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telemonitoring - Top 30 Publications

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.

Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions.

Telerehabilitation of Patients with Injuries of the Lower Extremities.

Timely access to orthopedic rehabilitation is an important problem for the Ukrainian healthcare system. The international orthopedic community aims to achieve the best possible outcome for patient care by modifying rehabilitation methods and using telemedicine technology. The theme of this article is to discuss the integration of telemedicine technology in the rehabilitation of patients with injuries of the lower extremities.

Cost-effectiveness of telehealthcare to patients with chronic obstructive pulmonary disease: results from the Danish 'TeleCare North' cluster-randomised trial.

To investigate the cost-effectiveness of a telehealthcare solution in addition to usual care compared with usual care.

Bluetooth Low Energy Peripheral Android Health App for Educational and Interoperability Testing Purposes.

Based on recent telemonitoring activities in Austria for enabling integrated health care, the communication interfaces between personal health devices (e.g. blood pressure monitor) and personal health gateway devices (e.g. smartphone, routing received information to wide area networks) play an important role. In order to ease testing of the Bluetooth Low Energy interface functionality of the personal health gateway devices, a personal health device simulator was developed. Based on specifications from the Bluetooth SIG a XML software test configuration file structure is defined that declares the specific features of the personal health devices simulated. Using this configuration file, different scenarios are defined, e.g. send a single measurement result from a blood pressure reading or sending multiple (historic) weight scale readings. The simulator is intended to be used for educational purposes in lectures, where the number of physical personal health devices can be reduced and learning can be improved. It could be shown that this simulator assists the development process of mHealth applications by reducing the time needed for development and testing.

Telemonitoring and Medical Care of Heart Failure Patients Supported by Left Ventricular Assist Devices - The Medolution Project.

Long-term survival after left ventricular assist device (LVAD) implantation in heart failure patients is mainly determined by a sophisticated after-care. Ambulatory visits only take place every 12 weeks. In case of life-threatening complications (pump thrombosis, driveline infection) this might lead to delayed diagnosis and delayed intervention. It is the intention of the international project Medolution (Medical care evolution) to develop new approaches in order to create best structures for telemonitoring of LVAD patients. In the very early period of the project a questionnaire was sent to 180 LVAD patients to evaluate the need and acceptance of telemonitoring. Thereafter, a graphical user interface (GUI) mockup was developed as one of the first steps to improve the continuous contact between the LVAD patient and the physician. As a final goal the Medolution project aims to bundle all relevant informations from different data sources into one platform in order to provide the physician a comprehensive overview of a patient's situation. In the systems background a big data analysis should run permanently and should try to detect abnormalities and correlations as well. At crucial events, a notification system should inform the physician and should provide the causing data via a decision support system. With this new system we are expecting early detection and prevention of common and partially life-threatening complications, less readmissions to the hospital, an increase in quality of life for the patients and less costs for the health care system as well.

Propose of Standards Based IT Architecture to Enrich the Value of Allergy Data by Telemonitoring Data.

Interoperability is a key requirement for any IT-System to be future proof and cost efficient, due to the increasing interaction of IT-Systems in Healthcare. This feasibility study is part of a larger project focusing on the conceptualization and evaluation of interoperable and modular IT-Framework components for exchanging big data information sets. Hence, this project investigates the applicability of a standard based IT-Architecture for the integration of Personal Health Devices data and open data sources. As a proof of concept use case, pollen forecast data from the Medical University of Vienna were combined with Personal Health Device data and a data correlation was investigated. The standards were identified as well as selected in expert's reviewed and the Architecture was designed based on a literature research. Subsequently the prototype was implemented and successfully tested in interoperability tests. The study shows that the architecture meets the requirements. It can be flexibly extended according to further requirements due to its generic setup. However, further extensions of the Interoperability-Connector and a full test setup needs to be realized in future.

Smartphone Applications for Hypertension Management: a Potential Game-Changer That Needs More Control.

This review article will summarize available data on mobile applications for the management of hypertension, by highlighting their potential for clinical use, the current limitations and the yet pending issues to be addressed in future studies.

Telehealthcare for patients suffering from chronic obstructive pulmonary disease: effects on health-related quality of life: results from the Danish 'TeleCare North' cluster-randomised trial.

