Patient Self-monitoring Research Articles

International Survey of Pediatric Oncologists' Beliefs and Communication Practices Regarding Symptom Self-Monitoring by Childhood Cancer Survivors.

Childhood cancer survivors report self-monitoring for and worrying about symptoms of disease recurrence and secondary cancers, although symptom-related worry is associated with poorer health-related quality of life. This survey captured pediatric oncologists' beliefs and communication practices regarding symptom self-monitoring for childhood cancer survivors. Using a closed-loop snowball sampling technique, pediatric oncologists completed an online survey regarding the importance of symptom self-monitoring for off-therapy patients, the degree to which symptom self-monitoring was perceived to cause stress and worry, and communication practices. 196 pediatric oncologists (White [78%]; female [64%]; Mage = 47 years) from every continent except Antarctica participated. Oncologists believed it is important for off-therapy patients to self-monitor for symptoms of cancer recurrence (90%) and treatment late effects (94%), although some noted that recurrence (30%) and late effects (55%) are typically detected by routine surveillance before symptoms appear. Oncologists varied in their beliefs that off-therapy patients do (31%) or do not (31%) worry unnecessarily about symptoms of recurrence. Two thirds (62%) of oncologists reported often/always discussing with off-therapy patients which symptoms could indicate cancer recurrence, whereas fewer than half (43%) often/always discussed which symptoms were unlikely to indicate recurrence. Oncologists identified a need for education regarding how to communicate around symptom self-monitoring and the potential utility of a screening tool to identify those who worry excessively. Despite nearly universal belief that their off-therapy patients should self-monitor for symptoms of disease recurrence and late effects, a substantial proportion of pediatric oncologists do not counsel patients on symptom self-monitoring. Since nearly one-third believe that off-therapy patients worry unnecessarily about symptoms of recurrence, improving patient education regarding which symptoms are and are not medically concerning could decrease stress and improve health-related quality of life for pediatric cancer survivors.

Artificial intelligence in medical practice: current status and future perspectives

Artificial intelligence in medical practice: current status and future perspectives

Интерстициальные заболевания легких — опыт применения телепатронажа

INTRODUCTION: Interstitial lung diseases (ILD) are a group of diseases, the only or the main manifestation of which is a pathological process in the pulmonary interstitium. One of factors of the unfavorable course of chronic forms of ILD is progressing fibrosis of the lung tissue. While idiopathic pulmonary fibrosis is a classic fibrosing ILD with the poorest prognosis, diffuse pulmonary fibrosis can also occur in other ILDs. The progression of the disease leads to restrictive alterations of breathing and to impairment of the diffusion capacity of lungs, which results in respiratory failure, reduced tolerance to physical exercise and disability of the patient. This impedes routing of such patients and limits access to specialized medical care. Restrictive measures introduced in 2020–2021 in connection with a new coronavirus infection, and for elderly people with chronic diseases as well, produced an additional negative impact on the possibility of patients to receive qualified medical care of specialists. In these conditions, the relevance of standard telemedicine healthcare services increased, and there appeared an urgent need for developments of a digital nursing system for chronic patients providing a possibility of active remote communication of a doctor and a patient. This review presents the experience in use of a digital nursing program for monitoring and self-monitoring of chronic non-infectious patients, including those with respiratory diseases. The article presents a clinical case of joint management of a comorbid patient with a severe damage to pulmonary interstitium and the underlying rheumatoid arthritis by pulmonologists and rheumatologists through telenursing. Positive aspects of the remote monitoring are discussed. CONCLUSION: Use of telenursing technology in patients with chronic respiratory diseases may improve clinical effectiveness of treatment of this group of patients as well as reduce the load on the primary healthcare doctors and frequency of untargeted hospitalizations, which, in turn, will reduce the treatment costs.

Specifications and feasibility of technology-based self-management of COPD: An exploratory qualitative study with patients and providers.

This article outlines the findings of a study that looked at the self-management needs of Chronic Obstructive Pulmonary Disease (COPD) patients and the feasibility of an eHealth intervention. This study found that patient self-monitoring is sub-optimal. Patients want the technology to include record keeping, feedback, the integration of biomedical and environmental data, exacerbation detection, and the ability to connect with providers. Health leaders could benefit from this information by working with their suppliers to eliminate system and technology barriers, and ensuring that technology is interactive, personalized and easy to use.

Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping.

BackgroundThe COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS).ObjectiveWe presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic.MethodsFirst, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period.ResultsUsing data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84).ConclusionsOur approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes.

