Efficacy of Telemedicine and Telemonitoring in At-Home Monitoring of Patients with COVID-19

Aim: this work aims to assess if telemedicine and telemonitoring are clinically useful and safe for at-home monitoring of Coronavirus disease 2019 (COVID-19) patients. Methods: This is a retrospective cohort study of all patients diagnosed with COVID-19 in Galicia (Northwestern Spain) between 26 December 2020 and 15 February 2021. The structured, proactive monitoring via telemonitoring (TELEA) of patients considered to be high-risk in the Lugo, A Mariña, and Monforte Healthcare Area (ASLAM) was evaluated compared to other models in the remaining healthcare areas of Galicia. Results: Of the 47,053 COVID-19 patients, 4384 (9.3%) were in ASLAM. Of them, 1187 (27.1%) were monitored via TELEA, and the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored via other methods. Patients monitored in ASLAM via TELEA were older, consulted in the emergency department less frequently (p = 0.05), were hospitalized less frequently (p < 0.01), had shorter hospital stays (p < 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). No at-home life-threatening emergencies were recorded. Conclusions: these data suggest that, for COVID-19 patients, a care model involving proactive at-home monitoring with telemedicine and telemonitoring is associated with reduced pressure on hospital services and a lower mortality rate.

Download Full-text

Pulse oximetry home monitoring in infants with single-ventricle physiology and a surgical shunt as the only source of pulmonary blood flow

Cardiology in the Young ◽

10.1017/s1047951112000352 ◽

2012 ◽

Vol 23 (1) ◽

pp. 75-81 ◽

Cited By ~ 7

Author(s):

Annika Öhman ◽

Eva Strömvall-Larsson ◽

Boris Nilsson ◽

Mats Mellander

Keyword(s):

Oxygen Saturation ◽

Single Ventricle ◽

Home Monitoring ◽

Shunt Complication ◽

Single Ventricle Physiology ◽

Life Saving ◽

Shunt Occlusion ◽

Life Threatening ◽

Shunt Dysfunction ◽

At Home

AbstractBackgroundShunt occlusion is a major cause of death in children with single ventricle. We evaluated whether one daily measurement of oxygen saturation at home could detect life-threatening shunt dysfunction.MethodsA total of 28 infants were included. Parents were instructed to measure saturation once daily and if less than or equal to 70% repeat the measurement. Home monitoring was defined as positive when a patient was admitted to Queen Silvia Children's Hospital because of saturation less than or equal to 70% on repeated measurement at home. A shunt complication was defined as arterial desaturation and a narrowing of the shunt that resulted in an intervention to relieve the obstruction or in death. Parents’ attitude towards the method was investigated using a questionnaire.ResultsA shunt complication occurred out of hospital eight times in eight patients. Home monitoring was positive in five out of eight patients. In two patients, home monitoring was probably life saving; in one of them, the shunt was replaced the same day and the other had an emergency balloon dilatation of the shunt. In three out of eight patients, home monitoring was negative; one had an earlier stage II and survived, but two died suddenly at home from thrombotic shunt occlusion. On seven occasions in three patients home monitoring was positive but there was no shunt complication. The method was well accepted by the parents according to the results of the questionnaire.ConclusionHome monitoring of oxygen saturation has the potential to detect some of the life-threatening shunt obstructions between stages I and II in infants with single-ventricle physiology.

Download Full-text

Utility of At-home Monitoring of Exercise Capacity by App-based 6-minute Walk Test

Case Medical Research ◽

10.31525/ct1-nct03893500 ◽

2019 ◽

Author(s):

Keyword(s):

Exercise Capacity ◽

Home Monitoring ◽

Walk Test ◽

6 Minute Walk Test ◽

Minute Walk ◽

At Home

Download Full-text

Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy

Mini-Reviews in Medicinal Chemistry ◽

10.2174/1389557519666190313161854 ◽

2019 ◽

Vol 19 (12) ◽

pp. 980-987 ◽

Cited By ~ 9

Author(s):

Mohammad Ridwane Mungroo ◽

Ayaz Anwar ◽

Naveed Ahmed Khan ◽

Ruqaiyyah Siddiqui

Keyword(s):

Mortality Rate ◽

Free Living ◽

Outdoor Activities ◽

The Past ◽

Free Living Amoeba ◽

Challenges And Opportunities ◽

Life Threatening ◽

The Central Nervous System ◽

Living Nature ◽

Treatment And Diagnosis

Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as “brain-eating amoebae”. The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.

Download Full-text

Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

Annals of Intensive Care ◽

10.1186/s13613-020-00652-0 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 3

Author(s):

Rene A. Posma ◽

Trine Frøslev ◽

Bente Jespersen ◽

Iwan C. C. van der Horst ◽

Daan J. Touw ◽

...

