scholarly journals Results of the “GER-e-TEC” Experiment Involving the Use of an Automated Platform to Detect the Exacerbation of Geriatric Syndromes

2020 ◽  
Vol 9 (12) ◽  
pp. 3836
Author(s):  
Abrar-Ahmad Zulfiqar ◽  
Orianne Vaudelle ◽  
Mohamed Hajjam ◽  
Bernard Geny ◽  
Samy Talha ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Patient Group ◽  
Decompensated Heart Failure ◽  
University Hospital ◽  
Physiological Data ◽  
Geriatric Syndromes ◽  
Telemedicine System ◽  
Predictive Values ◽  
Automated Platform ◽  
Analysis System

Introduction: Telemedicine is believed to be helpful in managing patients suffering from chronic diseases, in particular elderly patients with numerous accompanying conditions. This was the basis for the “GERIATRICS and e-Technology (GER-e-TEC) study”, which was an experiment involving the use of the smart MyPredi™ e-platform to automatically detect the exacerbation of geriatric syndromes. Methods: The MyPredi™ platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. These alerts are issued in the event that the health of a patient deteriorates due to an exacerbation of their chronic diseases. An experiment was conducted between 24 September 2019 and 24 November 2019 to test this alert system. During this time, the platform was used on patients being monitored in an internal medicine unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, and positive and negative predictive values with respect to clinical data. The results of the experiment are provided below. Results: A total of 36 patients were monitored remotely, 21 of whom were male. The mean age of the patients was 81.4 years. The patients used the telemedicine solution for an average of 22.1 days. The telemedicine solution took a total of 147,703 measurements while monitoring the geriatric risks of the entire patient group. An average of 226 measurements were taken per patient per day. The telemedicine solution generated a total of 1611 alerts while assessing the geriatric risks of the entire patient group. For each geriatric risk, an average of 45 alerts were emitted per patient, with 16 of these alerts classified as “low”, 12 classified as “medium”, and 20 classified as “critical”. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts had an impact on the duration of hospitalization due to decompensated heart failure, a deterioration in the general condition, and other reasons. Conclusion: The MyPredi™ telemedicine system allows the generation of automatic, non-intrusive alerts when the health of a patient deteriorates due to risks associated with geriatric syndromes.

scholarly journals Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results

2021 ◽  
Vol 12 ◽  
Author(s):  
Abrar-Ahmad Zulfiqar ◽  
Delwende Noaga Damien Massimbo ◽  
Mohamed Hajjam ◽  
Bernard Gény ◽  
Samy Talha ◽  
...  
Keyword(s):  
New Technologies ◽  
Monitoring Program ◽  
University Hospital ◽  
Physiological Data ◽  
Diabetic Patients ◽  
Predictive Values ◽  
Preliminary Results ◽  
And Gender ◽  
Analysis System ◽  
Disorder Risk

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. This was the basis for the “GER-e-TEC COVID study,” an experiment involving the use of the smart MyPrediTM e-platform to automatically detect the exacerbation of glycemic disorder risk in COVID-19 older diabetic patients.Methods: The MyPrediTM platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. An experiment was conducted between December 14th, 2020 and February 25th, 2021 to test this alert system. During this time, the platform was used on COVID-19 patients being monitored in an internal medicine COVID-19 unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, positive and negative predictive values with respect to clinical data.Results: 10 older diabetic COVID-19 patients in total were monitored remotely, six of whom were male. The mean age of the patients was 84.1 years. The patients used the telemedicine solution for an average of 14.5 days. 142 alerts were emitted for the glycemic disorder risk indicating hyperglycemia, with an average of 20.3 alerts per patient and a standard deviation of 26.6. In our study, we did not note any hypoglycemia, so the system emitted any alerts. For the sensitivity of alerts emitted, the results were extremely satisfactory, and also in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts and gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (COVID-19 management).Conclusion: This work is a pilot study with preliminary results. To date, relatively few projects and trials in diabetic patients have been run within the “telemedicine 2.0” setting, particularly using AI, ICT and the Web 2.0 in the era of COVID-19 disease.

