 platform, as our proposed Industry 4.0 remote platform is capable of connecting multiple heterogeneous types of devices for remote programming. In this way, it is possible to easily design open remote labs for the digital transition to Industry 4.0 in a standardized way, which is the main research goal of our In4Labs project. Several users already conducted a series of IoT experiments on our remote Industry 4.0 platform, providing useful recommendations to be included in future versions of the platform.

Remote programming in stage I sacral neuromodulation: a multicentre prospective feasibility study.

Sacral neuromodulation (SNM) has emerged as an effective therapy for refractory lower urinary tract dysfunction (LUTD). Remote programming holds promise in addressing the time and economic burdens associated with outpatient programming, especially for patients in the observation period following Stage I implant surgery (where the lead is implanted first without the pulse generator). The study aimed to explore the effectiveness and patient satisfaction of remote programming for Stage I SNM patients, and analyze the benefits patients gain from remote programming. This prospective study was conducted at multiple high-level clinical SNM centres in China. Patients requiring SNM implantation were enroled and divided into two groups based on patient preference: remote programming (RP) group and outpatient control (OC) group. Patient attitudes toward RP were assessed through questionnaires, and the degree of symptom improvement was compared between the two groups to explore the usability of RP. A total of 63 participants from 6 centres were included in the study, with 32 belonging to the RP group. The remote programming system presents a high level of usability (98%) and willingness (satisfaction rate: 96.83%) in result of questionnaire. RP showed a significant advantage in improving patients' score of ICSI/ICPI (medianΔICSI/ICPI RP vs. OC= -13.50 vs -2, P =0.015). And slightly ameliorate urinary symptoms such as pain (medianΔVAS RP vs. OC= -1 vs 0, P = 0.164) and urgency (medianΔOBASS -2.5 vs. -1, P = 0.,229), but the difference was not statistically significant. RP did not significantly impact the quality of life of patients ( P =0.113), so do the rate of phase-two conversion ( P = 0.926) or programming parameters. To the best of our knowledge, the presented study is the first multicenter research focusing on the remote programming of Stage I SNM patients. Through the clinical implementation and patient feedback, we demonstrate that remote programming is not inferior to in-person programming in terms of success rate, effectiveness, safety, and patient satisfaction.

Cluster and trajectory analysis of motivation in an emergency remote programming course.

Emergency remote teaching is a temporary change in the way education occurs, whereby an educational system unexpectedly becomes entirely remote. This article analyzes the motivation of students undertaking a university course over one semester of emergency remote teaching in the context of the COVID-19 pandemic. University students undertaking a programming course were surveyed three times during one semester, about motivation and COVID concern. This work explores which student motivation profiles existed, how motivation evolved, and whether concern about the pandemic was a factor affecting motivation throughout the course. The most adaptive profile was highly motivated, more prepared and less frustrated by the conditions of the course. However, this cluster experienced the highest levels of COVID-19 concern. The least adaptive cluster behaved as a mirror image of the most adaptive cluster. Clear differences were found between the clusters that showed the most and least concern about COVID-19.

Utilization of remote reprogramming to manage insertable cardiac monitor arrhythmia alert burden.

The increasing use of insertable cardiac monitors (ICMs) for long-term continuous arrhythmia monitoring creates a high volume of transmissions and a significant workload for clinics. The ability to remotely reprogram device alert settings without in-office patient visits was recently introduced, but its impact on clinic workflow compared to the previous ICM iteration is unknown. The aim of this real-world study was to evaluate the impact of device reprogramming capabilities on ICM alert burden and on clinic workflow. Deidentified data was obtained from USpatients and a total of 19 525 receiving a LINQ II were propensity score-matched with 19 525 implanted with LINQ TruRhythm (TR) ICM based on age and reason for monitoring. After reprogramming, ICM alerts reduced by 20.5% (p < .001). Compared with patients monitored with LINQ TR, patients with LINQ II had their device reprogrammed sooner after implant and more frequently during follow-up. Adoption of remote programming was projected to lead to an annual total clinic time savings of 211 h per 100 ICM patients managed. These data suggest that utilization of ICM alert reprogramming has increased with remote capabilities, which may reduce clinic and patient burden for ICM follow-up and free clinician time for other valuable patient care activities.

