A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

telemonitoring - Top 30 Publications

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.

Mobile Device-Based Electronic Data Capture System Used in a Clinical Randomized Controlled Trial: Advantages and Challenges.

Electronic data capture (EDC) systems have been widely used in clinical research, but mobile device-based electronic data capture (mEDC) system has not been well evaluated.

Exacerbations in Chronic Obstructive Pulmonary Disease: Identification and Prediction Using a Digital Health System.

Chronic obstructive pulmonary disease (COPD) is a progressive, chronic respiratory disease with a significant socioeconomic burden. Exacerbations, the sudden and sustained worsening of symptoms, can lead to hospitalization and reduce quality of life. Major limitations of previous telemonitoring interventions for COPD include low compliance, lack of consensus on what constitutes an exacerbation, limited numbers of patients, and short monitoring periods. We developed a telemonitoring system based on a digital health platform that was used to collect data from the 1-year EDGE (Self Management and Support Programme) COPD clinical trial aiming at daily monitoring in a heterogeneous group of patients with moderate to severe COPD.

Detection of different types of noise in lung sounds.

Lung sound signal processing has proven to be a great improvement to the traditional acoustic interpretation of lung sounds. However, that analysis can be seriously hindered by the presence of different types of noise originated in the acquisition environment or caused by physiological processes. Consequently, the diagnostic accuracy of pulmonary diseases can be severely affected, especially if the implementation of telemonitoring systems is considered. The present study is focused on the implementation of an algorithm able to identify noisy periods, either voluntarily (vocalizations, chest movement and background voices) or involuntarily produced during acquisitions of lung sounds. The developed approach also had to deal with the presence of simulated cough events, that carry important diagnostic information regarding several pulmonary diseases. Features such as Katz fractal dimension, Teager-Kaiser energy operator and normalized mutual information, were extracted from the time domain of healthy and a pathological lung signals. Noise detection was the result of a good discrimination between uncontaminated lung sounds and both cough and noise episodes and a slightly worse classification of cough events. In fact, detection of cough periods carrying diagnostic information was influenced by the presence of two other types of noise having similar signal characteristics.

Efficient compressive sensing of ECG segments based on machine learning for QRS-based arrhythmia detection.

A novel method for efficient telemonitoring of arrhythmia based on using QRS complexes is proposed. Two features, namely, sum of absolute differences (SAD) and maximum of absolute differences (MAD) are efficiently computed for each ECG segment in the bio-sensor. The computed features can be transmitted from the bio-sensor using wireless channel, and they can be used in the receiver for determining the absence of QRS complex in the segment. By avoiding computationally expensive signal reconstruction for the ECG segments without QRS complex, it is shown, using simulation results, that computation time can be reduced by approximately 7.4% for long-term telemonitoring of QRS-based arrhythmia. Detection of the absence of QRS complex can be carried out in around 7 milliseconds in a standard laptop computer with 2.2GHz processor and 8GB RAM.

e-Health prototype system for cardiac telemonitoring.

This paper presents the approach of an e-health system for cardiac telemonitoring which uses the development board LinkIt ONE as a monitoring system. Such board was adapted to measure the cardiac pulse, analyze it and determine whether a person is having a cardiac arrhythmia or not. When an arrhythmia appears, the prototype activates an alarm in order to report the patient's condition and its location to a caregiver or a close healthcare center. The data of the cardiac pulse is originated in an e-health sensor platform connected to an Arduino. Location data comes from a GPS module in the aforementioned board which is connected by WiFi with the virtual platform UBIDOTS. It provides visual information about the variables measured, the patient's location and the alarms; keeping the patient's caregiver or the healthcare center constantly informed.

A telemonitoring platform for the investigation of blood pressure profiles in pacemaker patients.

Rate responsive pacemakers (PM) use different strategies to adapt the patient paced rate, with the aim of having the best hemodynamic performance in response to internal or external conditions. Closed-loop stimulation (CLS) uses intracardiac impedance as a sensor principle. The evaluation of impact of different pacing modalities and technologies on the blood pressure (BP) profiles is mainly investigated in short-term laboratory settings, mainly due to the need of reliable daily-based BP values. The impact of CLS pacing on systemic blood pressure (BP) has been studied on short term basis, but data on long term effects are scarse. This study present a telemedicine platform designed for evaluating the effect of the rate responsive technology on daily systolic and diastolic BP data. BP and pacemaker data were collected daily from fourteen patients during a 3 month period. The total number of monitoring days was 1277 (91 day/patient), for a total number of 4455 BP measures. On average 3.5 measure/day/patient were received). The analysis of the BP data showed that CLS pacing results in diastolic pressure closer to the normal values than accelerometer-based pacing, which were associated to lower diastolic pressures.