scholarly journals Results of the Second Phase of the GER-e-TEC Experiment Concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes

2021 ◽  
Vol 11 (11) ◽  
pp. 1117
Author(s):  
Abrar-Ahmad Zulfiqar ◽  
Delwende Noaga Damien Massimbo ◽  
Mohamed Hajjam ◽  
Bernard Geny ◽  
Samy Talha ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Patient Group ◽  
New Technologies ◽  
Economic Damage ◽  
Second Phase ◽  
Geriatric Syndromes ◽  
Telemedicine System ◽  
Predictive Values ◽  
Female Ratio

Background: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the “GER-e-TEC COVID study”. Methods: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. Results: 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1. 11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. Conclusion: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes.

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

scholarly journals Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

2007 ◽  
Vol 125 (6) ◽  
pp. 338-342 ◽  
Author(s):  
Camila Toffoli Ribeiro ◽  
Júlio César Rosa-e-Silva ◽  
Marcos Felipe Silva-de-Sá ◽  
Ana Carolina Japur de Sá Rosa-e-Silva ◽  
Omero Benedicto Poli Neto ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Standard Procedure ◽  
University Hospital ◽  
Histopathological Analysis ◽  
Benign Lesions ◽  
Predictive Values ◽  
Asymptomatic Patients ◽  
Cavity Design ◽  
Diagnostic Hysteroscopy ◽  
Sensitivity Specificity

CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

scholarly journals STRATEGIES OF FAMILIES IN THE CARE OF CHILDREN WITH CHRONIC DISEASES

2015 ◽  
Vol 24 (3) ◽  
pp. 662-669 ◽  
Author(s):  
Marli dos Santos Salvador ◽  
Giovana Calcagno Gomes ◽  
Pâmela Kath de Oliveira ◽  
Vera Lúcia de Oliveira Gomes ◽  
Josefine Busanello ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Qualitative Approach ◽  
University Hospital ◽  
Support Network ◽  
Exploratory Research ◽  
Work Study ◽  
Positive Coping ◽  
Care Seek ◽  
The Family ◽  
South Of Brazil

ABSTRACTthis study aimed to know the strategies of families in the care of children with chronic diseases. A descriptive and exploratory research was carried out using a qualitative approach, in a Pediatric Unit of a university hospital in the south of Brazil, during the first and second halves of 2013. The study involved 15 participating families. Data were collected by means of interviews subjected to thematic analysis. It was identified as strategies: balance work, study and care, share tasks throughout the day, adapt the physical area of the house, engage the child in their own care, seek resources in the network of social support and faith, seek assistance in another city; and engage in physical activity to reduce stress. It was concluded that it is necessary that the nurses participate of the family support network, as a support source for the strengthening of the family to the care, acquiring skills and expertise to a positive coping of the child's chronic disease.

scholarly journals Excess fluid volume: clinical validation in patients with decompensated heart failure

2011 ◽  
Vol 19 (3) ◽  
pp. 540-547 ◽  
Author(s):  
Quenia Camille Soares Martins ◽  
Graziella Badin Aliti ◽  
Joelza Chisté Linhares ◽  
Eneida Rejane Rabelo
Keyword(s):  
Heart Failure ◽  
Jugular Vein ◽  
Venous Pressure ◽  
Decompensated Heart Failure ◽  
Cross Sectional Study ◽  
Fluid Volume ◽  
University Hospital ◽  
Central Venous ◽  
Cross Sectional ◽  
Nursing Diagnosis