To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD).

Safety Evaluation of an Automated Remote Monitoring System for Heart Failure in an Urban, Indigent Population.

Heart Failure (HF) is the most expensive preventable condition, regardless of patient ethnicity, race, socioeconomic status, sex, and insurance status. Remote telemonitoring with timely outpatient care can significantly reduce avoidable HF hospitalizations. Human outreach, the traditional method used for remote monitoring, is effective but costly. Automated systems can potentially provide positive clinical, fiscal, and satisfaction outcomes in chronic disease monitoring. The authors implemented a telephonic HF automated remote monitoring system that utilizes deterministic decision tree logic to identify patients who are at risk of clinical decompensation. This safety study evaluated the degree of clinical concordance between the automated system and traditional human monitoring. This study focused on a broad underserved population and demonstrated a safe, reliable, and inexpensive method of monitoring patients with HF.

The effects of increasing calcium channel blocker dose vs. adding a diuretic to treatment regimens for patients with uncontrolled hypertension.

In patients with insufficient blood pressure (BP) control, despite using a combination regimen containing an angiotensin receptor blocker and a calcium channel blocker (CCB), whether a greater dose of CCB or adding a diuretic is more effective at lowering BP remains unclear. We conducted a multicenter randomized clinical trial to compare the efficacy of switching from the daily administration of a single-pill fixed-dose combination of irbesartan (100 mg) and amlodipine (5 mg) to irbesartan (100 mg) with an increased dose of amlodipine (10 mg) (HD group, n=62) or irbesartan (100 mg) and amlodipine (5 mg) with 1 mg of indapamide (D group, n=63) in patients with poorly controlled hypertension. BP measured at home was monitored by a physician using a telemonitoring system. Between the HD and D groups, no significant differences were observed in morning home BP changes (mean reduction of systolic/diastolic BP, 1.7/0.9 mmHg; 95% confidence intervals, -2.4 to 5.7/-1.4 to 3.2; P=0.19/0.37), achievement rate of target BP (45.2% vs. 42.9%, P=0.80), BP variability independent of the mean (P⩾0.74), other variability indices (P⩾0.55) and time to stabilization, which was calculated using a fitted analysis (13.1 days vs. 11.4 days, P=0.99). Although a significant increase in serum uric acid was observed in the D group (P<0.0001), neither clinically relevant abnormal laboratory test results nor critical BP changes were observed throughout the trial period. Both antihypertensive drug combination strategies were effective treatment options. Further investigation is required to determine the appropriate use of both therapies based on the various pathologies associated with hypertension.Hypertension Research advance online publication, 27 April 2017; doi:10.1038/hr.2017.56.

Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use.

Recent evidence indicates that home telemonitoring of chronic patients reduces the use of healthcare resources. However, further studies exploring this issue are needed in primary care.

Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes.

We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existing Veterans Affairs (VA) telemedicine infrastructure. To refine the intervention and inform the delivery of the intervention in other settings, we examined participants' experiences.

An Intelligent Remote Monitoring System for Total Knee Arthroplasty Patients.

For the first six weeks following total knee arthroplasty (TKA), a patient will attend an outpatient clinic typically seen twice weekly. Here, an exercise regime is performed and improvement assessed using a hand held goniometer that measures the maximum angle of knee flexion, an important metric of progress. Additionally a series of daily exercises is performed at home, recorded in a diary. This protocol has problems. Patients must attend the hospital with assistance since they are not permitted to drive for six weeks following the procedure; appointments are sometimes missed; there are occasionally not enough physiotherapy appointment available; furthermore, it is difficult to be sure that patients are compliant with their exercises at home. The economic and social costs are therefore significant both to the patient and the health service. We describe here an automatic system that performs the monitoring of knee flexion within a domestic environment rather than in a hospital setting. It comprises a master and slave sensor unit that attach using Velcro straps to the thigh and shin above and below the operation wound. The patient performs the prescribed knee exercises whilst wearing the device, during which time it measures and records the angles of knee flexion. The device utilises the Global System for Mobile Communications (GSM) infrastructure to transmit data through the Internet to a secure hospital-based server using an on-board GSM modem. The clinician is then able to view and interpret the information from any computer with internet access and the software. The system does not require the patient to possess a mobile telephone, a computer, or have internet access; the necessary communications technology is completely integrated into the device.

