Abstract TP374: Risk Assessment Scale for the Consideration of Long-Term Alternate Means of Nutrition

Objectives: The decision to utilize percutaneous enteral feeding for hospital patients after stroke or as a result neurological disease is based on qualitative measures. There is no defined protocol for the evaluation of patients who may require alternative means of feeding such as a PEG tube. We developed a quantitative scale HOGLIO scale.We developed a quantitative scale to determine which patients with neurologic disease/deficits will require Percutaneous Enteral Gastrostomy. The scale identifies patients at risk for aspiration by applying a score based on patient’s (a) level of arousal as measure by the Observational Scale Level of Arousal (OSLA),(b)respiratory status as measured by peripheral capillary oxygen saturation (c)aspiration risk as measured by formal bedside swallow evaluation/instrumental assessment (d)Long term nutritional needs as measured by patient’s ability to meet nutritional needs orally. Methods: We conducted a prospective registry review of patients with consultation for speech and swallow on the stroke ward at our comprehensive stroke Center, between June-July 2019. The following variables were collected for each patients; Age ,NIH score, OSLA score, HOGLIO score, vital signs ,medication list and per oral diet status. Result: The patients ranged in age from 21-85 years with mean age of 63.6 years. Patients with H score > 10 need PEG. We found that the strongest correlation between the need for PEG and H score was in the level of consciousness .Our preliminary data indicate that score greater than 10 is a good indicator for PEG.A high score on the Level of Arousal testing appears to be indicative of a need for PEG, as is a failed barium swallow, and a failed bedside swallowing test. Conclusion: Historically patients with neurological disease are at risk of aspiration. The PEG tube can be used to improve nutrition and meet metabolic needs of patients at higher risk of aspiration. It is cost effective and associated with lower complications compared to parenteral nutrition. The pilot study may suggest a relationship between HOGLIO score, risk of aspiration and need for an alternative route of nutrition such as PEG. We propose to carry out our study on a larger number of patients to further understand the relationships.

Download Full-text

Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

The Ultrasound Journal ◽

10.1186/s13089-021-00231-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Andrew W. Kirkpatrick ◽

Jessica L. McKee ◽

John M. Conly

Keyword(s):

At Risk ◽

Lung Ultrasound ◽

Point Of Care ◽

Human Life ◽

Vital Signs ◽

Home Monitoring ◽

Cost Effective ◽

Care Providers ◽

Vital Signs Monitoring ◽

Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

Download Full-text

Transplant-Amenable Hepatocellular Carcinoma in a Fontan Patient

Case Reports in Gastroenterology ◽

10.1159/000501198 ◽

2019 ◽

Vol 13 (2) ◽

pp. 275-279 ◽

Cited By ~ 2

Author(s):

Brian Patrick Rutledge ◽

Anupama Devara ◽

Sindhuri Benjaram ◽

Stephanie Judd ◽

Murray Ehrinpreis

Keyword(s):

Hepatocellular Carcinoma ◽

At Risk ◽

Liver Transplant ◽

Fontan Procedure ◽

Venous Pressure ◽

Fontan Patient ◽

Number Of Patients ◽

Fontan Physiology ◽

The Ideal

The Fontan circulation alters a patient’s physiology and imparts long-term risks related to chronically elevated systemic venous pressure. An increasing number of patients with Fontan physiology are surviving into adulthood and are at risk of hepatic sequalae. The ideal timeline and method of hepatic surveillance in the Fontan population remains to be defined. In this case, the patient was diagnosed with hepatocellular carcinoma more than 20 years after undergoing the Fontan procedure and was a candidate for combined heart-liver transplant. That her disease progressed prior to organ availability supports the argument for hepatic surveillance in this population.

Download Full-text

Clinical Use of Tolerogenic Dendritic Cells-Harmonization Approach in European Collaborative Effort

Mediators of Inflammation ◽

10.1155/2015/471719 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 33

Author(s):

Anja Ten Brinke ◽

Catharien M. U. Hilkens ◽

Nathalie Cools ◽

Edward K. Geissler ◽

James A. Hutchinson ◽

...

Keyword(s):

Dendritic Cells ◽

Cost Effective ◽

Administration Route ◽

European Cooperation ◽

Information Models ◽

Tolerogenic Dendritic Cells ◽

Specific Objective ◽

Number Of Patients ◽

Loss Of Tolerance

The number of patients with autoimmune diseases and severe allergies and recipients of transplants increases worldwide. Currently, these patients require lifelong administration of immunomodulatory drugs. Often, these drugs are expensive and show immediate or late-occurring severe side effects. Treatment would be greatly improved by targeting the cause of autoimmunity, that is, loss of tolerance to self-antigens. Accumulating knowledge on immune mechanisms has led to the development of tolerogenic dendritic cells (tolDC), with the specific objective to restrain unwanted immune reactions in the long term. The first clinical trials with tolDC have recently been conducted and more tolDC trials are underway. Although the safety trials have been encouraging, many questions relating to tolDC, for example, cell-manufacturing protocols, administration route, amount and frequency, or mechanism of action, remain to be answered. Aiming to join efforts in translating tolDC and other tolerogenic cellular products (e.g., Tregs and macrophages) to the clinic, a European COST (European Cooperation in Science and Technology) network has been initiated—A FACTT (action to focus and accelerate cell-based tolerance-inducing therapies). A FACTT aims to minimize overlap and maximize comparison of tolDC approaches through establishment of minimum information models and consensus monitoring parameters, ensuring that progress will be in an efficient, safe, and cost-effective way.

