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.

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 O15 Using a smartphone app to characterise and quantify skin colour changes in Raynaud's attacks

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Graham Dinsdale ◽  
Joanne Manning ◽  
Ariane Herrick ◽  
Mark Dickinson ◽  
Christopher Taylor
Keyword(s):  
Mobile Phone ◽  
Strong Association ◽  
Colour Change ◽  
Objective Measure ◽  
Skin Colour ◽  
Smartphone App ◽  
Limiting Factor ◽  
Bhattacharyya Distance ◽  
Automated Method ◽  
The Mean

Abstract Background/Aims  The lack of objective outcome measures for Raynaud's phenomenon (RP) has been a major limiting factor in development of effective treatments. At present, the Raynaud's Condition Score (RCS) is the only validated outcome measure, and is highly subjective. Mobile phone technology could provide a way forward. We have developed a smartphone app for RP monitoring that guides the patient through the process of capturing images of their hands during RP episodes, as well as capturing other data through post-attack and daily questionnaires. One of the objectives of our research programme (reported here) was to compare digital image (photographic) parameters to the RCS. Methods  40 patients with RP (8 with primary RP, 32 with RP secondary to systemic sclerosis) were recruited (40 female, median age (range): 57 years (25-74), median (range) duration of RP symptoms: 17 (0-53) years). Patients were given a smartphone handset with a pre-installed Raynaud’s Monitoring app and were trained on how to use it/take usable photographs. They were then asked to take photographs of RP attacks over a 14 day period and also to record the RCS for each episode. The app specifically prompts the patient to take a picture of their hand every minute during an attack, until confirmation is given that the attack is complete. At a 2nd visit, the handsets, images, and data were collected for analysis. The mean colour change during each RP attack was quantified (semi-automated method) by the Bhattacharyya distance (BD) in colour space between a region of interest (e.g. a section of a digit) and a control region (dorsal hand). BD was then compared to the RCS using ANOVA, after controlling for patient variability in the range of RCS values used by each patient. Results  A total of 3,030 images were collected, describing 229 RP attacks. The median RCS reported was 6 (inter-quartile range [IQR]: 4), while the median for BD was 5.6 (IQR 3.2). ANOVA showed that measured values of the mean image BD were significantly different when different values of RCS were recorded by the patient (p &lt; 0.001), i.e. attacks where patients selected different values of RCS had significantly different values of BD. Across all attacks/patients the F-value from ANOVA for RCS was 76.2, suggesting that the variation in BD for different values of RCS is much greater than the variation in BD for any one value of RCS. Conclusion  Patients successfully used a smartphone app to collect photographs and data during episodes of RP. A strong association was found between skin colour change (via BD) and the gold-standard RCS. Mobile phone-documented colour change therefore has potential as an objective measure of RP. Further validation work is now required, as well as studies examining sensitivity to change. Disclosure  G. Dinsdale: None. J. Manning: None. A. Herrick: None. M. Dickinson: None. C. Taylor: None.

THE INFLUENCE OF WEIGHT AND HEIGHT ON WEIGHT CHANGES ASSOCIATED WITH PREGNANCY IN WOMEN

1957 ◽  
Vol 15 (4) ◽  
pp. 423-429 ◽  
Author(s):  
THOMAS McKEOWN ◽  
R. G. RECORD
Keyword(s):  
Weight Change ◽  
Weight Changes ◽  
Body Build ◽  
Weight Increment ◽  
Time Table ◽  
The Mean ◽  
Significant Change ◽  
First Time

SUMMARY Three hundred and eighty-three women whose weights were recorded during and after pregnancy were divided into groups of short (under 64 in.) and tall (64 in. and over) individuals, and further subdivided according to an index of body build (based on the observed regression of antenatal weight on height). Differences between the weight 12 months after delivery and the antenatal weight (adjusted according to the number of days by which it preceded or followed the 124th day of gestation) were examined. The proportion of short women who added weight in this interval was relatively high for those who were thinnest at the antenatal examination, was lowest for those who were moderately thin and thereafter increased with increasing degree of obesity (from about 1 in 3 to 4 in 5); the proportion of tall women who added weight showed no significant change (Fig. 2). This variation in weight change according to height is exhibited by women pregnant for the first time (Table 3). For both short and tall women, the mean weight increment of those who added weight, and the mean weight decrement of those who lost weight, increased with increasing degree of obesity (Fig. 3). When weight change is expressed as a proportion of the antenatal weight these trends disappear (Fig. 4).