Assessing the reliability of self-reported weight for the management of heart failure: application of fraud detection methods to a randomised trial of telemonitoring.

Since clinical management of heart failure relies on weights that are self-reported by the patient, errors in reporting will negatively impact the ability of health care professionals to offer timely and effective preventive care. Errors might often result from rounding, or more generally from individual preferences for numbers ending in certain digits, such as 0 or 5. We apply fraud detection methods to assess preferences for numbers ending in these digits in order to inform medical decision making.

Telemedicine is the way forward for the management of Cystic Fibrosis - the case in favour: The debate: Telemedicine is the future for CF care.

Despite rapid changes in Information and Communication Technology, outpatient chronic disease management has changed very little in decades. However, the introduction of Telemedicine defined here as the use of remote patient-centred clinical services including the use of video and audio connections, telemonitoring and mobile applications provides us with an ideal opportunity to revolutionise care. Its appeal in cystic fibrosis (CF) care is clear offering better access to services, the opportunity of earlier intervention and improved monitoring and self management through virtual clinics and the use of real-time applications for adherence monitoring. It has the potential to reduce costs and has been shown to be effective in other chronic disease conditions. There is a lack of good quality data in CF and studies are needed to provide supportive evidence. Nonetheless, it would seem that telemedicine is the future of CF care.

Cost-effectiveness of home telemonitoring in chronic kidney disease patients at different stages by a pragmatic randomized controlled trial (eNephro): rationale and study design.

Home telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study.

Telemonitoring in IVF/ICSI.

Traditionally, ovarian stimulation for IVF/intracytoplasmic sperm injection is performed by healthcare professionals, requiring the patient to make frequent visits to these centres. We describe the rationale, research findings and early clinical experience with home-based sonography for IVF patients.

The management of patients with chronic heart failure: the growing role of e-Health.

The increasing pandemic of heart failure is becoming a serious challenge for the health care system. The medical world is searching for solutions which could decrease its scale and improve patients' quality of life and prognosis. Telemanagement of heart failure patients is a new promising option. Technical and technological platforms to perform e-Health management in heart failure patients' homes have become available. This paper's aims are to present different forms of e-Health including telecare, home monitoring of cardiovascular implantable electronic devices, remote monitoring of hemodynamic implantable devices and telerehabilitation in providing optimal long term management for heart failure patients. Areas covered: E-education and self-monitoring, structured telephone support and telemonitoring, remote monitoring of cardiovascular implantable electronics devices and hemodynamic implantable electronic devices and telerehabilitation. Expert commentary: The data analyzed in the paper suggests that remote monitoring is capable of identifying life-threatening deterioration and helps heart failure patients avoid seeking medical assistance in hospitals and that home-based telerehabilitation is well accepted, safe, effective and has high adherence among HF patients.

Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System.

Medicare recently approved coverage of home telemonitoring for early detection of incident choroidal neovascularization (CNV) among patients with age-related macular degeneration (AMD), but no economic evaluation has yet assessed its cost-effectiveness and budgetary impact.

Home Telehealth Interventions for Older Adults With Diabetes.

The purpose of this literature review was to explore home telemedicine interventions for the treatment of older adults with diabetes. Eight databases were searched for articles published between 2011 and 2016, in the English language, and in peer-reviewed journals, resulting in 1,274 relevant articles. Following review against inclusion and exclusion criteria, six articles were retained. Studies included participants with a mean age from 68 to 76.8 years and from three different countries, with either Type 1 or Type 2 Diabetes Mellitus. The articles reviewed suggest that case management, education, closed-loop feedback and communication, home telemonitoring devices or units, and motivational interviewing or coaching can effectively decrease admissions, costs per person per year, mortality, and cognitive decline in older adults with diabetes. The scarcity of high-quality studies is consistent with findings from previous systematic reviews, and highlights the need for additional investigation before applying the results in practice.

Parental evaluation of a telemonitoring service for children with Type 1 Diabetes.

