Feasibility of a telemedicine framework for collaborative pacemaker follow-up

2007 ◽  
Vol 13 (7) ◽  
pp. 341-347 ◽  
Author(s):  
Alexander Kollmann ◽  
Dieter Hayn ◽  
José García ◽  
Jesús Daniel Trigo ◽  
Peter Kastner ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Point Of Care ◽  
Screening Method ◽  
Number Of Patients ◽  
Working Status ◽  
Expert Classification ◽  
Electrocardiogram Ecg ◽  
Efficient Screening ◽  
Manual Review

We propose a telemedicine framework for remote and manufacturer independent pacemaker (PM) follow-up. The main goal is to provide the caregiver at the point-of-care with an efficient screening method to identify possible malfunction of the pacing system in collaboration with the specialist at the PM clinic. The concept was evaluated in a clinical trial on 44 patients (mean age 76 years). A total of 62 electrocardiogram (ECG) recordings were transmitted using a mobile PM follow-up unit. Using the automatic classification algorithm, 32 PMs were classified as 'OK' and eight PMs were classified as 'not OK'. In four cases a prediction regarding the working status of the PM was not possible. The signal processing classification was confirmed by expert classification (manual review of the ECG). The results indicate that the proposed PM follow-up concept has the potential to work as an efficient screening method and may spare a significant number of patients the burden of having to travel to specialized PM clinics.

Nanosensors for therapeutic drug monitoring: implications for transplantation

Nanomedicine ◽  
2019 ◽  
Vol 14 (20) ◽  
pp. 2735-2747 ◽  
Author(s):  
Ashkan Shafiee ◽  
Elham Ghadiri ◽  
Jareer Kassis ◽  
Anthony Atala
Keyword(s):  
State Of The Art ◽  
Point Of Care ◽  
Therapeutic Drug ◽  
Organ Rejection ◽  
Number Of Patients ◽  
Deceased Donors ◽  
Transplanted Organs ◽  
Further Development

The number of patients requiring organ transplantations is exponentially increasing. New organs are either provided by healthy or deceased donors, or are grown in laboratories by tissue engineers. Post-surgical follow-up is vital for preventing any complications that can cause organ rejection. Physiological monitoring of a patient who receives newly transplanted organs is crucial. Many efforts are being made to enhance follow-up technologies for monitoring organ recipients, and point-of-care devices are beginning to emerge. Here, we describe the role of biosensors and nanosensors in improving organ transplantation efficiency, managing post-surgical follow-up and reducing overall costs. We provide an overview of the state-of-the-art biosensing technologies and offer some perspectives related to their further development.

scholarly journals Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms

2020 ◽  
Vol 2 (1) ◽  
pp. 78
Author(s):  
Madhumitha Pandiaraja ◽  
James Brimicombe ◽  
Martin Cowie ◽  
Andrew Dymond ◽  
Hannah Clair Lindén ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Feasibility Study ◽  
Stroke Risk ◽  
Heart Rhythm ◽  
Fold Increase ◽  
Signal Quality ◽  
Number Of Patients ◽  
Electrocardiogram Ecg ◽  
Manual Review

Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. However, the ECG recordings must be manually reviewed, which is time-consuming and costly. Our aims were to: (i) evaluate the manual review workload; and (ii) evaluate strategies to reduce the workload. In total, 2141 older adults were asked to record their ECG four times per day for 1–4 weeks in the SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) Feasibility Study, producing 162,515 recordings. Patients with AF were identified by: (i) an algorithm classifying recordings based on signal quality (high or low) and heart rhythm; (ii) a nurse reviewing recordings to correct algorithm misclassifications; and (iii) two cardiologists independently reviewing recordings from patients with any evidence of rhythm abnormality. It was estimated that 30,165 reviews were required (20,155 by the nurse, and 5005 by each cardiologist). The total number of reviews could be reduced to 24,561 if low-quality recordings were excluded from review; 18,573 by only reviewing ECGs falling under certain pathological classifications; and 18,144 by only reviewing ECGs displaying an irregularly irregular rhythm for the entire recording. The number of AF patients identified would not fall considerably: from 54 to 54, 54 and 53, respectively. In conclusion, simple approaches may help feasibly reduce the manual workload by 38.4% whilst still identifying the same number of patients with undiagnosed, clinically relevant AF.

