scholarly journals A Smartphone App Is Feasible for Outpatient Cirrhotic Ascites Management

Iproceedings ◽  
10.2196/15130 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15130
Author(s):  
Patricia Bloom ◽  
Madeline Marx ◽  
Thomas Wang ◽  
Ashwini Arvind ◽  
Jasmine Ha ◽  
...  
Keyword(s):  
Weight Gain ◽  
Interim Analysis ◽  
Active Management ◽  
Smartphone App ◽  
Free Fluid ◽  
Weight Changes ◽  
Bacterial Peritonitis ◽  
Study Enrollment ◽  
Cirrhotic Patients ◽  
Weight Data

Background Ascites, or accumulation of abdominal free fluid, develops in two-thirds of patients with cirrhosis. Ascites is painful and, if inadequately managed, can lead to life-threatening complications, including spontaneous bacterial peritonitis and kidney failure. Body weight is an effective proxy for ascites volume; therefore, monitoring daily weights is recommended for optimal ascites management. At present, patients with ascites rarely proactively alert providers of significant weight gains, and there are no widely available technologies specifically designed for ascites monitoring. Objective The objective of this pilot study is to assess the feasibility of a smartphone app to manage outpatient ascites. Methods In this feasibility study, cirrhotic patients with significant ascites requiring specialist management are identified through an inpatient hepatology consult census and outpatient referrals. Each candidate is sent home with a Bluetooth-connected scale, which transmits weight data to the PGHD Connect Smartphone App, and then via the cloud into the electronic medical record (EMR). Weights are monitored every weekday by study staff and alerts are sent to providers if their patients’ weight changes by ≥5lbs within a week or from the weight documented at discharge. The primary outcomes are percentage of study enrollment days when weight data was successfully transmitted into the EMR and percentage of weight alerts to which providers responded. Results Seventy-eight cirrhotic patients were identified as requiring active management of ascites. Of these patients, 8 did not own a smartphone, 23 were encephalopathic, and thus were excluded; another 1 declined to participate, and 3 were consented but subsequently withdrawn due to physical limitation or death prior to hospital discharge. Each patient is enrolled in the program for 28 days. Of the 16 patients currently enrolled, 5 (31%) are male, mean age is 60.9 years (SD 11.1), 13 (81%) were enrolled as inpatients, 8 (50%) have non-alcoholic steatohepatitis cirrhosis, 4 (25%) alcohol-associated cirrhosis, and 2 (12.5%) viral cirrhosis. At this interim analysis, transmission of weight data into the EMR has successfully occurred on 70% of study enrollment days. Patients experienced technology issues during 10% of days enrolled. Of the total 20 weight alerts to date, 12 (60%) were triggered by weight loss ≥5lb in one week, 7 (35%) by weight gain ≥5lb in one week, and 1 (5%) by weight gain ≥5lb since discharge. Providers responded to 13 (65%) of the weight alerts within 24 hours. Of the 13 alerts with a provider response, 7 (54%) were followed by a call or email to the patient to discuss care, 4 (31%) a scheduled appointment, 4 (31%) a change in diuretic dosage, 3 (23%) scheduling for paracentesis (procedure to remove ascites fluid), and 3 (23%) further laboratory workup. To date, there have been 13 readmissions. Conclusions On the basis of our interim analysis, we demonstrate feasibility of a martphone app to facilitate ascites management. We report encouraging rates of patient and provider engagement. This innovation shows promise in enabling early intervention and enhancing quality of life in cirrhotic patients. Future studies will investigate the efficacy of mobile health technology to improve outcomes in this population.

scholarly journals A Smartphone App to Manage Cirrhotic Ascites Among Outpatients: Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Patricia Bloom ◽  
Thomas Wang ◽  
Madeline Marx ◽  
Michelle Tagerman ◽  
Bradley Green ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Weight Change ◽  
Active Management ◽  
Smartphone App ◽  
Patient Scheduling ◽  
Phone Calls ◽  
The Mean ◽  
Patient Readmissions ◽  
Outpatient Settings ◽  
Weight Data