Introduction In the past years, we developed a telemonitoring service for young patients affected by Type 1 Diabetes. That service provides data to the clinical staff and offers an important tool to the parents, that are able to oversee in real time their children. The aim of this work was to analyze the parents' perceived usefulness of the service. Methods The service was tested by the parents of 31 children enrolled in a seven-day clinical trial during a summer camp. To study the parents' perception we proposed and analyzed two questionnaires. A baseline questionnaire focused on the daily management and implications of their children's diabetes, while a post-study one measured the perceived benefits of telemonitoring. Questionnaires also included free text comment spaces. Results Analysis of the baseline questionnaires underlined the parents' suffering and fatigue: 51% of total responses showed a negative tendency and the mean value of the perceived quality of life was 64.13 in a 0-100 scale. In the post-study questionnaires about half of the parents believed in a possible improvement adopting telemonitoring. Moreover, the foreseen improvement in quality of life was significant, increasing from 64.13 to 78.39 ( p-value = 0.0001). The analysis of free text comments highlighted an improvement in mood, and parents' commitment was also proved by their willingness to pay for the service (median = 200 euro/year). Discussion A high number of parents appreciated the telemonitoring service and were confident that it could improve communication with physicians as well as the family's own peace of mind.

Practical Insight to Monitor Home NIV in COPD Patients.

Home noninvasive ventilation (NIV) is used in COPD patients with concomitant chronic hypercapnic respiratory failure in order to correct nocturnal hypoventilation and improve sleep quality, quality of life, and survival. Monitoring of home NIV is needed to assess the effectiveness of ventilation and adherence to therapy, resolve potential adverse effects, reinforce patient knowledge, provide maintenance of the equipment, and readjust the ventilator settings according to the changing condition of the patient. Clinical monitoring is very informative. Anamnesis focuses on the improvement of nocturnal hypoventilation symptoms, sleep quality, and side effects of NIV. Side effects are major cause of intolerance. Screening side effects leads to modification of interface, gas humidification, or ventilator settings. Home care providers maintain ventilator and interface and educate patients for correct use. However, patient's education should be supervised by specialized clinicians. Blood gas measurement shows a significant decrease in PaCO2 when NIV is efficient. Analysis of ventilator data is very useful to assess daily use, unintentional leaks, upper airway obstruction, and patient ventilator synchrony. Nocturnal oximetry and capnography are additional monitoring tools to assess the impact of NIV on gas exchanges. In the near future, telemonitoring will reinforce and change the organization of home NIV for COPD patients.

Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies.

To summarise evidence about the effectiveness of home blood pressure telemonitoring (HBPT) and identify the key components of intervention. We comprehensively searched PubMed, EMBASE and the Cochrane Library for relevant studies. The authors were contacted for additional information. Two authors independently extracted the data and assessed the risk of bias. 46 randomised controlled trials including a total of 13 875 cases were identified. Compared with usual care, HBPT improved office systolic blood pressure (BP) and diastolic BP by 3.99 mm Hg (95% confidence interval (CI): 5.06-2.93; P<0.001) and 1.99 mm Hg (95% CI: -2.60 to -1.39; P<0.001), respectively. A larger proportion of patients achieved BP normalisation in the intervention group (relative risk (RR): 1.16; 95% CI: 1.08-1.25; P<0.001). For HBPT plus additional support (including counselling, education, behavioural management, medication management with decision, adherence contracts and so on) versus HBPT alone (or plus less intense additional support), the mean changes in systolic and diastolic BP were 2.44 mm Hg (95% Cl, 4.88 to 0.00 mm Hg; P=0.05) and 1.12 mm Hg (95% CI, -2.34 to 0.1 mm Hg; P=0.07), respectively. For those surrogate outcomes, low-strength evidence failed to show difference. In subgroup analysis, high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel. HBPT can improve BP control in the hypertensive patients. It may be more efficacious when a proactive additional support is provided during the intervention process.Journal of Human Hypertension advance online publication, 23 March 2017; doi:10.1038/jhh.2016.99.