Download Full-text

The Effectiveness of Three Psychotherapies of Different type and Length in the Treatment of Patients Suffering from Anxiety Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1472 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s777-s777

Author(s):

P. Knekt ◽

O. Lindfors ◽

T. Maljanen

Keyword(s):

Anxiety Disorder ◽

Work Ability ◽

Psychodynamic Psychotherapy ◽

Cost Effective ◽

Term Therapy ◽

Short Term ◽

Number Of Patients ◽

Axis I

IntroductionData on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.AimTo compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.MethodsAltogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.ResultsDuring the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.ConclusionsThe difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

A Functional Threshold for Long-Term Use of Hand and Arm Function Can Be Determined: Predictions From a Computational Model and Supporting Data From the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial

Physical Therapy ◽

10.2522/ptj.20080402 ◽

2009 ◽

Vol 89 (12) ◽

pp. 1327-1336 ◽

Cited By ~ 62

Author(s):

Nicolas Schweighofer ◽

Cheol E. Han ◽

Steven L. Wolf ◽

Michael A. Arbib ◽

Carolee J. Winstein

Keyword(s):

Controlled Trial ◽

Hand Function ◽

Cost Effective ◽

Phase Iii ◽

Future Research ◽

Therapy Evaluation ◽

Effective Interventions ◽

Term Change ◽

Number Of Patients

Background Although spontaneous use of the more-affected arm and hand after stroke is an important determinant of participation and quality of life, a number of patients exhibit decreases in use following rehabilitative therapy. A previous neurocomputational model predicted that if the dose of therapy is sufficient to bring performance above a certain threshold, training can be stopped. Objective The aim of this study was to test the hypothesis that there exists a threshold for function of the paretic arm and hand after therapy. If function is above this threshold, spontaneous use will increase in the months following therapy. In contrast, if function is below this threshold, spontaneous use will decrease. Methods New computer simulations are presented showing that changes in arm use following therapy depend on a performance threshold. This prediction was tested by reanalyzing the data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial, a phase III randomized controlled trial in which participants received constraint-induced movement therapy for 2 weeks and were tested both 1 week and 1 year after therapy. Results The results demonstrate that arm and hand function measured immediately after therapy predicts, on average, the long-term change of arm use. Above a functional threshold, use improves. Below this threshold, use decreases. Limitations The reanalysis of the EXCITE trial data provides a “group” threshold above which a majority of patients, but not all, improve spontaneously. A goal of future research is to provide the means to assess when patients reach their individual threshold. Conclusion Understanding of the causal and nonlinear relationship between limb function and daily use is important for the future development of cost-effective interventions and prevention of “rehabilitation in vain.”

Download Full-text

Remote Monitoring of Vital Signs Using Computer Vision Systems

10.32545/encyclopedia201911.0010.v1 ◽

2019 ◽

Author(s):

Fatema-Tuz-Zohra Khanam

Keyword(s):

Computer Vision ◽

Vital Signs ◽

Cost Effective ◽

Long Distance ◽

Sensor Platforms ◽

Clinical Scenarios ◽

Multiple Regions ◽

Computer Vision Systems ◽

Term Monitoring

Techniques for noncontact measurement of vital signs using camera imaging technologies have been attracting increasing attention. For noncontact physiological assessments, computer vision-based methods appear to be an advantageous approach that could be robust, hygienic, reliable, safe, cost effective and suitable for long distance and long-term monitoring. In addition, video techniques allow measurements from multiple individuals opportunistically and simultaneously in groups. This paper aims to explore the progress of the technology from controlled clinical scenarios with fixed monitoring installations and controlled lighting, towards uncontrolled environments, crowds and moving sensor platforms. We focus on the diversity of applications and scenarios being studied in this topic. From this review it emerges that automatic multiple regions of interest (ROIs) selection, removal of noise artefacts caused by both illumination variations and motion artefacts, simultaneous multiple person monitoring, long distance detection, multi-camera fusion and accepted publicly available datasets are topics that still require research to enable the technology to mature into many real-world applications.