Evaluation of a Remote Youth Health Advocate Training Program During the COVID-19 Pandemic

Abstract: Background: Since 2016, Changing Health through Advocacy &amp; eMPloyment In Our NeighborhoodS (CHAMPIONS) has utilized in-person programming to engage high school students from underserved Chicago communities in health advocacy education and exposure to health professional careers. Objective: Describe outcomes after CHAMPIONS' shift from in-person to remote programming during the corona-virus disease 2019 (COVID-19) pandemic. Methods: The Summer 2020 remote program consisted of four main activities: 1) didactic public health curriculum, 2) phone calls to COVID-19 patients, 3) COVID-19 community health projects, and 4) health professional speaker series. Program evaluation consisted of pre-/post-program surveys and focus groups. Results: Participants were very satisfied with CHAMPIONS and reported increased healthy habits, self-efficacy, and knowledge. "First-hand experiences" increased equivalently or more for the remote compared to in-person cohorts. Conclusions: The remote CHAMPIONS program maximized positive effects for participants. Strengths and lessons learned may be used in future enrichment programs to improve accessibility and exposure for underserved students.

Precise management system for chronic intractable pain patients implanted with spinal cord stimulation based on a remote programming platform: study protocol for a randomized controlled trial (PreMaSy study)

BackgroundSpinal cord stimulation (SCS) is a surgical technique used in patients with chronic intractable pain, and its effectiveness and safety have been validated by multiple studies. However, to maintain an optimal and steady long-term effect is still challenging. Here, we report a new management paradigm integrating smartphone application and remote programming. Chronic pain patients with SCS implants can monitor their pain status on the phone and change stimulation parameters accordingly. The PreMaSy study is a randomized controlled trial to evaluate the clinical effectiveness and safety of this precise management system.MethodsPatients with chronic intractable pain will be screened for eligibility, and 82 participants are anticipated to be enrolled in this trial. After the electrode implantation, the stimulation effectiveness will be tested. Participants with a reduction of more than 50% in the visual analog scale (VAS) will receive implantation of an implantable pulse generator and randomized (1:1) into the experimental group or control group. All participants will be asked to take online follow-ups and complete assessments using a smartphone application. Daily pain characteristic assessments and monthly quality of life questionnaires are integrated into the App, and participants will be required to complete these assessments. The daily VAS for pain intensity will be monitored and a threshold will be set based on baseline VAS score. The interventional appointment will be scheduled once the threshold is reached. The primary outcome is the health condition and quality of life assessed by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). Utility values of EQ-5D-5L will be assessed at baseline and 1, 3, and 6 months post-operative.DiscussionThe PreMaSy study aims to evaluate the effectiveness and safety of a novel App-based, patient-centered, self-assessment management system for chronic intractable pain. A randomized controlled trial is designed to test the non-inferiority of this precise management system compared to the monthly online follow-ups. It is also expected to yield valuable experiences regarding precision medicine.Trial registrationClinicalTrials.gov NCT05761392. Registered on March 07, 2023.

Design of the Remote Optimization Adjustment and Measurement for Deep Brain Stimulation (ROAM-DBS) randomized prospective outcomes study of remote programming

Design of the Remote Optimization Adjustment and Measurement for Deep Brain Stimulation (ROAM-DBS) randomized prospective outcomes study of remote programming

ID: 214658 First-in-Human Experience With an Implantable SCS System With Automated Daily Remote Monitoring and Remote Programming

The BENEFIT-03 Study (NCT04683718) is designed to evaluate the safety and effectiveness of an implantable spinal cord stimulation (SCS) system with multiphase stimulation and remote device management. While results of an SCS teleprogramming pilot study have been reported previously,1 to our knowledge, BENEFIT-03 is the world’s first long-term study of an SCS system with automated remote device monitoring and remote programming capabilities.

