Telemonitoring Of Patients Research Articles

Level of Technological Maturity of Telemonitoring Systems Focused on Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis Treatment: A Systematic Literature Review

In the field of eHealth, several works have proposed telemonitoring systems focused on patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) treatment. Nevertheless, no secondary study presents a comparative analysis of these works regarding the technology readiness level (TRL) framework. The TRL scale goes from 1 to 9, with 1 being the lowest level of readiness and 9 being the highest. This paper analyzes works that propose telemonitoring systems focused on patients with CKD undergoing PD treatment to determine their TRL. We also analyzed the requirements and parameters that the systems of the selected works provide to the users to perform telemonitoring of the patient’s treatment undergoing PD. Fourteen works were relevant to the present study. Of these works, eight were classified within TRL 9, two were categorized within TRL 7, three were identified within TRL 6, and one within TRL 4. The works reported with the highest TRL partially cover the requirements for appropriate telemonitoring of patients based on the specialized literature; in addition, those works are focused on the treatment of patients in the automated peritoneal dialysis (APD) modality, which limits the care of patients undergoing the continuous ambulatory peritoneal dialysis (CAPD) modality.

Feasibility and safety of oxygen saturation remote monitoring in COVID-19: A descriptive research

BackgroundThe COVID-19 pandemic created an urgent need to implement digital health solutions for remote clinical management of infected patients who could be monitored at home. Since the first wave, the “A. Gemelli” Polyclinic in Rome supported the Lazio Region with a digital health program (SatCov) to monitor at home newly diagnosed COVID-19 patients, or after an early discharge from the COVID units. A digital application and a wireless oximeter were provided to patients. Oxygen saturation, heart rate and body temperature were monitored at least twice a day, for at least 14 consecutive days.Clinicians personalized their remote assistance defining specific alerts for each patient and could plan video-consultation with the patient and/or require a timely hospitalization in a dedicated COVID unit if necessary. ObjectivesThe aim of this research was to evaluate the feasibility and safety of the oxygen saturation telemonitoring in COVID-19 patients. To cover these aspects, primary endpoints were expressed as the adherence to the remote monitoring and the hospitalization ratio in the overall telemonitored population. ResultsAt the end of December 2020, 105 patients have been enrolled and followed remotely. The study population had acceptable adherence to telemonitoring, with more than 85% of measurements sent out of the total of those required by the protocol. Only 3 patients required hospitalization, indicating that telemonitoring is feasible in patients with COVID-19 and could be helpful in reducing both unnecessary hospitalizations and duration of hospital stay.

Telemonitoring patients with chronic heart failure. Results from a pilot study in the Veneto Region, Italy

Remote monitoring of patients with chronic heart failure (HF) can prevent acute episodes of HF, optimize treatment, reduce emergency room (ER) visits and hospitalizations, and improve quality of life of patients and caregivers. In current clinical practice, however, the most appropriate model is still under debate. We aimed to evaluate the impact of a new remote telemonitoring (TM) system in the clinical management of HF patients on the reduction of hospitalizations and ER admissions and on possible related-economic benefits. A working group participated by primary care and family practitioners, cardiologists, home care nurses of the 8th Local Health Unit of the Veneto Region, Italy, has established a new operating procedure for TM chronic HF patients, identifying the clinical profiles and the inclusion/exclusion criteria of enrollment, the clinical parameters to be monitored, the input/output modalities of the information to/from the call center, the alarm criteria and the response procedures. Patients were profiled into three risk categories based on age, clinical characteristics, prognosis assessment, and social needs and provided with appropriate devices for remote measurement and transmission of blood pressure, heart rate, peripheral oxygen saturation (SpO2) and body weight. Clinical data, self-measured at home according to a predetermined schedule based on the patient's risk profile, were automatically transmitted to the operating center, generating, if above the threshold, a grading of alarms (green/cyan, yellow, red) and the consequent activation of the most appropriate response (returned phone calls to check patient's status, reporting to primary physician/family practitioner for clinical evaluation, notification to the HF outpatient clinic for an early follow-up visit, alerting medical emergency services). The number of hospitalizations and ER visits during the TM period was compared with the pre-TM equivalent for each individual patient. Overall, 22 patients with chronic HF were enrolled (mean age 82.3 ± 8.6 years, 17 males). The average duration of TM was 18.7 ± 8.8 months. Overall, 62 108 home measurements were performed and transmitted. The alarms received by the operating center were 4120 (6.6% of all measurements): 62% cyan, 30% yellow, 8% red. Most of the data above the threshold concerned weight gain (42.0%) and SpO2 variations (28.0%). During the observation period (TM period and pre-TM equivalent interval calculated for each individual patient), a total of 127 hospitalizations and 181 ED visits were recorded. Compared to the pre-TM period, there was a 66% reduction in hospitalizations for all causes (95 vs 32, p<0.001) and a 68% decrease in ED visits (137 vs 44, p<0.001). Similarly, hospitalizations and ED visits due to HF were reduced by 82% (p<0.001) and 66% (p<0.001), respectively, with a decrease in days of HF-related hospitalization from 211 to 48. Despite a higher cost for TM of € 6911.15, a total saving of € 64 103.87 was obtained for the reduction of expenses from € 8665.45 to € 2664.00 for ED visits and from € 71 627.93 to € 13 525.51 for HF hospitalizations. This pilot experience on remote monitoring HF patients proved to be effective in determining a significant reduction in ED visits and hospitalizations with a consequent significant economic benefit. Larger studies are needed to confirm this favorable outcome.