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Lower Mortality ◽

Prognostic Impact ◽

Icu Admission ◽

Lactate Levels ◽

Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

Download Full-text

The Role of Place of Delivery in Preventing Neonatal and Infant Mortality Rate in India

Geographies ◽

10.3390/geographies1010004 ◽

2021 ◽

Vol 1 (1) ◽

pp. 47-62

Author(s):

Ujjwal Das ◽

Barkha Chaplot ◽

Hazi Mohammad Azamathulla

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Neonatal Mortality ◽

Public Hospitals ◽

Infant Mortality Rate ◽

Private Institutions ◽

Public And Private ◽

Place Of Delivery ◽

At Home

Skilled birth attendance and institutional delivery have been advocated for reducing maternal, neonatal mortality and infant mortality (NMR and IMR). This paper examines the role of place of delivery with respect to neo-natal and infant mortality in India using four rounds of the Indian National Family Health Survey conducted in 2015–2016. The place of birth has been categorized as “at home” or “public and private institution.” The role of place of delivery on neo-natal and infant mortality was examined by using multivariate hazard regression models adjusted for clus-tering and relevant maternal, socio-economic, pregnancy and new-born characteristics. There were 141,028 deliveries recorded in public institutions and 54,338 in private institutions. The esti-mated neonatal mortality rate in public and private institutions during this period was 27 and 26 per 1000 live births respectively. The study shows that when the mother delivers child at home, the chances of neonatal mortality risks are higher than the mortality among children born at the health facility centers. Regression analysis also indicates that a professionally qualified provider′s antenatal treatment and assistance greatly decreases the risks of neonatal mortality. The results of the study illustrate the importance of the provision of institutional facilities and proper pregnancy in the prevention of neonatal and infant deaths. To improve the quality of care during and imme-diately after delivery in health facilities, particularly in public hospitals and in rural areas, accel-erated strengthening is required.

Download Full-text

The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217421989147 ◽

2021 ◽

pp. 009121742198914

Author(s):

Jennifer Brady ◽

R David Hayward ◽

Elango Edhayan

Keyword(s):

Length Of Stay ◽

Psychiatric Illness ◽

Traumatic Injury ◽

Lower Mortality ◽

Linear Modeling ◽

Psychiatric Comorbidities ◽

Trauma Outcomes ◽

Hospital Stays ◽

The Impact ◽

The Relationship

Introduction Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods Patient data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients’ psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

Download Full-text

Irrespective of the degree of hyperlactatemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with non-users: beware of confounders!

Annals of Intensive Care ◽

10.1186/s13613-020-00766-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Patrick M. Honore ◽

Leonel Barreto Gutierrez ◽

Luc Kugener ◽

Sebastien Redant ◽

Rachid Attou ◽

...

Keyword(s):

Mortality Rate ◽

Lower Mortality ◽

Lactate Levels

Download Full-text

Assessing Sleepiness and Sleep Disorders in Australian Long-Distance Commercial Vehicle Drivers: Self-Report Versus an “At Home” Monitoring Device

SLEEP ◽

10.5665/sleep.1726 ◽

2012 ◽

Vol 35 (4) ◽

pp. 469-475 ◽

Cited By ~ 26

Author(s):

Lisa N. Sharwood ◽

Jane Elkington ◽

Mark Stevenson ◽

Ronald R. Grunstein ◽

Lynn Meuleners ◽

...

Keyword(s):

Sleep Disorders ◽

Commercial Vehicle ◽

Home Monitoring ◽

Self Report ◽

Monitoring Device ◽

Long Distance ◽

At Home

Download Full-text

Care at home for people with dementia: as in a total institution?

Ageing and Society ◽

10.1017/s0144686x06005307 ◽

2006 ◽

Vol 27 (1) ◽

pp. 3-24 ◽

Cited By ~ 24

Author(s):

JANET ASKHAM ◽

KATE BRIGGS ◽

IAN NORMAN ◽

SALLY REDFERN

Keyword(s):

Intimate Relationships ◽

Social Relationship ◽

Intimate Relationship ◽

Total Institution ◽

Home Life ◽

The People ◽

People With Dementia ◽

Custodial Care ◽

Care At Home ◽

At Home

This article examines three kinds of social relationship likely to be present when people with dementia are cared for at home by relatives or friends: custodial care, an intimate relationship, and home-life. Using Goffman's three defining aspects of custodial care – routinisation, surveillance and mortification of the self – the paper examines whether these characterised the care of people with dementia at home and, if so, whether they conflicted with the intimate relationship and with home-life. The study involved sustained observations and interviews with 20 people with dementia and their carers in and around London, and qualitative analysis of the data. It was found that all three aspects of custodial care were present although not fully realised, and that they led to difficulties, many of which were associated with the concurrent pursuit of an intimate relationship and home-life. In all cases, daily life was routinised partly to help accomplish care tasks but was found monotonous, while surveillance was usual but restrictive, and prevented both the carers and those with dementia from doing things that they wished to do. Those with dementia were distressed by the denial of their former identities, such as car-driver or home-maker, and by being treated like children. Both the carers and the people with dementia had various ways of balancing custodial care, their intimate relationships and home-life, such as combining routines with other activities, evading surveillance or carrying it out by indirect means, and there were many attempts to maintain some semblance of former identities.

Download Full-text

Letters to the Editor

PEDIATRICS ◽

10.1542/peds.65.5.1055 ◽

1980 ◽

Vol 65 (5) ◽

pp. 1055-1055

Author(s):

Dorothy Kelly ◽

Daniel C. Shannon

Keyword(s):

Social Worker ◽

Monitoring Program ◽

Home Monitoring ◽

Medical Decision ◽

Community Resources ◽

Letters To The Editor ◽

At Home

We have now supervised 230 families who have monitored an infant at home and have gradually developed our hospital and home monitoring program in response to our families' needs. The hospital program begins once a medical decision has been reached that the infant requires continuous surveillance. It consists of: (1) Evaluation of the family's strengths and weaknesses by the pediatrician and social worker. (2) Determination of family and community resources available to support weaknesses and to provide relief services.

Download Full-text