scholarly journals Prospective Pilot Study of Telehealth As Domiciliary Follow-up after Hematopoietic Cell Transplantation during the COVID19 Pandemic

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-36
Author(s):  
Alberto Mussetti ◽  
Maria Queralt Salas Gay ◽  
Maria Condom ◽  
Maite Antonio ◽  
Cristian Ochoa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Oxygen Saturation ◽  
Real Time ◽  
Emotional Distress ◽  
Patient Monitoring ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Clinical Information ◽  
Patient Monitoring System

Introduction An increased risk of mortality has been documented in transplanted patients affected by Coronavirus Disease 2019 (COVID19) with an estimated mortality rate between 20-40%. Multiple efforts are ongoing to control COVID19 pandemic, and clinical practice is being adapted at the same time as the pandemic progresses around the world. To reduce unnecessary in-person appointments has become crucial to minimize hospital exposition. Digital technologies allow us to perform real-time monitoring of patients' clinical status. A real-time patient monitoring system through the use of a smartphone application and wearable devices was implemented at our Center during the COVID19 pandemic. Methods Since March 2020, a real time patient monitoring system was implemented at our HCT program. All consecutive adults patients transplanted between April 2020 and July 2020 were considered for the study. Vital signs and relevant clinical information were reported during 14 consecutive days after being discharged, through the online platform provided by Trilema Fundation (saludencasa.trilema.org, Fundación Trilema, Valencia, Spain). Vital signs (cardiac frequency, blood pressure, oxygen saturation) were measured with validated oxymeters (Onyx II®, Nonin Inc, Plymouth MN USA) and blood pressure monitors (iHealth Track®, Mountain View, CA USA). Temperature was measured through domiciliary thermometers. Patients were educated to measure their respiratory frequency. A checklist of clinical symptoms was filled daily. An analogue visual scale (0-10) to detect potential cases of anxiety or depressive disorders was reported daily. Scores of >6 were evaluated by a psycho-oncologist through videoconference. All the data were reported to the online platform using a smartphone app compatible with iPhone and Android systems. A direct chat between patients and physician was available through the app. Clinical information was daily supervised by an experienced HCT hematologist. Clinical interventions were arranged if significant clinical abnormalities were documented. A hematologist with experience in HCT patients revised all the patients' data daily. Programmed alarms were set in case of any of the following situations: fever >38 oC; oxygen saturation <92%; tachicardia >125/bpm, hypotension (sytolic<90 mmHg, diastolic > 60 mmHg; altered mental status; persistent emesis or diarrhea). Patient´s satisfaction questionnaires were evaluated individually after finalizing the 14-days clinical monitoring. Results During the study period, 21 adults underwent HCT and 16 were s were eligible to be recruited into the study (80% feasibility) with team effort and without additional costs. Reasons for not being enrolled were: language incompatibility (1 patient), no consent (1 patient), not compatible smartphone (3 patients). Of the 16 enrolled patients, median age was 50 (range 22-70 years), 37% were female and 94% had lymphoid diseases. Thirty-eight percent of HCTs were autologous and 62% allogeneic. Of the 16 enrolled patients, 25% were not able to adequately use the app due to inability in using smartphone applications. Of the remaining 12 patients, adherence in reporting study data (number of days reported of the planned 14 days study period) was as follows (average): temperature 89%, oxygen saturation 90%, respiratory frequency 70%, cardiac frequency 85%, blood pressure 89%, symptoms reporting 65%, emotional distress 71%. Automatic alarms were activated only 3 times: twice for the presence of clinical symptoms and once, for emotional distress. A videoconference with the psycho-oncologist was requested by one patient only. The chat service to communicate with hospital personnel was used in 4 patients. Data collected with the digital system helped the clinician to early recognize arterial hypertension (1 patient) and acute cutaneous GVHD grade 1 (1 patient). Only two patients of the whole cohort were readmitted within 14 days from discharge due to grade 4 odynophagia due to HSV1/2 reactivation. Patients´ experiences with telehealth systems are reported in table 1. Conclusion Telehealth monitoring can potentially improve patient's follow-up in terms of both physical and psychological outcomes. Technological problems still represent a barrier to a wider application of telehealth monitoring systems in the medical setting. Disclosures Mussetti: Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Incyte: Consultancy; Janssen: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Sanofi: Consultancy, Honoraria; Gilead/Kite: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau.

Patient Monitoring System using Computer Vision for Emotional Recognition and Vital Signs Detection

2020 ◽  
Author(s):  
Ahmad Anwar Zainuddin ◽  
Sakthyvell Superamaniam ◽  
Andrea Christella Andrew ◽  
Ramanand Muraleedharan ◽  
John Rakshys ◽  
...  
Keyword(s):  
Computer Vision ◽  
Monitoring System ◽  
Patient Monitoring ◽  
Vital Signs ◽  
Emotional Recognition ◽  
Patient Monitoring System

Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lauren East ◽  
Zainab Mahmoud ◽  
Amanda Verma
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Vital Signs ◽  
Wilcoxon Test ◽  
Initial Visit ◽  
Office Visits ◽  
Paired Data ◽  
Cardiology Clinic ◽  
Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

Detection of Seizure Activity in the Paralyzed Neonate Using Continuous Monitoring

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 583-586
Author(s):  
Ronald N. Goldberg ◽  
Steven L. Goldman ◽  
R. Eugene Ramsay ◽  
Rosalyn Feller
Keyword(s):  
Blood Pressure ◽  
Oxygen Saturation ◽  
Arterial Blood Pressure ◽  
Cardiac Arrhythmias ◽  
Seizure Activity ◽  
Vital Signs ◽  
Transcutaneous Oxygen ◽  
Mechanically Ventilated ◽  
Arterial Blood ◽  
Systolic Arterial Blood Pressure

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.