Economic evaluation of telemonitoring as a follow-up approach for patients with obstructive sleep apnea syndrome starting treatment with continuous positive airway pressure.

Telemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost-effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost-effective strategy compared with the standard follow-up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow-up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow-up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow-up, there was no significant difference in treatment compliance, and the mean residual apnea-hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72-1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04-13.84), and about 73% fewer physical healthcare visits 0.27 (0.20-0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow-up, -192 USD (-346 to -41). The form of follow-up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment.

Telemonitoring of patients after COVID-19 hospitalization: study design and baseline characteristics

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study is part of the research and development project “Telemed50000” and is supported by the German Federal Ministry of Economic affairs and Climate Action on the basis of a decision by the German Bundestag. Background There is a robust evidence about the beneficial effects of telemedicine in heart failure (HF) patients causing an implementation process of this method of digital care in the health care systems of several European countries. It remains unclear whether it’s feasible to prevent complications of pre-existing comorbidities as well as detecting the onset of other clinical complications after discharge due to COVID-19 using telemonitoring on a daily basis. Purpose The primary endpoint of this study is to detect unplanned clinical events during a one year follow-up after hospitalization due to COVID-19 with a standard non-invasive telemonitoring system used for HF patients. The definition of unplanned clinical event includes: telemedical emergency interventions, admission to emergency room, unplanned hospitalization and all-cause death. Methods and study design Inclusion criteria were age ≥18 years and a PCR- positive Sars-CoV-2 infection with acute respiratory symptoms requiring hospitalization. The follow-up period was one year with a clinical onsite visit at baseline, a telemedical visit after 6 months (phone-call) and a final onsite visit after 12 months. Recruitment took place from February 2021 until February 2022 at 5 hospitals located in 3 different federal states across Germany (Figure 1). The telemedical system, including 5 telemedical devices, was installed at the patient´s home during a nurse-led visit (n=83) or it was installed by themselves, video-guided, after sending the telemedical equipment by a parcel service (n=26). The daily transferred vital parameter, included body weight, systolic and diastolic blood pressure, pulse rate, a three channel electrocardiogram (ECG) and peripheral capillary oxygen saturation (SPO2). A 2-miutes voice recording of standardized text was required once a week. Data were sent to a telemedicine centre (TMC). All parameters were reviewed by physicians and nurses of the TMC from Monday to Friday (8 am to 4 pm). A six minutes walking test (6MWT) was performed during the nurse led home visit at baseline (n=37), if the patients were able to do the test. A second 6MWT was required at final visit. Health-related quality of life was measured by the Patient Reported Outcomes Measurement Information System (PROMIS)-29 questionnaire at baseline, after 6 and 12 months. Telemedical interventions were only initiated in case of a life-threatening emergency. Conclusions The established telemedical approach for HF patients, is also an appropriate tool to investigate the long-term recovery process, in particular to detect systemic sequelae in a cohort of COVID-19 patients. The Telemed-COVID-19 trial will provide prospective epidemiological data about the frequency of unplanned clinical events after hospitalization due to COVID-19 because of the daily telemedical transfer of vital parameters.