scholarly journals A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum haemorrhage in a tertiary care hospital in Bankura district of West Bengal, India

2020 ◽  
Vol 9 (5) ◽  
pp. 1976
Author(s):  
Rahul Kirtania ◽  
Jayita Pal ◽  
Sisir Biswas ◽  
Aditi Aich
Keyword(s):  
Randomized Controlled Trial ◽  
Blood Loss ◽  
Controlled Trial ◽  
Active Management ◽  
Control Group ◽  
Care Hospital ◽  
Normal Delivery ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Mean

Background: PPH is the prime cause of maternal mortality worldwide. The incidence of PPH can be drastically combatted by application of uterotonic in active management of third stage labour. Timing of its administration is a matter of concern. This study aimed to assess whether timing of administration of oxytocin would have any impact on incidence or mean blood loss of PPH.Methods: It was a single blinded randomized controlled trial conducted in the department of Obstetrics and Gynecology, Bankura Sammilani Medical College for 6 months where 100 antenatal mothers admitted for normal delivery in labour room were allocated randomly in study and control group considering inclusion and exclusion criteria. Incidence of PPH and mean blood loss had been identified clinically by following them for 24 hours.Results: Only 9% of study population had experienced PPH. There was no statistically significant difference in incidence of PPH with difference in timing of administration of oxytocin (p >0.05). But there was statistically significant decrease in mean blood loss if oxytocin was administered before the placental delivery. The mean blood loss with oxytocin administered before placental delivery was 296.8 ml (102.45) and after placental delivery was 452.0 (128.87) ml respectively.Conclusions: Policy makers should keep in mind not only the incidence of PPH, but the mean blood loss amount too in a setting where anaemia in pregnancy is quite prevalent.

scholarly journals Effects of solasodine of Solanum melongena peel origin in the treatment of palmar arsenical keratosis

2020 ◽  
Vol 13 (2) ◽  
pp. 47-52
Author(s):  
Razia Sultana ◽  
Mir Misbahuddin
Keyword(s):  
Mass Spectrometry ◽  
Nuclear Magnetic Resonance ◽  
Liquid Chromatography ◽  
Solanum Melongena ◽  
Resonance Spectroscopy ◽  
Liquid Chromatography Mass Spectrometry ◽  
Inclusion Criteria ◽  
Phone Calls ◽  
The Mean ◽  
Peel Extract

This study was conducted to confirm the effect of the ointment containing Solanum melongena peel extract in the treatment of palmar arsenical keratosis and to identify the compound responsible for the effect. In total, 30 patients with moderate to severe palmar arsenical keratosis were enrolled according to the inclusion criteria. Extract from S. melongena peel was obtained and a topical ointment was prepared from the extract and supplied at the field level at an interval of two weeks. Instruction was given to the patients about how to apply the ointment. Adherence and adverse effects of the treatment were monitored regularly through phone calls and during each visit. The mean (± SD) size of the keratotic nodules was 21.9 ± 10.0 mm2 before intervention and 6.6 ± 5.3 mm2 after intervention. The percentage of reduction was 69.8. Nuclear magnetic resonance spectroscopy, infrared spectroscopy, liquid chromatography-mass spectrometry and elemental analysis of the extract was done to identify the compound and solasodine, a steroidal alkaloid, was identified.

scholarly journals Improving Log Trucking Efficiency by Using In-Woods Scales

2011 ◽  
Vol 35 (4) ◽  
pp. 178-183 ◽  
Author(s):  
Ryan P. Reddish ◽  
Shawn A. Baker ◽  
W. Dale Greene
Keyword(s):  
Coefficient Of Variation ◽  
Forest Products ◽  
Fuel Prices ◽  
Southern States ◽  
Vehicle Weight ◽  
Gross Vehicle Weight ◽  
The Mean ◽  
Weight Data