BACKGROUND Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. OBJECTIVE This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. METHODS In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. RESULTS In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (<i>P</i>=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (<i>r</i>=0.60; <i>P</i>=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. CONCLUSIONS We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis.

scholarly journals A Smartphone App to Manage Cirrhotic Ascites Among Outpatients: Feasibility Study

10.2196/17770 ◽  
2020 ◽  
Vol 8 (9) ◽  
pp. e17770
Author(s):  
Patricia Bloom ◽  
Thomas Wang ◽  
Madeline Marx ◽  
Michelle Tagerman ◽  
Bradley Green ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Weight Change ◽  
Active Management ◽  
Smartphone App ◽  
Patient Scheduling ◽  
Phone Calls ◽  
The Mean ◽  
Patient Readmissions ◽  
Outpatient Settings ◽  
Weight Data

Background Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. Objective This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. Methods In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. Results In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (P=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (r=0.60; P=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. Conclusions We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis.

Microbial epidemiology in cirrhotic patients with spontaneous bacterial peritonitis in Vienna

2013 ◽  
Vol 51 (05) ◽  
Author(s):  
P Schwabl ◽  
K Soucek ◽  
T Bucsics ◽  
M Mandorfer ◽  
A Blacky ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

scholarly journals A meta-analysis comparing short-term weight and cardiometabolic changes between olanzapine/samidorphan and olanzapine

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manit Srisurapanont ◽  
Sirijit Suttajit ◽  
Surinporn Likhitsathian ◽  
Benchalak Maneeton ◽  
Narong Maneeton
Keyword(s):  
Weight Gain ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dropout Rates ◽  
Lower Percentage ◽  
Current Evidence ◽  
Weight Changes ◽  
Short Term ◽  
Short Term Treatment

AbstractThis study compared weight and cardiometabolic changes after short-term treatment of olanzapine/samidorphan and olanzapine. Eligible criteria for an included trial were ≤ 24 weeks, randomized controlled trials (RCTs) that compared olanzapine/samidorphan and olanzapine treatments in patients/healthy volunteers and reported weight or cardiometabolic outcomes. Three databases were searched on October 31, 2020. Primary outcomes included weight changes and all-cause dropout rates. Standardized mean differences (SMDs) and risk ratios (RRs) were computed and pooled using a random-effect model. This meta-analysis included four RCTs (n = 1195). The heterogeneous data revealed that weight changes were not significantly different between olanzapine/samidorphan and olanzapine groups (4 RCTs, SDM = − 0.19, 95% CI − 0.45 to 0.07, I2 = 75%). The whole-sample, pooled RR of all-cause dropout rates (4 RCTs, RR = 1.02, 95% CI 0.84 to 1.23, I2 = 0%) was not significant different between olanzapine/samidorphan and olanzapine groups. A lower percentage of males and a lower initial body mass index were associated with the greater effect of samidorphan in preventing olanzapine-induced weight gain. Current evidence is insufficient to support the use of samidorphan to prevent olanzapine-induced weight gain and olanzapine-induced cardiometabolic abnormalities. Samidorphan is well accepted by olanzapine-treated patients.

scholarly journals Managing Obesity in Lockdown: Survey of Health Behaviors and Telemedicine

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1359
Author(s):  
Noga C Minsky ◽  
Dafna Pachter ◽  
Galia Zacay ◽  
Naama Chishlevitz ◽  
Miriam Ben-Hamo ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Weight Gain ◽  
Health Behaviors ◽  
Online Survey ◽  
Eating Patterns ◽  
Weight Changes ◽  
Exercise Habits ◽  
Prevent Weight Gain ◽  
Vegetables And Fruits