Certificate-Based Anonymous Authentication With Efficient Aggregation for Wireless Medical Sensor Networks

Wireless medical sensor networks (WMSNs) have aroused widespread attention in recent years with the development of Internet of Things (IoT) technology. WMSNs offer many new opportunities for healthcare professionals to monitor patients and patient self-monitoring. To overcome the resource (such as memory and power) limitations of sensors and attain data security of patients’ private medical information, researchers have designed plenty of work for securing WMSNs. For years, certificate-based aggregate signature (CBAS) schemes have been put forward for WMSNs to prevent patients’ sensitive medical data from being tampered with and damaged. In this work, we analyze the security flaws of a very recent CBAS scheme proposed by Verma <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">et al.</i> (2021) by presenting two types of security attacks. We later propose a CBAS scheme with user anonymity protection for WMSNs and prove its security based on the standard cryptographic assumption. The performance comparison results from theory and experiment illustrate the practicality of our design.

FACTORS ASSOCIATED WITH ADHERENCE TO MEDICATIONS, DIET AND SELF-MONITORING IN PATIENTS WITH HEART FAILURE

Objectives: Adherence to treatment and lifestyle changes is necessary for patients with heart failure. The objective of this study was to determine the factors associated with adherence to medications, diet, and self-monitoring of patients with heart failure. Methodology: This research was conducted as a descriptive cross-sectional study. The data were collected using the patient information form and beliefs and compliance scales for patients with chronic heart failure. Results: The average age of patients was 68.75±12.54. While the medication adherence barrier scores of the patients were slightly higher (21.53±0.32), the diet adherence benefit scores of the patients were slightly higher (20.67±0.40), and self-monitoring adherence barrier scores of the patients were higher (34.55±0.29). Conclusion: Identifying barriers or benefits of medication and dietary adherence may improve self-care behaviours in patients with HF. In clinics, it may be useful to provide training about potential barriers perceived by patients.

679-P: Costs and Cost-Effectiveness of the FreeStyle Libre System vs. Blood Glucose Self-Monitoring in Patients with Type 2 on MDI Insulin Treatment in Israel

Introduction: Frequent glucose monitoring is essential to obtaining glucose control. We assessed the costs and cost-effectiveness of using the FreeStyle Libre® Flash Continuous Glucose Monitoring system (FSL) compared to self-monitoring of blood glucose (SMBG) in people with type 2 diabetes treated with multiple daily insulin injections (T2D MDI) from a healthcare payer perspective in Israel. Methods: We calculated the incremental cost per quality adjusted life year (QALY) gained. Glucose monitoring costs are based on actual costs of FreeStyle Libre®, strips and lancets, assuming full adherence to monitoring. Severe hypoglycemic events (SHE) and diabetic ketoacidosis (DKA) costs are based on real-world data from Israel and the Israeli Ministry of Health list price. Costs are presented in Israeli Shekel (ILS) and $US. The incidence rates of SHE and DKA are based on real-world data from a large cohort of patients in France. Due to the short time horizon of this analysis, we assumed no mortality differences between the two monitoring alternatives. Utility increments for the use of CGM vs. SMBG, decrease in HbA1C and disutility for SHE and DKA events are based on estimates from the literature. The analysis was conducted over a 5-year time horizon, applying an annual discount rate of 3% on costs and outcomes. One way sensitivity analyses were performed on difference in costs. Results: FreeStyle Libre® use is associated with a cost increase of ILS 27,021 ($US 8,444) and an increase of 0.26 QALYs, generating an incremental cost-effectiveness ratio of ILS 103,977 ($US 32,493) per QALY gained. These results are highly sensitive to changes in costs of glucose monitoring. Conclusion: Assuming a willingness to pay threshold of $US 43,600 per QALY gained (GDP per capita in Israel in 2020) , the FreeStyle Libre® system is a highly cost-effective glucose monitoring alternative to SMBG for T2D MDI patients in Israel. Disclosure D.Greenberg: Advisory Panel; Abbott Diabetes, Consultant; Geffen Medical, Israel.

Самоконтроль гликемии – что полезно знать клиницисту

Diabetes mellitus (DM) is the most common disease of the endocrine system faced by doctors of all specialties, and it is characterized by high disability and mortality of patients due to micro- and macrovascular complications caused primarily by chronic hyperglycemia. Achieving glycemic targets improves the course of DM and disease prognosis with respect to the development of complications. A priority area in the treatment of DM is patient education and self-monitoring of glycemia using modern glucose measuring tools, including the Contour Plus One glucometer.

EDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study.

BackgroundChronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue.ObjectiveWe hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL.MethodsWe conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians.ResultsData from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1.ConclusionsThis work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management.Trial RegistrationClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694

Reliability and concurrent validity of mobile health technology for patient self-monitoring in physical rehabilitation

BackgroundForearm pronation and supination are important for everyday functional tasks and some recreational activities. Healthcare providers use reliable and valid tools during the physical rehabilitation process to measure joint range of motion (ROM), assess functional mobility, guide decisions for skilled interventions, and progress a plan of care. Since the onset of the COVID-19 pandemic, both healthcare providers and patients benefited from mobile health technologies that have emerged, which can be used by patients in the home to monitor ROM and assist the healthcare provider in guiding the rehabilitation process when utilizing telehealth.PurposeThe goal of this study was to investigate the reliability and concurrent validity of a smartphone application for obtaining goniometric measurements of forearm pronation and supination.MethodsThis study consisted of 83 participants that were recruited on a voluntary basis from an academic institution. An iPhone with the application Clinometer and a standard goniometer (SG) were utilized to obtain goniometric measurements of forearm pronation and supination. The intraclass correlation coefficient (ICC) was used to analyze intrarater reliability, and the Pearson correlation coefficient was used to analyze concurrent validity. Scatterplots with regression lines were created to visually display the results.ResultsThe smartphone demonstrated strong correlations for both pronation and supination (r = 0.71, P < .001; r = 0.73, P < .001). This study demonstrated overall good-excellent intrarater reliability and good concurrent validity for the smartphone application with a higher test-retest reliability in the measurement of forearm pronation compared to supination.ConclusionsThis study concludes that the reliability and concurrent validity of the smartphone was consistent with the SG for assessing forearm pronation and supination. It may be of value to further investigate interrater reliability between patient and healthcare practitioner, and report on the ease of use to assess ROM with a smartphone.

Intellicor: Mobile Design for Monitoring Phonographic Signals.

A mobile and web-based prototype was developed to explore utility of heart sound data in the context of patient self-monitoring. There are not many applications available despite measurement equipment that can be purchased. This research aimed at developing an application that could help patients understand and use phonocardiography. The resulting prototype Intellicor enables easy-to-use web and mobile solutions such as registering heart sound, review of previous heart signal recordings, summaries of terms related to patient condition, and medication taken. These functions can be utilized by both patients and physicians to create understanding of heart signals and build communication as a part of treatment. Three development iterations included several expert evaluators who gave positive feedback on the concept of the application. It was appreciated that patients could monitor heart signals and better understand the results. The medical experts would welcome such a system into their work domain if developed correctly and in accordance with the formal expectations, both legal and clinical. The prototype has shown the advantage of gathering data otherwise impossible to obtain. The Intellicor prototype presents the foundation that ought to be further developed in close cooperation of clinical and biomedical experts. The self-monitoring of this kind could benefit patients and the healthcare sector as demonstrated by the Intellicor prototype.

Problems of blood glucose self-monitoring in patients with diabetes mellitus

Glycemic self-monitoring is essential in the treatment of diabetes mellitus. Compliance with the recommendations for selfmonitoring of glycemia is an important condition for the prevention of diabetes complications. The article provides a review of the problems associated with blood glucose self-monitoring faced by diabetic patients and doctors. These include low frequency of blood glucose self-monitoring, technical errors in glucose measurements, errors in keeping a diary and errors in using measurement data to diabetes control. The blood glucose monitoring system, which includes the glucometer, test strips, application, сloud for data storage can be used for blood glucose self-monitoring in patients with diabetes mellitus. The article discusses the features and advantages of the blood glucose monitoring system. The advantages of the glucometer are the no сoding technology and the following options: аpplication of additional amount of blood to the test strip; adding meal marks, testing as the measurement results compare with targets and informing about it; storage a large number of measurement results. In addition to the standard blood glucose measurement, the glucose meter and the application offer many features to improve blood glucose self-monitoring that can help to improve diabetes management: automatic transferring measurement results to smartphone or tablet; saving notes in logbook; display of glucose trends and testing as they compare with targets; offering quick and valuable tips for critical high/low glucose values.