Download Full-text

Automated Arrhythmia Detection Based on RR Intervals

Diagnostics ◽

10.3390/diagnostics11081446 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1446

Author(s):

Oliver Faust ◽

Murtadha Kareem ◽

Ali Ali ◽

Edward J. Ciaccio ◽

U. Rajendra Acharya

Keyword(s):

Learning Algorithm ◽

Cost Effective ◽

Arrhythmia Detection ◽

Rr Interval ◽

Deep Learning Algorithm ◽

Number Of Patients ◽

Life Threatening ◽

Term Monitoring ◽

Fold Cross Validation

Abnormal heart rhythms, also known as arrhythmias, can be life-threatening. AFIB and AFL are examples of arrhythmia that affect a growing number of patients. This paper describes a method that can support clinicians during arrhythmia diagnosis. We propose a deep learning algorithm to discriminate AFIB, AFL, and NSR RR interval signals. The algorithm was designed with data from 4051 subjects. With 10-fold cross-validation, the algorithm achieved the following results: ACC = 99.98%, SEN = 100.00%, and SPE = 99.94%. These results are significant because they show that it is possible to automate arrhythmia detection in RR interval signals. Such a detection method makes economic sense because RR interval signals are cost-effective to measure, communicate, and process. Having such a cost-effective solution might lead to widespread long-term monitoring, which can help detecting arrhythmia earlier. Detection can lead to treatment, which improves outcomes for patients.

Download Full-text

Remote Monitoring of Vital Signs in Diverse Non-Clinical and Clinical Scenarios Using Computer Vision Systems: A Review

Applied Sciences ◽

10.3390/app9204474 ◽

2019 ◽

Vol 9 (20) ◽

pp. 4474 ◽

Cited By ~ 8

Author(s):

Khanam ◽

Al-Naji ◽

Chahl

Keyword(s):

Computer Vision ◽

Vital Signs ◽

Cost Effective ◽

Long Distance ◽

Sensor Platforms ◽

Clinical Scenarios ◽

Multiple Regions ◽

Computer Vision Systems ◽

Term Monitoring

Download Full-text

A remote patient monitoring based on WBAN implementation with internet of thing and cloud server

Bulletin of Electrical Engineering and Informatics ◽

10.11591/eei.v10i3.1813 ◽

2021 ◽

Vol 10 (3) ◽

pp. 1640-1647

Author(s):

Jaber H. Majeed ◽

Qais Aish

Keyword(s):

Low Cost ◽

Vital Signs ◽

Delivery Ratio ◽

Specialist Care ◽

Average Delay ◽

Hospital Capacity ◽

Number Of Patients ◽

Cloud Server ◽

Remote Patient

A healthcare employment is the mainly domain in emergent technology of WBAN, and an e-health system created of cloud computing in addition to a WSN considers an important part of this field. An implementation of remotely system for monitoring the patient's vital signs require continuous observation to form low-cost networks with the ability of portability and flexibility and may be applied with separate position and long-term intensive care of peoples in the absence of disturbance of their everyday activities. The patient carries body sensor's patches to get transmitted vital signs continuously to the cloud environment, and a website is designed for presenting and analyzing the data based on designed algorithm. A comparison is made every received measurement with a that stored in the algorithm. In remote specialist care, the execution of confidence and confidentiality conservation is critical, as essential restrictions were being communicating with remote locations. To ensure reliability, the implemented system offers real time monitoring and certification to the patient's condition by means of a medical record, with rapid medical data delivery to the medical staff and can also increase the service delivery ratio of hospital capacity and monitoring of large number of patients with concentrated average delay.

Download Full-text

Neuropsychiatric Disorders and COVID-19: What We Know So Far

Pharmaceuticals ◽

10.3390/ph14090933 ◽

2021 ◽

Vol 14 (9) ◽

pp. 933

Author(s):

Fernanda Majolo ◽

Guilherme Liberato da Silva ◽

Lucas Vieira ◽

Cetin Anli ◽

Luís Fernando Saraiva Macedo Timmers ◽

...

Keyword(s):

Nervous System ◽

Neurological Disorders ◽

Vital Signs ◽

Severe Infection ◽

Neurological Symptoms ◽

Number Of Patients ◽

Life Threatening ◽

The Central Nervous System ◽

New Treatments

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) affects the central nervous system (CNS), which is shown in a significant number of patients with neurological events. In this study, an updated literature review was carried out regarding neurological disorders in COVID-19. Neurological symptoms are more common in patients with severe infection according to their respiratory status and divided into three categories: (1) CNS manifestations; (2) cranial and peripheral nervous system manifestations; and (3) skeletal muscle injury manifestations. Patients with pre-existing cerebrovascular disease are at a higher risk of admission to the intensive care unit (ICU) and mortality. The neurological manifestations associated with COVID-19 are of great importance, but when life-threatening abnormal vital signs occur in severely ill COVID-19 patients, neurological problems are usually not considered. It is crucial to search for new treatments for brain damage, as well as for alternative therapies that recover the damaged brain and reduce the inflammatory response and its consequences for other organs. In addition, there is a need to diagnose these manifestations as early as possible to limit long-term consequences. Therefore, much research is needed to explain the involvement of SARS-CoV-2 causing these neurological symptoms because scientists know zero about it.

Download Full-text