Fewer Worsening Heart Failure Events With HeartLogic on top of Standard Care: a Propensity-Matched Cohort Analysis

The implantable cardiac defibrillator-based HeartLogic algorithm aims to detect impending fluid retention in patients with heart failure (HF). Studies show that HeartLogic is safe to integrate into clinical practice. The current study investigates whether HeartLogic provides clinical benefit on top of standard care and device telemonitoring in patients with HF. A multicenter, retrospective, propensity-matched cohort analysis was performed in patients with HF and implantable cardiac defibrillators, and it compared HeartLogic to conventional telemonitoring. The primary endpoint was the number of worsening HF events. Hospitalizations and ambulatory visits due to HF were also evaluated. Propensity score matching yielded 127 pairs (median age 68 years, 80% male). Worsening HF events occurred more frequently in the control group (2; IQR 0-4) compared to the HeartLogic group (1; IQR 0-3; P = 0.004). The number of HF hospitalization days was higher in controls than in the HeartLogic group (8; IQR 5-12 vs 5; IQR 2-7; P = 0.023), and ambulatory visits for diuretic escalation were more frequent in the control group than in the HeartLogic group (2; IQR 0-3 vs 1; IQR 0-2; P = 0.0001). Integrating the HeartLogic algorithm in a well-equipped HF care path on top of standard care is associated with fewer worsening HF events and shorter duration of fluid retention-related hospitalizations.

39 - Technical testing and patients and providers satisfaction of new telemedicine platform for telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy (RARP)

39 - Technical testing and patients and providers satisfaction of new telemedicine platform for telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy (RARP)

Observational study on telemonitoring of patients with heart failure

Observational study on telemonitoring of patients with heart failure

Patient-Perceived Hand Function Can Predict Treatment for Dupuytren Disease.

Web-based patient-reported outcome measures (PROMs) could help surgeons remotely assess the need for examination and subsequent treatment of patients with Dupuytren disease (DD). The authors studied whether the Unité Rhumatologique des Affections de la Main (URAM) and the Michigan Hand Questionnaire (MHQ) could predict DD treatment. In this prospective cohort study, the authors compared MHQ and URAM scores of treated patients with those of untreated patients. For the treatment group, the authors selected a score closest to 1 year before treatment. For controls, the authors randomly selected a score. The authors also tested the predictive value of a 1-year change score between 15 months and 6 weeks before treatment. The primary outcome measure was DD treatment. The predictive value was determined using the area under the curve (AUC). An AUC greater than 0.70 was considered good predictive ability; 0.70 to 0.50, poor predictive ability; and less than 0.50, no predictive ability. The authors included 141 patients for the MHQ analysis and 145 patients for the URAM analysis. The AUC of the MHQ and URAM scores measured 1 year before treatment were 0.80 (95% CI, 0.71 to 0.88) and 0.75 (95% CI, 0.68 to 0.82), respectively. The 1-year change score resulted in an AUC less than 0.60 for both questionnaires. The results show that both the MHQ and URAM score measured around 1 year before treatment can predict treatment for DD. If future studies show that telemonitoring of patients with DD with PROMs is also cost-effective, web-based PROMs could optimize patient care and effectiveness of DD treatment. Risk, III.

Cultivating patient-centered care competence through a telemedicine-based course: An explorative study of undergraduate medical students' self-reflective writing.

The COVID-19 pandemic has encouraged adaptations of learning methods in clinical clerkship. There have been limited reports on the merits of involving medical students in telemedicine. This study, therefore, aims to investigate students' reflection on what they learned and identify the challenges and benefits of doctor-patient interaction through their experience in a telemedicine-based course. A 4 week telemedicine-based course for medical students to participate in telemonitoring of COVID-19 patients undergoing self-isolation was conducted. This is a qualitative study using an interpretive phenomenology design to investigate students' self-reflection on their experiences in monitoring COVID-19 patients. Students were asked to reflect on their experience upon completion of the course through 750-1,000 words essays. A thematic analysis which considers units of meaning based on students' experiences was completed. Our study identified four main themes gathered from students' experiences related to the telemedicine-based course: communication and education, professionalism and professional identity formation, system-based practice, and patient-centered care. The course was part of an integrative effort involving multiple parties to tackle the burden on the nation's healthcare system during the pandemic. Telemedicine is part of future medical practice which supports the medical curriculum adaptability along with attempts to develop future-proof medical doctors through various clinical learning experiences.

Telemonitoring during Exercise Training in Cardiac Telerehabilitation: A Review.