This cross-sectional study aimed to clinically validate the defining characteristics of the Nursing Diagnosis Excess Fluid Volume in patients with decompensated heart failure. The validation model used follows the model of Fehring. The subjects were 32 patients at a university hospital in Rio Grande do Sul. The average age was 60.5 ± 14.3 years old. The defining characteristics with higher reliability index (R): R ≥ 0.80 were: dyspnea, orthopnea, edema, positive hepatojugular reflex, paroxysmal nocturnal dyspnea, pulmonary congestion and elevated central venous pressure, and minor or secondary, R> 0.50 to 0.79: weight gain, hepatomegaly, jugular vein distention, crackles, oliguria, decreased hematocrit and hemoglobin. This study indicates that the defining characteristics with R> 0.50 and 1 were validated for the diagnosis Excess Fluid Volume.

scholarly journals Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population / Kardioemboliska Cerebrāla Infarkta Primārās un Sekundārās Profilakses Problēmas Latvijā

2015 ◽  
Vol 69 (5) ◽  
pp. 199-204
Author(s):  
Kristaps Jurjāns ◽  
Santa Sabeļnikova ◽  
Evija Miglāne ◽  
Baiba Luriņa ◽  
Oskars Kalējs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Patient Group ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Cardioembolic Stroke ◽  
University Hospital ◽  
Primary And Secondary Prevention ◽  
Stroke Patients ◽  
Very High

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

scholarly journals The diagnosis of delirium in 80 emergency unit patients

1998 ◽  
Vol 56 (2) ◽  
pp. 176-183
Author(s):  
AFONSO CARLOS NEVES ◽  
RICARDO DE CASTRO CINTRA SESSO ◽  
HENRIQUE BALLALAI FERRAZ ◽  
SÍLVIO FRANCISCO ◽  
JOÃO BAPTISTA DOS REIS-FILHO
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
University Hospital ◽  
Emergency Unit ◽  
Predictive Values ◽  
Kappa Test ◽  
History Of ◽  
Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

scholarly journals A novel telerehabilitation with educational program for caregivers using telelecture is a feasible procedure for fall prevention in elderly people – A pilot study

2020 ◽  
Author(s):  
Kentaro Moriichi ◽  
Mikihiro Fujiya ◽  
Takanori Ro ◽  
Tetsuo Ota ◽  
Hitomi Nishimiya ◽  
...  
Keyword(s):  
Elderly People ◽  
Fall Prevention ◽  
Educational Program ◽  
Medical Information ◽  
The Elderly ◽  
Berg Balance Scale ◽  
University Hospital ◽  
Telemedicine System ◽  
Before And After ◽  
Clinical Trials Registry

Abstract Background: The importance of fall prevention rehabilitations has been well recognized. Recently, telerehabilitation was developed, however, there have been no reports on the use of telerehabilitation with direct support from specialists for fall prevention among the elderly. We herein reported telerehabilitation by carers educated by our novel educational program.Methods: Nine elderly people in two nursing homes were enrolled using our original criteria. Carers are educated with our educational program using telelecture system. Telerehabilitation was performed by carers following the instruction from rehabilitation specialists in Asahikawa Medical University using the telemedicine system every 2-4 weeks for three months. Carers were assessed with our original questionnaire before and after the telelecture. Berg Balance Scale (BBS), Timed Up & Go test (TUG test), Hand-held dynamometer (HHD) and Mini-Mental State Examination (MMSE) were assessed before and after telerehabilitation.Results: The average number of times to perform telerehabilitation in all institutes was 4.7. Levels of understanding of carers were significantly increased after the telelecture. No adverse event occurred during the study period. Median BBSs before and three months after telerehabilitation were 43 and 49, respectively. Those of TUG test, right and left HHD and MMSE were 17.89 and 18.53, 7.95 and 11.55, 9.85 and 13.20, and 16 and 19, respectively. All results were improved after telerehabilitation.Conclusions: Our telerehabilitation program exhibited significant effects in elderly people as well as levels of understanding rehabilitation of caregivers in the facilities for the elderly people safely.Trial registration: University Hospital Medical Information Network Clinical Trials Registry（UMIN-CTR）UMIN000041439, August 17th, 2020

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

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