Clinical Comparison of Automatic, Noninvasive Measurements of Blood Pressure in the Forearm and Upper Arm With the Patient Supine or With the Head of the Bed Raised 45°: A Follow-Up Study

2006 ◽  
Vol 15 (2) ◽  
pp. 196-205 ◽  
Author(s):  
Kathleen Schell ◽  
Denise Lyons ◽  
Elisabeth Bradley ◽  
Linda Bucher ◽  
Maureen Seckel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vital Signs ◽  
Upper Arm ◽  
Mean Values ◽  
Noninvasive Measurements ◽  
Starting Position ◽  
Arm Circumference ◽  
Blood Pressures ◽  
Cuff Size

• Background Noninvasive measurement of blood pressure in the forearm is used when the upper arm is inaccessible and/or when available blood pressure cuffs do not fit a patient’s arm. Evidence supporting this practice is limited. • Objective To compare noninvasive measurements of blood pressure in the forearm and upper arm of medical-surgical inpatients positioned supine and with the head of the bed raised 45°. • Methods Cuff size was selected on the basis of forearm and upper arm circumference and manufacturers’ recommendations. With a Welch Allyn Vital Signs 420 Series monitor, blood pressures were measured in the forearm and then in the upper arm of 221 supine patients with their arms resting at their sides. Patients were repositioned with the head of the bed elevated 45° and after 2 minutes, blood pressures were measured in the upper arm and then the forearm. Starting position was alternated on subsequent subjects. • ResultsPaired t tests revealed significant differences between systolic and diastolic blood pressures measured in the upper arm and forearm with patients supine and with the head of the bed elevated 45°. The Bland-Altman procedure revealed that the distances between the mean values and the limits of agreement were from 15 to 33 mm Hg for individual subjects. • Conclusions Noninvasive measurements of blood pressure in the forearm and upper arm cannot be interchanged in medical-surgical patients who are supine or in patients with the head of the bed elevated 45°.

Design and Development of Real Time Patient Monitoring System with GSM Technology

2020 ◽  
pp. 627-642
Author(s):  
Sindhu Suryanarayanan ◽  
Sreekala Manmadhan ◽  
N. Rakesh
Keyword(s):  
Critical Care ◽  
Real Time ◽  
Monitoring System ◽  
Medical Equipment ◽  
Patient Monitoring ◽  
Weather Forecast ◽  
Essential Information ◽  
Life Saving ◽  
Patient Monitoring System ◽  
User Friendly

Technology keeps evolving every second. Humans receive all the essential information with just one touch. Be it the weather forecast or ordering any grocery or communicating with one's peers, everything happens so easily and efficiently. It is undoubtedly user friendly. When the same technology associates itself with the medical equipment it becomes easier to fetch and process the patient's data in real time. It also helps to make several life-saving, spontaneous decisions for the critical care. This paper talks about the patient monitoring system. The physiological parameters of the patient are continuously monitored in real time using sensors. The data that is obtained from the sensor is then sent to an Arduino Uno microcontroller where it is analyzed. If the patient's data differs from the required threshold values, an emergency message is sent to the assigned doctor's mobile. This is done using the GSM module which is interfaced with the microcontroller. Verifying the system in software is done using Proteus.

Design and Development of Real Time Patient Monitoring System with GSM Technology

2017 ◽  
Vol 19 (4) ◽  
pp. 22-36 ◽  
Author(s):  
Sindhu Suryanarayanan ◽  
Sreekala Manmadhan ◽  
N. Rakesh
Keyword(s):  
Real Time ◽  
Monitoring System ◽  
Medical Equipment ◽  
Patient Monitoring ◽  
Weather Forecast ◽  
Threshold Values ◽  
Essential Information ◽  
Life Saving ◽  
Patient Monitoring System ◽  
User Friendly

Technology keeps evolving every second. Humans receive all the essential information with just one touch. Be it the weather forecast or ordering any grocery or communicating with one's peers, everything happens so easily and efficiently. It is undoubtedly user friendly. When the same technology associates itself with the medical equipment it becomes easier to fetch and process the patient's data in real time. It also helps to make several life-saving, spontaneous decisions for the critical care. This paper talks about the patient monitoring system. The physiological parameters of the patient are continuously monitored in real time using sensors. The data that is obtained from the sensor is then sent to an Arduino Uno microcontroller where it is analyzed. If the patient's data differs from the required threshold values, an emergency message is sent to the assigned doctor's mobile. This is done using the GSM module which is interfaced with the microcontroller. Verifying the system in software is done using Proteus.

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