ID: 209013 Combining Remote Programming and Remote Monitoring Towards a Closed-Loop DBS System

Deep Brain Stimulation (DBS) is an effective therapy for Parkinson’s Disease (PD). However, it is currently applied in an open-loop fashion and symptom management relies on iterative programming. The field is trending towards closed-loop solutions that enable stimulation parameters to be adjusted in real-time in response to patient-specific feedback signals. Identifying reliable and robust feedback signals is a challenge in developing closed-loop DBS solutions. As such, in this study, we aim to combine remote monitoring and remote programming to identify specific sensor signals that correlate with DBS programming and symptom profile changes.

ID: 214607 First-in-Human Study Protocol to Evaluate a Multiphase Spinal Cord Stimulation System With Remote Device Management

Short-term clinical results from the BENEFIT-02 study1 provided evidence to support the use of novel multiphase spinal cord stimulation (SCS) to aid in the management of chronic low back and leg pain. Other recent SCS paradigms require in-person reprogramming and stimulation adjustments to optimize stimulation parameters. It is hypothesized that providing patients with more convenient access to optimize SCS therapy through remote device management (i.e., automated remote device monitoring and remote programming) may improve their experience with SCS therapy. BENEFIT-03 (NCT04683718) is the first long-term study of an SCS system with remote management capabilities.

ID: 222362 3-Month Study Results for an Implantable SCS System With Multiphase Stimulation and Remote Device Management

Patients receiving spinal cord stimulation (SCS) therapy require frequent reprogramming following device implantation to achieve optimal pain management and commonly encounter therapy disruptions.1-3 Delays scheduling in-clinic visits are common and may extend periods of pain relapse and contribute to worsening outcomes.4,5 Further, evidence suggests pain intensity reported during in-clinic assessments may be inconsistent with at-home daily reports, and may not fully reflect SCS patient experience in real-world settings.6,7 The BENEFIT-03 Study (NCT04683718) is designed to evaluate the safety and effectiveness of an implantable SCS system with automated remote device monitoring, remote programming and multiphase stimulation.

ID: 221289 Early Experience From the Remote Optimization Adjustment and Measurement for Deep Brain Stimulation Trial

There is a critical need for Deep Brain Stimulation (DBS) telemedicine systems that allow for remote adjustment of stimulation parameters. This would reduce the need for patients to travel to clinic which is a barrier to care. A third of DBS patients with Parkinson’s Disease (PD) cannot easily travel to a clinic, and a quarter report difficulty contacting their provider or staff for clinical questions [1]. While newly introduced DBS remote programming platforms [2] allow for DBS device interrogation and programming remotely, evidence directly comparing real world outcomes of remote and traditional in-clinic programming is lacking. The ROAM-DBS trial compares remote and in-clinic programming in the immediate post-operative period.

ID: 213412 Comparison of Remote Programming and On-Site Programming in Patients With SCS and DRG Stimulation

Spinal cord and dorsal root ganglion stimulation (SCS and DRG) are standard of care in chronic neuropathic pain. During the COVID-19 pandemic, it was critical to arrange postoperative care. Furthermore, the disparity between travel times and transportation options could influence the decision on seeking healthcare. Lacking financial resources could enhance this issue.

Remote Patient Monitoring: What Have We Learned and Where Are We Going?

Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is an important part of patient follow-up. The increasing number of patients with CIEDs and the recent pandemic pose several challenges for already limited device clinic resources. This review focuses on recent evolutions in RM and identifies future needs to improve RM. RM has been associated with multiple clinical benefits, including improved survival, early detection of actionable events, reduction in inappropriate shocks, longer battery lives, and more efficient healthcare utilization. The survival benefit was driven by studies using alert-based continuous RM with daily transmissions and fast reaction times. Patients report a high satisfaction rate without significant differences in quality of life between RM and in-office follow-up.The increasing workload, due to the increasing number of CIEDs implanted with daily remote transmissions, results in several challenges for the future of RM. RM requires appropriate reimbursement for RM device clinics to optimize patient/staff ratios, including sufficient non-clinical and administrative support. Universal alert programming and data processing may minimize inter-manufacturer differences, improve the signal-to-noise ratio, and allow the development of standard operating protocols and workflows. In the future, programming by remote control and true remote programming may further improve remote CIED management, patient quality of life, and device clinic workflows. RM should be considered standard of care in management of patients with CIEDs. The clinical benefits of RM can be maximized by an alert-based continuous RM model. Adapted healthcare policies are required to keep RM manageable for the future.