Abstract We evaluated weight data from 47,953 truckloads of wood delivered to forest products mills in nine southern states to determine the effect of in-woods scale use on reducing the variability of net and gross weights. Four mill-owning companies provided the data and indicated whether in-woods scales were used for each load. We used these data to compare the mean tare, net, and gross weights of truckloads using scales to those not using scales. Trucks using scales had average tare weights only 108 lb greater, but their net payload averaged 1,799 lb higher than trucks not using scales. The coefficient of variation for the net payload was 38% lower for loads with scales than those without (P < 0.001). Individual southern states have different regulations regarding maximum gross vehicle weight (GVW), so we calculated a GVW index to remove state bias and allow comparisons of loads across states. Loads using scales were within 2% of the legal maximum GVW 54% of the time compared with 30% for loads not weighed in-woods. We estimated haul costs for trucks using scales at $7.44 per ton, compared with $7.74 per ton for trucks not using scales (P < 0.001). We found that 11% of loads with in-woods scales had haul costs exceeding $8.00 per ton, compared with 32% of loads not using scales. Across all data, scales represent a 4% savings on per-ton haul costs with even greater savings available as fuel prices increase.

Active management of BP using heart 360® for secondary stroke prevention - a feasibility study

2015 ◽  
Vol 9 (4) ◽  
pp. e121
Author(s):  
Muhammad U. Farooq ◽  
Jiangyong Min ◽  
Susan Woolner ◽  
Kyaw Z. Win ◽  
Nina-Serena Burkett ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Stroke Prevention ◽  
Active Management ◽  
Secondary Stroke Prevention

Optimal emergency personnel allocation after a natural disaster

2012 ◽  
Vol 7 (1) ◽  
pp. 31-36 ◽  
Author(s):  
James S. Davis, MD ◽  
Bassan J. Allan, MD, MBA ◽  
Amy M. Pearlman, BS ◽  
Daniel P. Carvajal, BBA, PMP ◽  
Carl I. Schulman, MD, PhD, MSPH
Keyword(s):  
Natural Disasters ◽  
Public Awareness ◽  
Public Health Education ◽  
South Florida ◽  
Emergency Personnel ◽  
Phone Calls ◽  
Network Utilization ◽  
Before And After ◽  
The Mean ◽  
Personnel Allocation

Objective: Little work has been devoted to the links between natural disasters, subsequent Emergency Medical Services (EMS) network utilization, triage, and public awareness. The aim of this study was to investigate the types and distribution of emergency calls recorded after each South Florida hurricane during the 2005 season, identifying target areas for public health education, and emergency personnel use and training.Design: Retrospective database review.Setting: Miami-Dade Fire Rescue (MDFR) emergency dispatch headquarters.Patients, participants: All persons making 911 phone calls to the MDFR emergency dispatch headquarters in the 3 days before and after category 3 or higher hurricanes during 2005.Interventions: None.Results: There were 192,363 emergencies reported in 2005. The mean number of 911 emergencies reported per day for the 3 days before and after Katrina was 503 ± 26 and 819 ± 105, respectively (p = 0.007). The mean number for Wilma was 533 ± 42 before and 800 ± 63 after (p = 0.004). However, Rita had no impact on the number of 911 emergencies reported. Katrina resulted in a statistically significant increase in 911 calls for breathing (p = 0.03), convulsions and seizures (p = 0.02), and hazardous situations (p = 0.04). Rita led to an increase in convulsions and seizures (p = 0.03). Lastly,Wilma caused a rise in breathing emergencies (p = 0.02) and hazardous situations (p = 0.02).Conclusions: This study suggests that 911 calls regarding respiratory complaints, convulsions, seizures, and hazardous situations can be expected to significantly increase after a hurricane. Educational initiatives,EMS resource allocation, and modified triage systems designed to target these areas may limit EMS system-wide strain and improve health outcomes following natural disasters.

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