Comprehensive cardiac rehabilitation (CR) is promising strategy for various cardiovascular diseases. Despite these benefits and the recommendation, adherence to outpatient CR remains low. Home-based CR with telemedicine (tele-CR) is emerging concept that is a good alternative to conventional center-based CR. With the development of e-health and e-Cardiology, real-time telemonitoring of patients' parameters such as vital signs and supervising by healthcare professionals during exercise training via internet might make it possible for safe and effective tele-CR to be performed. Therefore, the present study reviews the literature to summarize the current situation and methodology of patient telemonitoring in tele-CR.

MP61-20 NEW TELEMEDICINE PLATFORM FOR TELEMONITORING AND TELEREHABILIZATION IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP)

You have accessJournal of UrologyCME1 Apr 2023MP61-20 NEW TELEMEDICINE PLATFORM FOR TELEMONITORING AND TELEREHABILIZATION IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) Sabrina De Cillis, Daniele Amparore, Federico Piramide, Enrico Checcucci, Michele Sica, Alberto Piana, Juliette Meziere, Edoardo Cisero, Gabriele Volpi, Davide Zamengo, Giovanni Busacca, Federica Pini, Dalia Cidda, Cecilia Gatti, Angelo Giordano, Anca Georgiana Mesterca, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Sabrina De CillisSabrina De Cillis More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Federico PiramideFederico Piramide More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Michele SicaMichele Sica More articles by this author , Alberto PianaAlberto Piana More articles by this author , Juliette MeziereJuliette Meziere More articles by this author , Edoardo CiseroEdoardo Cisero More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Davide ZamengoDavide Zamengo More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Federica PiniFederica Pini More articles by this author , Dalia CiddaDalia Cidda More articles by this author , Cecilia GattiCecilia Gatti More articles by this author , Angelo GiordanoAngelo Giordano More articles by this author , Anca Georgiana MestercaAnca Georgiana Mesterca More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been demonstrated how early postoperative monitoring and rehabilitation protocols provide better recovery of continence and erectile function in patient underwent RARP, but their adoption is limited by the lack of human resources and local services. The aim of this research was to investigate patient and providers satisfaction in the use of a new telemedicine (TM) platform designed for telemonitoring and telerehabilitation of patient undergoing RARP. METHODS: We worked with software engineers to modify and implement the existing MAIA TM platform (ab medica s.p.a.). The TM system consists of an online platform that enables the acquisition, management and archiving of perioperative data and makes it possible to define a treatment plan and monitor the clinical response of rehabilitation activities. By means of an App for SmartPhone and Tablet devices, it is possible to receive notifications for medication and/or rehabilitation exercises and to upload information for monitoring clinical parameters (such as validated questionnaires or PAD tests). Patients undergoing RARP at our institution in September 2022 who had access to the Internet were included in this first part of the study. Patient satisfaction was measured using the Telemedicine Satisfaction Questionnaire (TSQ; range 1-5) and a visual analogue scale (VAS; range 0-100) after 30 days of use. Technical problems and platform/app malfunctions were recorded. RESULTS: 28 patients and 3 providers were enrolled in this first phase of the study. Patients and providers mean (SD) VAS satisfaction scores were 88.7 (17.2) and 82.2 (11.2), respectively. The mean (SD) TSQ score was 4.6 (0.4), all 28 patients reported they would use this new telemedicine platform again and would recommend it to other people. 10/28 (35.7%) patients reported App technical issues, namely 6 (21.4%) notification malfunctions and 4 (14.2%) online questionnaires filling failures. All these issues were easily solved by changing the smartphone's accessibility settings. Providers reported no technical malfunctions of the online MAIA platform. CONCLUSIONS: Our new TM MAIA platform specifically designed for telemonitoring and telerehabilitation of patients undergoing RARP appears to be user-friendly and shows a high level of satisfaction among both patients and providers. The prosecution of this study will be necessary to evaluate the long-term satisfaction and clinical effectiveness of this TM platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e860 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sabrina De Cillis More articles by this author Daniele Amparore More articles by this author Federico Piramide More articles by this author Enrico Checcucci More articles by this author Michele Sica More articles by this author Alberto Piana More articles by this author Juliette Meziere More articles by this author Edoardo Cisero More articles by this author Gabriele Volpi More articles by this author Davide Zamengo More articles by this author Giovanni Busacca More articles by this author Federica Pini More articles by this author Dalia Cidda More articles by this author Cecilia Gatti More articles by this author Angelo Giordano More articles by this author Anca Georgiana Mesterca More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers.