Continuity of Care to Prevent Readmissions for Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Readmissions of patients with chronic obstructive pulmonary disease (COPD) to hospitals cast a heavy burden to health care systems. This meta-analysis was aimed to assess the efficacy of continuity of care as interventions, which reduced readmission and mortality rates of such patients. PubMed, Cochrane Library and Embase were searched for articles published before July 2015. A total of 31 reports with randomized controlled trials (RCTs) were finally included in this meta-analysis. The results showed that health education reduced all-cause readmission at 3 months. In addition, health education, comprehensive nursing intervention (CNI) and telemonitoring reduced all-cause readmissions over 6-12 months, and the effect of CNI was best because CNI also reduced COPD-specific readmissions. Home visits also reduced COPD-specific readmissions (the quality more than moderate), but it did not reduce the risk for all-cause readmissions (risk ratios (RRs), 0.92 [95% CI, 0.82-1.04]; moderate quality). There was no statistically significant difference in reducing mortality and quality of life (QOL) among various continued cares. In conclusion, CNI, telemonitoring, health education and home visits should receive more consideration than other interventions by caregivers seeking to implement continued care interventions for patients with COPD.

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review.

Background: This paper explores telemonitoring/mhealth approaches as a promising real time and contextual strategy in overhauling HIV and TB interventions quality access and uptake, retention,adherence and coverage impact in endemic and prone-epidemic prevention and control in sub-Sahara Africa. Methods: The scoping review method was applied in acknowledged journals indexing platforms including Medline, Embase, Global Health, PubMed, MeSH PsycInfo, Scopus and Google Scholar to identify relevant articles pertaining to telemonitoring as a proxy surrogate method in reinforcing sustainability of HIV/TB prevention/treatment interventions in sub-Saharan Africa. Full papers were assessed and those selected that fosters evidence on telemonitoring/mhealth diagnosis, treatment approaches and strategies in HIV and TB prevention and control were synthesized and analyzed. Results: We found telemonitoring/mhealth approach as a more efficient and sustained proxy in HIV and TB risk reduction strategies for early diagnosis and prompt quality clinical outcomes. It can significantly contribute to decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Improved integrated HIV and TB telemonitoring systems sustainability hold great promise in health systems strengthening including patient centered early diagnosis and care delivery systems, uptake and retention to medications/services and improving patients' survival and quality of life. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging)acceptability, access and uptake are crucial in monitoring and improving uptake, retention,adherence and coverage in both local and national integrated HIV and TB programs and interventions. Moreover, telemonitoring is crucial in patient-providers-health professional partnership, real-time quality care and service delivery, antiretroviral and anti-tuberculous drugs improvement, susceptibility monitoring and prescription choice, reinforcing cost effective HIV and TB integrated therapy model and survival rate.

Advances in heart failure: a review of biomarkers, emerging pharmacological therapies, durable mechanical support and telemonitoring.

The purpose of this review is to provide an overview of diagnosis, prognosis and management of heart failure (HF) with reduced ejection fraction (HFrEF). Specifically, this review is divided into three sections. The first section will address biomarkers. The discovery of biomarkers has allowed further understanding of the pathophysiology of HF and provides insight into potential therapeutic targets. This review will focus on novel applications of natriuretic peptides (NPs) in clinical trials. Next, emerging biomarkers of HF, such as ST2, galectin-3 and copeptin, will be discussed. The second section aims to highlight HF therapies, including novel drugs and durable devices. The last section will review home haemodynamic monitoring and mobile health. We aim to provide context for the understanding of novel diagnostic and therapeutic advances in HF that are still in phase II or III trials, and have yet to become widely available.

Remote Monitoring in Heart Failure: the Current State.