Analysis of Machine Learning Techniques for Heart Failure Readmissions.

The current ability to predict readmissions in patients with heart failure is modest at best. It is unclear whether machine learning techniques that address higher dimensional, nonlinear relationships among variables would enhance prediction. We sought to compare the effectiveness of several machine learning algorithms for predicting readmissions.

Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews.

Diabetes is a common chronic disease that places an unprecedented strain on health care systems worldwide. Mobile health technologies such as smartphones, mobile applications, and wearable devices, known as mHealth, offer significant and innovative opportunities for improving patient to provider communication and self-management of diabetes.

Effects of hybrid comprehensive cardiac telerehabilitation conducted under the pension prevention program of the Social Insurance Institution.

The Polish Social Insurance Institution (SII), under its pension prevention initiative, has taken measures to support the patients return to work and thus developed a new model of hybrid, comprehensive, cardiac telerehabilitation (HCCT). The aim of the study was to analyze the effects of HCCT in terms of its acceptance, adherence to and influence on patients' physical capacity and ability to return to work.

Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis.

To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF).

Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders.

The use of telemonitoring in the care of patients with Sleep-related Breathing Disorders (SBD) can enhance medical support significantly. Telemonitoring aims at helping physicians to detect therapy problems early and thus improve patients' therapy adherence. Diagnostics and therapy decisions in the telemonitoring process nevertheless remain the responsibility of sleep specialists. The selection of data monitored, their evaluation and resulting consequences fall to the physician, who makes decisions and prescribes therapy in consultation with the patient. In light of professional legal and ethical requirements, it must be ensured that the extensive changes to the process flow in sleep medicine are designed in a way to guarantee high-quality patient care. In this position paper, the German Sleep Society, the German Respiratory Society, the Association of Pneumological Hospitals and the Federal Association of German Pneumologists comment on important aspects for implementation of telemonitoring for SRBD and describe the basic conditions required for its use.

Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme.

There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. home telemonitoring (HTM) to monitor patient's symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise, and stress) and to establish which variations affect weight, blood pressure, and heart rate.

Remote Monitoring to Reduce Heart Failure Readmissions.

Rehospitalization for heart failure remains a challenge in the treatment of affected patients. The ability to remotely monitor patients for worsening heart failure may provide an avenue through which therapeutic interventions can be made to prevent a rehospitalization. Available data on remote monitoring to reduce heart failure rehospitalizations are reviewed within.

Telemedicine in chronic obstructive pulmonary disease.

Telemedicine is a medical application of advanced technology to disease management. This modality may provide benefits also to patients with chronic obstructive pulmonary disease (COPD). Different devices and systems are used. The legal problems associated with telemedicine are still controversial. Economic advantages for healthcare systems, though potentially high, are still poorly investigated. A European Respiratory Society Task Force has defined indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of COPD patients including those undergoing home mechanical ventilation.

Telemonitoring and/or self-monitoring of blood pressure in hypertension (TASMINH4): protocol for a randomised controlled trial.

Self-monitoring of hypertension is associated with lower systolic blood pressure (SBP). However, evidence for the use of self-monitoring to titrate antihypertensive medication by physicians is equivocal. Furthermore, there is some evidence for the efficacy of telemonitoring in the management of hypertension but it is not clear what this adds over and above self-monitoring. This trial aims to evaluate whether GP led antihypertensive titration using self-monitoring results in lower SBP compared to usual care and whether telemonitoring adds anything to self-monitoring alone.

Transforming Gastroenterology Care With Telemedicine.

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy.

Moving Beyond the Walls of the Clinic: Opportunities and Challenges to the Future of Telehealth in Heart Failure.

Telehealth offers an innovative approach to improve heart failure care that expands beyond traditional management strategies. Yet the use of telehealth in heart failure is infrequent because of several obstacles. Fundamentally, the evidence is inconsistent across studies of telehealth interventions in heart failure, which limits the ability of cardiologists to make general conclusions. Where encouraging evidence exists, there are logistical challenges to broad-scale implementation as a result of insufficient understanding of how to transform telemedicine strategies into clinical practice effectively. Ultimately, when implementation is reasonable, the application of these efforts remains hampered by regulatory, reimbursement, and other policy issues. The primary aim of this paper is to describe these challenges and to outline a path forward to apply telehealth approaches to heart failure in conjunction with payment reform and pragmatic research study design.

Home-Telemonitoring Lung Cancer Intervention in Appalachia: A Pilot Study.