Wearable Tool for Breathing Pattern Recognition and Exacerbation Monitoring for COPD Patients via a Device-to-Cloud Communication Model

Chronic Obstructive Pulmonary Disease (COPD) has become one of the major causes of disability in the Philippines today. COPD is incurable and would also be one of the most painstaking diseases because it progresses over time. Patient self-monitoring, especially breathing patterns and frequency has become an increasingly recognized process which is beneficial for the ongoing care of COPD. Many potential technologies for the diagnosis and monitoring of COPD have been developed, but focusing on telehealth, imaging, and spirometry. This study has designed and created an IoT based system that could recognize and monitor the respiratory rate through breathing patterns and provide a means for doctors to remotely monitor the patient. The prototype device that has been developed was named X-Hale. X-Hale is a cost-effective and portable remote monitoring IoT-based tool, integrated within a wearable oxygen mask responsible for recognizing and recording accurate breathing frequency patterns. The system was designed to interweave underlying elements of Device-to-Cloud model for a straight-forward communication used in remote monitoring. The wearable device was tested using an HT50 ventilator that delivers machine-controlled dummy breathing in an actual hospital setting. Results show high accuracy in detecting breathing patterns in Slow, Normal and Fast respiratory rate per minute. X-Hale was also tested in actual patients to facilitate the remote monitoring of breathing patterns via the IoT communication model used.

Hypoglycaemia among adults with Type 2 Diabetes mellitus in a Family Medicine Clinic

Background: The prevalence of Diabetes mellitus (DM) is increasing worldwide. The complications of DM arising from hyperglycaemia are well documented and. However, there is a lack of data, poor awareness and information on hypoglycaemia in DM.&#x0D; Objective: To describe the prevalence and factors associated with hypoglycaemia among patients with Type 2 Diabetes mellitus (DM).&#x0D; Methods: This was a retrospective study of the clinical records of patients with Type 2 DM at the Family Medicine Clinic of a Nigerian teaching hospital from January 2019 to January 2020. The sociodemographic and clinical characteristics, including hypoglycaemia, Glycosylated Haemoglobin (HbA1c), Fasting and Random blood glucose, were retrieved.&#x0D; Results: A total number of 570 patients were assessed, with a prevalence of 43 (7.5%) of hypoglycaemia. The mean age of the patients in the study was 58.2±10.9 years (range: 36-83 years). Metformin (557; 97.7%), Sulphonylureas (377; 66.1%), Dipeptidylpeptidase -4 inhibitors (137; 24.0%) and insulin (72; 12.6%) were the most prescribed anti-diabetic medications. hypoglycaemiaA majority (29; 67.4%) of the hypoglycaemia episodes occurred in the morning, while most (24; 55.8%) of the episodes of hypoglycaemia were mild. Mean age (t= 2.35; p = 0.019), presence of hypertension (X2 = 6.92, p = 0.008) and dyslipidaemia (X2 = 7.86, p = 0.005) were associated with hypoglycaemia.&#x0D; Conclusions: The prevalence of hypoglycaemia in the Outpatient clinic was low, while the presence of comorbidities (hypertension and dyslipidaemia) and age were associated with hypoglycaemia. There is a need for patient education and Self-Monitoring of Blood Glucose (SMBG) to prevent complications of hypoglycaemia. hypoglycaemia

Perspectives of pharmacists in general practice from qualitative focus groups with patients during a pilot study.

BackgroundUtilising skill mix in general practice is proposed as a solution to the demand–supply issue. Pharmacists can play an important role in this context, leading to an increase in training and funding for independent prescriber roles. A role for pharmacists in general practice was funded, piloted, and evaluated by NHS England (NHSE) from 2015.AimTo answer the following question: what is the patient perspective of pharmacists in patient-facing roles in general practice in the UK?Design & settingFocus group interviews exploring patient perspectives on the pharmacist role in the UK.MethodThirty-four patients were interviewed in five focus group (January–December 2016). Data were iteratively analysed using the one sheet of paper technique.ResultsWhile the public were aware of the primary care crisis, they were less well informed about potential solutions. Data showed patients primarily sought access to a clinician over expressing a preference for any type of clinician. Low awareness was shown about the pharmacist role and there was initial confusion about it. Acceptability levels were high. It was found that pharmacists added value and provided an expert medication-focused service, which had a positive impact on medicines use. Patients reported benefit from longer appointments, feeling they were not rushed, and that all their conditions were being considered holistically. They trusted pharmacists as experts in medication and trust was consolidated over time. Regular coaching from a pharmacist could lead to improved patient self-monitoring and self-care.ConclusionPharmacists can add value to the general practice team and this is recognised by patients.

Nontouch Infrared Skin Thermometry: An Underutilized Tool.