The treatment of congestive heart failure is an expensive undertaking with much of this cost occurring as a result of hospitalization. It is not surprising that many remote monitoring strategies have been developed to help patients maintain clinical stability by avoiding congestion. Most of these have failed. It seems very unlikely that these failures were the result of any one underlying false assumption but rather from the fact that heart failure is a progressive, deadly disease and that human behavior is hard to modify. One lesson that does stand out from the myriad of methods to detect congestion is that surrogates of congestion, such as weight and impedance, are not reliable or actionable enough to influence outcomes. Too many factors influence these surrogates to successfully and confidently use them to affect HF hospitalization. Surrogates are often attractive because they can be inexpensively measured and followed. They are, however, indirect estimations of congestion, and due to the lack specificity, the time and expense expended affecting the surrogate do not provide enough benefit to warrant its use. We know that high filling pressures cause transudation of fluid into tissues and that pulmonary edema and peripheral edema drive patients to seek medical assistance. Direct measurement of these filling pressures appears to be the sole remote monitoring modality that shows a benefit in altering the course of the disease in these patients. Congestive heart failure is such a serious problem and the consequences of hospitalization so onerous in terms of patient well-being and costs to society that actual hemodynamic monitoring, despite its costs, is beneficial in carefully selected high-risk patients. Those patients who benefit are ones with a prior hospitalization and ongoing New York Heart Association (NYHA) class III symptoms. Patients with NYHA class I and II symptoms do not require hemodynamic monitoring because they largely have normal hemodynamics. Those with NYHA class IV symptoms do not benefit because their hemodynamics are so deranged that they cannot be substantially altered except by mechanical circulatory support or heart transplantation. Finally, hemodynamic monitoring offers substantial hope to those patients with normal ejection fraction (EF) heart failure, a large group for whom medical therapy has largely been a failure. These patients have not benefited from the neurohormonal revolution that improved the lives of their brothers and sisters with reduced ejection fractions. Hemodynamic stabilization improves the condition of both but more so of the normal EF cohort. This is an important observation that will help us design future trials for the 50% of heart failure patients with normal systolic function.

The effects of short-term omission of daily medication on the pathophysiology of heart failure.

Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP.

Wearable Pulse Oximetry Measurements on the Torso, Arms, and Legs: A Proof of Concept.

For decades pulse oximeters designed for use on the head, hands, or feet have provided invaluable estimates of oxygen saturation to medical personal attending to combat casualties. However, traditional placement sites are not ideal for the relatively new paradigm of continuous battlefield telemonitoring. To assess the feasibility of oximetry on nontraditional body sites, 42 healthy volunteers were enrolled, consented, and underwent an industry standard induced-hypoxia study. During the study volunteers used prototype wearable oximeters, designed for the torso, arms, and legs. Subsets (size n) of the volunteers had the wearables placed at the following body sites, and achieved accuracies (ARMS, root-mean-square difference) of the following: calf 1.7% (n = 26); bicep 3.1% (n = 12); forearm 3.4% (n = 11); pectoral 2.9% (n = 42); sternum 2.9% (n = 13). In keeping with regulatory guidance calibrations with an ARMS of less than 3.5% are acceptable for potential future development. Additionally, a new method was developed to enable accurate reporting of respiration rate from the pectoral oximeter, ARMS of 1.1 breaths per minute (n = 10). This study demonstrates the feasibility of monitoring oxygen saturation and respiration rate from nontraditional sites via a wearable pulse oximeter.

Home Blood Pressure Telemonitoring: Rationale for Use, Required Elements, and Barriers to Implementation in Canada.

Contemporary hypertension guidelines strongly endorse the use of home blood pressure (BP) monitoring for hypertension diagnosis and management. However, barriers exist that prevent optimal use of home BP measurements. Patients might not follow the recommended home BP measurement protocol, might not take the required number of readings, and/or might report only selected readings to their providers. Providers might not calculate the mean (used for clinical decision-making) and/or incorporate home BP measurements into the medical record. Use of home BP telemonitoring, defined as the process by which home BP readings are securely teletransmitted and summarized within a health care portal or electronic medical record for provider use, might overcome these barriers. Telemonitoring, especially when combined with protocolized case management, leads to statistically significant and clinically important BP reductions, and improvements in overall BP control. Despite evidence supporting its use, home BP telemonitoring is not widely used in Canada. Barriers to adoption can be classified as structural and financial. Although technological advancements have made telemonitoring highly feasible, infrastructure is lacking, and implementation remains a challenge; this is especially true with respect to creating simple and cost-effective systems that are user-friendly and acceptable to patients as well as to providers. Ensuring data security is crucial to successful implementation, as is developing appropriate reimbursement models for providers. If these barriers can be overcome, home BP telemonitoring has the potential to make care provision easier and more convenient for patients and providers, while improving BP control in Canadians with hypertension.