Benefits of home-telemonitoring for rural dwelling cancer patients are largely unknown. This study examined the effectiveness of home-telemonitoring surveillance with nurse coaching for self-management to improve lung cancer outcomes in mountainous Appalachia where health care access/ service is limited. This randomized clinical trial pilot study compared patient outcomes for telemonitoring versus routine care. A convenience sample (N = 47) was enrolled/ randomized (Telemonitored: 26/ Control: 21) from a university hospital and cancer center. Physiologic parameters and symptoms were collected in the telemonitored group for two weeks; all participants were studied for 60 days after the index treatment/ discharge. The telemonitored group showed greater improvement for both functional status (Wald X(2) = 3.78, p = .05) and quality of life (QOL) (Wald X(2) = 7.25, p = .007) from baseline to 60 days post-discharge. Compared to controls, telemonitored patients survived longer; had more scheduled medical visits (96% vs. 75%); made more unplanned calls to doctors/ nurses (32% vs. 30% & 64% vs. 50%); had fewer rehospitalizations (28% vs. 40%); and had more ER utilization (36% vs. 30%). The telemonitored group had relative improvements for health utility (.09 on a scale where 0 = death/ 1= perfect health) and QOL (15 on 0-100 VAS). Differences in health care utilization and cost were not significantly different (p > .05), likely due to the sample size. Telemonitoring group satisfaction with care was high and recommended by patients and caregivers. Results suggest that it is possible to improve patient outcomes with home-telemonitoring for self-management in rural areas. Short-term, telemonitoring-based coaching is feasible and offers a promising option to develop patient self-management knowledge and skills.

Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but treatment compliance is often unsatisfactory. This study investigated the efficacy and cost-effectiveness of telemonitoring for improving CPAP compliance.100 newly diagnosed OSA patients requiring CPAP (apnoea-hypopnoea index >15 events·h(-1)) were randomised to standard management or a telemonitoring programme that collected daily information about compliance, air leaks and residual respiratory events, and initiated patient contact to resolve issues. Clinical/anthropometric variables, daytime sleepiness and quality of life were recorded at baseline and after 3 months. Patient satisfaction, additional visits/calls, side-effects and total costs were assessed.There were no significant differences between the standard and telemedicine groups in terms of CPAP compliance (4.9±2.2 versus 5.1±2.1 h·night(-1)), symptoms, clinical variables, quality of life and unwanted effects. Telemedicine was less expensive than standard management (EUR123.65 versus EUR170.97; p=0.022) and was cost-effective (incremental cost-effectiveness ratio EUR17 358.65 per quality-adjusted life-year gained). Overall patient satisfaction was high, but significantly more patients rated satisfaction as high/very high in the standard management versus telemedicine group (96% versus 74%; p=0.034).Telemonitoring did not improve CPAP treatment compliance and was associated with lower patient satisfaction. However, it was more cost-effective than traditional follow-up.

The cost-effectiveness of real-time pulmonary artery pressure monitoring in heart failure patients: a European perspective.

Heart failure (HF) treatment guided by physicians with access to real-time pressure measurement from a wireless implantable pulmonary artery pressure (PAP) sensor (CardioMEMS), has previously been shown to reduce HF-related hospital admissions in the CHAMPION trial. However, uncertainty remains regarding the value of CardioMEMS in European health systems where healthcare costs are significantly lower than in the USA.

A place for Apnea Hypopnea Index telemonitoring in preventing heart failure exacerbation?

Throughput assurance of wireless body area networks coexistence based on stochastic geometry.

Wireless body area networks (WBANs) are expected to influence the traditional medical model by assisting caretakers with health telemonitoring. Within WBANs, the transmit power of the nodes should be as small as possible owing to their limited energy capacity but should be sufficiently large to guarantee the quality of the signal at the receiving nodes. When multiple WBANs coexist in a small area, the communication reliability and overall throughput can be seriously affected due to resource competition and interference. We show that the total network throughput largely depends on the WBANs distribution density (λp), transmit power of their nodes (Pt), and their carrier-sensing threshold (γ). Using stochastic geometry, a joint carrier-sensing threshold and power control strategy is proposed to meet the demand of coexisting WBANs based on the IEEE 802.15.4 standard. Given different network distributions and carrier-sensing thresholds, the proposed strategy derives a minimum transmit power according to varying surrounding environment. We obtain expressions for transmission success probability and throughput adopting this strategy. Using numerical examples, we show that joint carrier-sensing thresholds and transmit power strategy can effectively improve the overall system throughput and reduce interference. Additionally, this paper studies the effects of a guard zone on the throughput using a Matern hard-core point process (HCPP) type II model. Theoretical analysis and simulation results show that the HCPP model can increase the success probability and throughput of networks.

Telemedical Care and Monitoring for Patients with Chronic Heart Failure Has a Positive Effect on Survival.

Telemedical care and monitoring programs for patients with chronic heart failure have shown beneficial effects on survival in several small studies. The utility in routine care remains unclear.