Wound care clinicians and patients can identify surface skin temperature differences with noncontact infrared skin thermometers.1 These inflammatory changes can be important for the early identification of neuropathic complications (eg, repetitive trauma and Charcot foot) and deep/surrounding wound infection. This technology can replace the subjective and often inaccurate assessment of skin temperature differences using the back of the clinician’s hand.2 Role in Preventing Foot Ulcers Persons with diabetes and a high-risk neuropathic foot can use infrared thermometry at six sites on the foot to monitor plantar temperature changes: the first, third, and fifth metatarsal head, as well as the two midsides of the foot and the heel. If a temperature differential of 4 °F or higher is detected at any site, patients should restrict ambulation to reduce repetitive trauma and in turn reduce the likelihood of new foot ulcers.3 Three randomized controlled studies4–6 demonstrated that infrared thermometry prevented most new neuropathic ulcers in this patient population compared with both standard care and an education session for daily foot examinations, rendering this technology one of the few with strong clinical evidence.1,4–6 Charcot Joint A Charcot joint occurs from neuropathy and trauma, leading to microfractures of the bone (Charcot neuroarthropathy). It can occur in any joint, but this discussion is limited to the foot as the most common site. Acute swelling, often with deformity of a neuropathic foot, may be a sign of Charcot neuroarthropathy. The patient usually does not have a foot ulcer or loss of skin integrity, and there may be acute pain in an otherwise painless foot (Figure 1).Figure 1: BILATERAL CHARCOT FEET© WoundPediaClinicians and patients can use the infrared thermometer to assess the aforementioned six sites on each foot. The increased temperature is often 8 °F to 15 °F warmer than the mirror image on the opposite foot.7 With an acute Charcot joint, patients should not apply any direct weight on the foot and use a wheelchair, contact cast, or removable cast walker. Given a loss of proprioception, crutches may be associated with falls. With patient self-monitoring, and as the temperature normalizes, weight bearing can gradually be increased with custom orthopedic shoes, including the introduction of a CROW (Charcot Restraint Orthotic Walker). Infection Infrared thermometry was introduced into the Toronto Regional Dermatology and Wound Clinic in 1996 to detect early infection signs to prevent destruction of cellular and/or tissue-based products. This use of infrared thermometry contributed to the creation of the NERDS and STONEES mnemonics,8–10 which use clinical signs to differentiate superficial (NERDS) from deep and surrounding infection (STONEES; Figure 2). In reviewing the individual factor analysis of each of the STONEES criteria, an increase in skin temperature of 3 °F or higher versus a mirror-image measurement of noninfected comparator skin is more than 8 times more likely to be associated with deep and surrounding infection9 (although two or more other STONEES criteria are also required for definitive diagnosis).Figure 2: CLINICAL CRITERIA FOR INFECTION© WoundPediaPOINTS TO CONSIDER Inexpensive, commercially available noncontact infrared thermometers are useful instruments for wound care practitioners.1 The Fahrenheit scale is preferable to the Celsius scale because it allows detection of smaller intervals of temperature differences making it easier to interpret at the bedside. These thermometers (cost $25–100) are just as effective as scientific grade thermometers (eg, Exergen, at a cost of $615.07).11,12 Smart et al13 have similarly validated mini-infrared thermometers that can be carried in a nurse’s pocket to be equivalent to the scientific standard. Infrared thermometers should have a continuous mode with a maximum temperature reading and convert to Fahrenheit from Centigrade.14 Using the validated whole-wound zigzag method (Figure 3)14 when the thermometer is in activated continuous mode, practitioners can determine a maximum temperature more quickly than measuring four distinct areas to obtain the highest reading around the margin of an ulcer. Maliyar et al15 validated nontouch infrared thermometry had a 3 °F increased or higher temperature compared to the mirror image on the opposite leg but cautioned that temperatures on the front and back of the same extremity may be misleading because of transfer of heat from an active infection. The industrial nontouch infrared thermometers can be held 8 to 12 inches from the skin/wound and give an accurate measurement compared with the scientific standard thermometer (eg, Exergen) that must be held within 1 to 2 cm of the skin surface.2,12 The closer distance is more likely to result in accidental bacterial contamination from the wound surface or exudate. Interrater reliability has been validated with similar infrared thermometer results between two independent observers.11 Although arterial disease with ischemic changes can lower skin temperature, there are no validated studies on the use of nontouch surface infrared thermometry for this indication. Figure 3: ZIGZAG TECHNIQUE© WoundPedia