This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients' acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.

Effectiveness and cost-effectiveness of combined asynchronous telemonitoring and patient-initiated care for spondyloarthritis: protocol for a pragmatic multicentre randomised controlled trial (TeleSpA Study)

IntroductionDuring the COVID-19 pandemic, an accelerated uptake of remote monitoring strategies, replacing traditional face-to-face care, has been observed. However, data on the effects of remote care interventions for patients with...

Adherence and Effect of Home-Based Rehabilitation with Telemonitoring Support in Patients with Chronic Non-Specific Low Back Pain: A Pilot Study.

Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.

Artificial intelligence and digital medicine for integrated home care services in Italy: Opportunities and limits.

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.

Benefits of interventional telemonitoring in patients with chronic heart failure

Benefits of interventional telemonitoring in patients with chronic heart failure

Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial.

During the 30-day period prior to initiating dialysis, there is a 10-fold rise in emergency department visits and hospitalizations related to kidney failure. The Virtual Ward Incorporating Electronic Wearables (VIEWER) trial implemented a home telemonitoring system to track changes in patients' vitals and assess their adherence and the acceptability of telemonitoring in a chronic kidney disease (CKD) population. A pilot prospective clinical trial using a mixed methods approach was performed. The research was conducted in Winnipeg, Manitoba. There were 2 phases: Phase 1 was a 2-week-long pilot trial consisting of 10 participants. Phase 2 was a 3-month-long trial with a total of 26 participants. Patients with an estimated glomerular filtration rate <15 and a >40% risk of beginning dialysis in the next 2 years according to the kidney failure risk equation were eligible to participate in the study. The primary quantitative outcome was adherence, defined as the proportion of daily self-assessments completed using VIEWER over the follow-up period. The usability and acceptability of VIEWER was assessed qualitatively at the end of the trial through structured questionnaires and focus groups. Phase 1 participants (n = 10) had a median adherence of 77.17% for the 2-week observation period. Phase 2 participants (n = 26) showed a lower median adherence of 36% for the 3-month period. Focus group participants (n = 11) identified many positive aspects of VIEWER, including increased awareness and empowerment over health, simplicity of the data platform, and the ability to show clinical staff their health trends. Some challenges identified with VIEWER were connectivity issues with the Bluetooth, perceived inconvenience, and negative thoughts toward their health. Limitations of the study include a small sample size, which limited our ability to measure quantitative outcomes. In addition, patients agreeing to participate in any trial are generally more highly motivated and engaged in their care than those declining participation. Therefore, our results may not be generalizable to individuals who are not interested in self-management of their health. Our results suggest that home telemonitoring in patients with advanced CKD is feasible using a CKD-specific platform like VIEWER. We anticipate that improved functionality with incorporation of feedback from this study will result in greater long-term adherence. A future randomized clinical trial is planned.

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM) has several advantages over office BP recordings, including avoidance of white-coat reaction, ability to diagnose white-coat and masked hypertension, detection of BP variability, and better ability to predict cardiovascular morbidity and mortality, all of which commonly occur in CKD. The addition of telemonitoring and management support to HBPM allows remote monitoring, especially when close contact is difficult (e.g., patients in remote/rural areas, pandemic, natural disaster, or patients treated with home dialysis). Although there are few studies that have assessed the efficacy of home BP telemonitoring (HBPT) in patients with CKD, these studies suggest the benefits of HBPT for BP control and even limited evidence that it may improve kidney function. This review, using limited available evidence, assesses the roles of HBPT in patients with CKD, barriers to HBPT implementation in the care of patients with CKD, and discusses newer technologies that can be leveraged in the management of hypertension in patients with CKD.

A portable artificial respirator with remote managing features

COVID-19 is a disease that particularly attacks the respiratory system. As the situation worsens, the lungs function less effectively, requiring artificial respiration support to maintain adequate oxygen levels. Moreover, the remote supervision of the patient's conditions and remote control of the parameters of a portable breathing apparatus should help decongest hospitals. Such a concept will help healthcare professionals save considerable time by avoiding round trips among patients who do not represent acute respiratory failure. In this work, we describe the basic concepts of telemonitoring of remote patients during ventilation. Our goal is to guarantee the appropriate functioning of a portable respirator including management functionalities. Thus, medical staff can remotely supervise and configure the various components of the portable respiratory system according to the patient's condition.