An automated system for cattle reproductive management under the IoT framework. Part I: the e-Synch system and cow responses

The objective of this manuscript was to present the e-Synch system, integrating an intravaginal electronically controlled hormone delivery and sensing device with an IoT platform for remote programming and monitoring. Secondary objectives were to demonstrate system functionality and cow responses to e-Synch. External components of e-Synch include a 3D-printed case with retention wings, a flexible wideband antenna, and silicone membrane for pressure balancing. Internal components include a central control board, battery, wireless charging coil, and two silicone hormone reservoirs connected to individual peristaltic pumps. An accelerometer and a high-accuracy temperature sensor are integrated in the custom printed circuit board (PCB). The IoT platform includes a gateway consisting of Raspberry PI 3 and a CC1352 radiofrequency module that collects sensor data at 915 mHz. Data is transferred to the Google Cloud utilizing the IoT Core service through TCP/IP, and then is pulled by the Pub/Sub service. After routing to a BigQuery table by the Dataflow service, data visualization is provided by Data Studio. Drug delivery protocols are selected using an IOS device app that connects to e-Synch through Bluetooth. Experiments with lactating Holsteins cows were conducted to demonstrate proof-of-concept system functionality and evaluate cow responses. Despite unstable communication and signal discontinuity because of signal strength attenuation by body tissue, devices (n=6) communicated with the IoT platform in 89% (24/27) of use instances. Temperature and accelerometer data were received for at least one 15 min period during an 8 h insertion period from all devices that communicated with the IoT platform. Variation in accelerometer data (± 8.565 m/s2) was consistent with cow activity during experimentation and mean vaginal temperature of 39.1 °C (range 38.6 to 39.5 °C) demonstrated sensor functionality. Hormone release was confirmed in all instances of device use except for one. Cow behavior evaluated through signs of discomfort and pain, and tail raising scores was mostly unaltered by e-Synch. Vaginal integrity and mucus scores also remained unaltered during and after device insertion. In conclusion, the e-Synch device integrated with a controlling app and IoT platform might be used to automate intravaginal hormone delivery and sensing for controlling the estrous cycle of cattle.

Sacral neuromodulation remote programming in patients with refractory lower urinary tract dysfunction: China's experience during the COVID-19 pandemic.

Sacral neuromodulation is an effective, minimally invasive treatment for refractory lower urinary tract dysfunction. However, regular postoperative programming is crucial for the maintenance of the curative effects of electronic sacral stimulator devices. The outbreak of coronavirus disease 2019 (COVID-19) limited the ability of practitioners to perform traditional face-to-face programming of these stimulators. Therefore, this study aimed to evaluate the application of remote programming technology for sacral neuromodulation during the COVID-19 pandemic in China. We retrospectively collected data including baseline and programming information of all patients with lower urinary tract dysfunction who underwent sacral neuromodulation remote programming in China after the outbreak of COVID-19 (i.e., December 2019). The patients also completed a self-designed telephone questionnaire on the subject. A total of 51 patients from 16 centers were included. They underwent 180 total remote programming visits, and 118, 2, 25, and 54 voltage, current, pulse width, and frequency adjustments, respectively, were performed. Additionally, remote switching on and off was performed 8 times; impedance test, 54 times; and stimulation contact replacement, 25 times. The demand for remote programming was the highest during the first 6 months of sacral neuromodulation (average, 2.39 times per person). In total, 36 out of the 51 patients completed the questionnaire survey. Of these, all indicated that they chose remote programming to minimize unnecessary travel because they had been affected by COVID-19. The questionnaire also showed that remote programming could reduce the number of patient visits to the hospital, save time, reduce financial costs, and would be easy for patients to master. All surveyed patients indicated that they were satisfied with remote programming and were willing to recommend it to other patients. Remote programming for sacral neuromodulation is feasible, effective, safe, and highly recommended by patients with refractory lower urinary tract dysfunction. Remote programming technology has great development and application potential in the post-pandemic era.