How to give home BP monitoring patients the correct cuff: using BMI as a surrogate estimate of arm circumference

Abstract Background The key role of patient self-monitoring, already well established by large-scale forward planning initiative such the British National Health Service's (NHS) long-term plan, has been emphasised by the COVID19 pandemic. In the management of hypertension, much can be achieved through the provision of blood pressure monitors to patients, along with appropriate education and online blood pressure (BP) recording facilities. However, it is important to ensure that patients have the correct equipment to reliably measure their own blood pressures and to ensure they purchase or are supplied with validated monitors and, as undersized cuffs yield artefactually elevated BP readings, with correctly sized cuffs. Purpose To demonstrate the use of Body Mass Index (BMI) as an estimate of Middle Upper Arm Circumference (MUAC) for purposes of blood pressure monitor cuff size requirement estimation and the application of this strategy to a national Home Blood Pressure Monitoring (HBPM) programme. Methods The relationship between MUAC and BMI is well established; MUAC is used surrogate measure of BMI particularly in identifying underweight patients especially in environments where accurate recording of weight and height is challenging. Here, we reverse this relationship to use the BMI (one of the most commonly recorded datum in primary care patient records) to estimate patient MUACs. First, using manufacturer recommended cuff arm-circumference ranges and aggregate pre-established MUAC to BMI linear equations, we generate a simplified BMI to cuff-size scheme. Second, we apply this scheme to a UK Integrated Care System (a regional NHS organisation supporting 1.7 million adult patients in an English city) to estimate cuff requirement under NHS England's BPM@h HBPM initiative (in which patients with poorly controlled hypertension are allocated free home BP monitors). Lastly, we propose a patient-level tool for BP monitor cuff size prediction. Results Our simplified scheme proposes the following cuff predictions: Small (S: 17–22cm): BMI &amp;lt;18kg/m2; Medium (M: 22–32cm): BMI ≥18 and &amp;lt;28kg/m2; Large (M: 32–42cm): BMI ≥28 and &amp;lt;38kg/m2 and Extra-large (X: 42–50cm): BMI ≥38kg/m2. In our population of approximately 157,000 adult hypertensive patients, 6,039 were eligible for a BP monitor under the NHS England's BPM@h HBPM initiative. Using our simplified scheme, we predict cuff requirements as follows: S: 2%, M: 32%, L: 46%, X: 19%. Conclusion Patient BMIs are a useful predictor of BP monitor cuff size requirement. They are readily available or calculatable from primary care records and their application to cuff size identification will improve accuracy of BP readings in HBPM initiatives. Our preliminary results suggest that the most commonly supplied “standard” cuff may be unsittable for well over 50% of patients and that extra-large cuff may be required for nearly 1 in 5 patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Barts CharityHealth Data Research UK

The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study.

BackgroundMost people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this.ObjectiveThe aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration.MethodsA multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service.ResultsWe investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high.ConclusionsSupported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients.

Outpatient nursing support for self-monitoring in patients with chronic heart failure.

BackgroundEarly symptoms of worsening heart failure are difficult for patients to detect and manage, contributing to the high readmission rate for worsening heart failure. Thus, it is important to promote self-monitoring and to support patients in recognizing and interpreting their symptoms. This study aimed to explore the ways in which specialized nurses in the outpatient setting provide support for self-monitoring in patients with chronic heart failure in Japan.MethodsThis exploratory study adopted a qualitative study design. The participants were a convenience sample of five nurses certified in chronic heart failure nursing and one advanced practice nurse certified in chronic care nursing, all with experience in outpatient nursing in Japan. Data were collected from June 2017 to October 2017 through semi-structured one-on-one interviews and were analyzed using an established qualitative inductive method.ResultsThe analysis identified seven themes describing the nursing support provided by the study participants. Among these were three themes describing different forms of direct support for self-monitoring: “Encourage patients to reflect on their own,” “Support touching the body and developing body awareness,” and “Support sharing the task.” Two themes described practice perspectives: “Support self-monitoring that is not overly sensitive” and “Support connection with the patient’s life.” Two final themes described contextual factors in the outpatient care setting: “Struggling with constraints and powerlessness” and “Building a support system in the outpatient setting.”ConclusionsThe findings provide a practice for nurses promoting self-monitoring in patients with chronic heart failure in the outpatient setting. The study findings inform and provide goals for the support of self-monitoring in patients with heart failure and also, suggest the need to establish a strong support system for outpatient care in Japan.