Abstract P268: The Impact Of Covid-19 On A Large Pragmatic Clinical Trial Embedded In Primary Care

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Cynthia Hau ◽  
Sarah Leatherman ◽  
Alison Klint ◽  
Peter Glassman ◽  
Addison Taylor ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Data Collection ◽  
Point Of Care ◽  
Pragmatic Trial ◽  
Pragmatic Trials ◽  
Pragmatic Clinical Trial ◽  
Medication Prescription ◽  
Critical Data ◽  
The Impact

Introduction: The COVID-19 pandemic has had a significant impact on traditional clinical trial operations, but it is unclear whether the impact persists in pragmatic trials with a centralized study design. The Diuretic Comparison Project (DCP) is a Point-of Care pragmatic trial that operates through a usual care system to compare chlorthalidone and hydrochlorothiazide at preventing major cardiovascular (CV) events and non-cancer death. We assessed the impact of the COVID-19 pandemic on the centralized recruitment, patient follow-up, data collection, and outcome ascertainment performed in the DCP. Methods: We assessed operations in two 8-month periods: Pre-COVID-19 (Jul 2019 - Feb 2020) and Mid-COVID-19 (Jul 2020 - Feb 2021). Enrollment, study medication adherence, blood pressure (BP) and electrolyte follow-up rates, VA records of CV events, all-cause hospitalization, and death rates were compared. Results: Providers agreed to participate at a lower rate, but more patients were contacted and randomized during mid-COVID-19. While BP evaluations decreased, the rates of electrolyte, major CV, and medication prescription records were comparable to the pre-COVID-19 period ( Table 1 ). Conclusions: The DCP was able to recruit and maintain critical data collection at the pre-COVID-19 levels. There were some decreases in BP evaluations, likely due to fewer in-person visits. All-cause VA hospitalizations also decreased, despite rises in COVID-related hospitalizations and death. While the impact on outcome and safety rates awaits complete data from Medicare, the DCP has demonstrated a promising centralized design that can support pragmatic trial operations during a pandemic.

STRUCTURAL AND DYNAMIC FEATURES OF EAR-LY DISABILITY DUE TO MENTAL DISEASES

2020 ◽  
pp. 62-67
Author(s):  
Shmakova O.P.
Keyword(s):  
People With Disabilities ◽  
Child And Adolescent Psychiatry ◽  
Child Psychiatrist ◽  
Childhood And Adolescence ◽  
Disabled Children ◽  
Dynamic Features ◽  
Factors Affecting ◽  
Number Of Children ◽  
Number Of Patients

Prevention of disability is one of the most significant tasks of child and adolescent psychiatry. Obtaining data on the dynamics of the number of people with disabilities and the factors affecting this indicator seems to be one of the relevant aspects. Aim: to trace the dynamics of the number of children with disabili-ties and to assess the change in the structure of early disability over the past decades. Materials and Meth-ods. A comparative analysis of two cohorts of patients was carried out: 1st - patients born in 1990-1992. (1203 patients (men - 914, 76%; women - 289, 24%)) who applied to the district neuropsychiatric dispensa-ry for outpatient care in childhood and adolescence; II - children and adolescents born in 2005 - 2018 (602 patients (male - 410, 68%; female - 192, 32%), ob-served at the time of the study by a child psychiatrist in the neuropsychiatric dispensary. Research methods: clinical and psychopathological; follow-up; statisti-cal. Results. Comparison of the number and nosologi-cal distribution of disabled children in two cohorts showed that over the 15th year there has been a shift towards an increase in the proportion of disabled children among patients observed by child and ado-lescent psychiatrists. The increase in the number of children with disabilities was due to those suffering from childhood autism and other disorders of general development. There were no statistically significant differences in the number of people with disabilities who received benefits before the age of 7, as well as differences in gender ratios among disabled people in the two cohorts. Conclusion. Early disability is a mul-tifactorial phenomenon, prevalence, dynamics, the structure of which depends not only on clinical, but also on socio-administrative realities. Children with autism require increased attention, since there has been a multiple increase in the number of patients with this diagnosis.

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