Since the outbreak of COVID-19, billions of people have gone into lockdown, facing pandemic related challenges that engender weight gain, especially in the obese. We report the results of an online survey, conducted during Israel’s first quarantine, of 279 adults treated in hospital-based obesity clinics with counseling, medications, surgery, endoscopic procedures, or any combination of these for weight loss. In this study, we assessed the association between changes in dietary and lifestyle habits and body weight, and the benefits of receiving weight management care remotely through telemedicine during lockdown. Compared to patients not receiving obesity care via telemedicine, patients receiving this care were more likely to lose weight (OR, 2.79; p = 0.042) and also to increase participation in exercise (OR, 2.4; p = 0.022). While 40% of respondents reported consuming more sweet or salty processed snacks and 33% reported less vegetables and fruits, 65% reported more homemade foods. At the same time, 40% of respondents reported a reduction in exercise and 52% reported a decline in mood. Alterations in these eating patterns, as well as in exercise habits and mood, were significantly associated with weight changes. This study highlights that lockdown affects health behaviors associated with weight change, and advocates for the use of telemedicine to provide ongoing obesity care during future quarantines in order to promote weight loss and prevent weight gain.

scholarly journals Rapid Identification of Bacterial Species with Bacterial DNA Microarray in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

2009 ◽  
Vol 48 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Takaaki Sugihara ◽  
Masahiko Koda ◽  
Yoshiko Maeda ◽  
Tomomitsu Matono ◽  
Takakazu Nagahara ◽  
...  
Keyword(s):  
Dna Microarray ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Species ◽  
Rapid Identification ◽  
Bacterial Dna ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Monoamine Oxidase Inhibitors and Weight Gain

1988 ◽  
Vol 22 (10) ◽  
pp. 755-759 ◽  
Author(s):  
Thomas G. Cantú ◽  
Joan S. Korek
Keyword(s):  
Weight Gain ◽  
Literature Review ◽  
Monoamine Oxidase ◽  
Tricyclic Antidepressants ◽  
Monoamine Oxidase Inhibitors ◽  
Weight Changes ◽  
Appetite Control ◽  
Drug Induced ◽  
Relative Potential ◽  
Induce Weight Gain

Weight gain associated with antidepressant therapy is a common problem that often results in noncompliance. Some authors suggest that monoamine oxidase inhibitors (MAOI) are less likely to produce weight gain than tricyclic antidepressants. This paper addresses the relative potential for weight gain with the MAOI. Assessing the potential for antidepressant-induced weight gain necessitates separating the weight changes associated with alterations in mood disorders from those due to drug-induced alterations in appetite control. The mechanisms of appetite control are reviewed briefly followed by proposed mechanisms by which the MAOI may alter this control. A literature review suggests that phenelzine is the MAOI most likely to induce weight gain; reports of isocarboxazid-induced weight gain are less common. There are no cases of tranylcypromine-induced weight gain in the literature that are clearly associated with the drug. The MAOI probably have different effects on the mechanisms of appetite control.

Growth and seasonal weight changes as they relate to spring and autumn set points in mule deer

1991 ◽  
Vol 69 (3) ◽  
pp. 744-747 ◽  
Author(s):  
Lyle A. Renecker ◽  
W. M. Samuel
Keyword(s):  
Growth Rate ◽  
Weight Loss ◽  
Weight Gain ◽  
Mule Deer ◽  
Odocoileus Hemionus ◽  
Weight Changes ◽  
Annual Cycles ◽  
Body Weights ◽  
Compensatory Gain ◽  
Highly Correlated

Growth rate and potential, 25 hand-reared mule deer (Odocoileus hemionus hemionus) were examined. When possible, body weights of all animals were recorded weekly. Female deer matured faster than males, but males attained a larger body size. Regressions of winter weight loss of both sexes on peak autumn weight were highly correlated. Similarly, spring and summer compensatory gain in females could be predicted from the minimum spring weight. Annual cycles of intake and weight gain may have adaptations that improve reproductive success and winter survival.

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