1
|
Wellmann N, Marc MS, Stoicescu ER, Pescaru CC, Trusculescu AA, Martis FG, Ciortea I, Crisan AF, Balica MA, Velescu DR, Fira-Mladinescu O. Enhancing Adult Asthma Management: A Review on the Utility of Remote Home Spirometry and Mobile Applications. J Pers Med 2024; 14:852. [PMID: 39202043 PMCID: PMC11355136 DOI: 10.3390/jpm14080852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
Asthma is a prevalent chronic disease, contributing significantly to the global burden of disease and economic costs. Despite advances in treatment, inadequate disease management and reliance on reliever medications lead to preventable deaths. Telemedicine, defined as the use of information and communication technology to improve healthcare access, has gained global attention, especially during the COVID-19 pandemic. This systematic review examines the effectiveness of home monitoring systems in managing severe asthma. A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library, focusing on studies from 2014 to 2024. Fourteen studies involving 9093 patients were analyzed. The results indicate that telemedicine, through tools such as mobile applications and portable spirometers, positively impacts asthma control, self-management, and quality of life. Home spirometry, in particular, shows strong agreement with clinic spirometry, offering a feasible alternative for continuous monitoring. Digital coaching and machine learning-based telemedicine applications also demonstrate significant potential in improving asthma outcomes. However, challenges such as technology accessibility, data privacy, and the need for standardized protocols remain. This review highlights the promise of telemedicine in asthma management and calls for further research to optimize its implementation and address existing barriers.
Collapse
Affiliation(s)
- Norbert Wellmann
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Monica Steluta Marc
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Emil Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Radiology and Medical Imaging University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ana Adriana Trusculescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Flavia Gabriela Martis
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Ioana Ciortea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Madalina Alexandra Balica
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Infectious Diseases University Clinic, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Raluca Velescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| |
Collapse
|
2
|
Chawla J, Tan HL. Monitoring of physiologic features and treatment aspects of children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2096-2102. [PMID: 38353355 DOI: 10.1002/ppul.26901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/15/2023] [Accepted: 01/27/2024] [Indexed: 07/27/2024]
Abstract
Pediatric home invasive mechanical ventilation patients are a small but resource-intensive cohort, requiring close monitoring and multidisciplinary care. Patients are often dependent on their ventilator for life support, with any significant complications such as equipment failure, tracheostomy blockage, or accidental decannulation becoming potentially life-threatening if not identified quickly. This review discusses the indications and variations in practice worldwide, in terms of models of care, including home care provision, choice of equipment, and monitoring. With advances in technology, optimal monitoring strategies for home, continue to be debated: In-built ventilator alarms are often inadequately sensitive for pediatric patients, necessitating additional external monitoring devices to minimize risk. Pulse oximetry has been the preferred monitoring modality at home, though in some special circumstances such as congenital central hypoventilation syndrome, home carbon dioxide monitoring may be important to consider. Children should be under regular follow-up at specialist respiratory centers where clinical evaluation, nocturnal oximetry, and capnography monitoring and/or poly(somno)graphy and analysis of ventilator download data can be performed regularly to monitor progress. Recent exciting advances in technology, particularly in telemonitoring, which have potential to hugely benefit this complex group of patients are also discussed.
Collapse
Affiliation(s)
- Jasneek Chawla
- Paediatric Respiratory and Sleep Specialist, Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
- Kids Sleep Research Team, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| |
Collapse
|
3
|
Bai X, Zhang H, Jiao Y, Yuan C, Ma Y, Han L. Digital Health Interventions for Chronic Wound Management: A Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e47904. [PMID: 39012684 PMCID: PMC11289581 DOI: 10.2196/47904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 05/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have shown promising results for the management of chronic wounds. However, its effectiveness compared to usual care and whether variability in the type of intervention affects wound outcomes are unclear. OBJECTIVE The main objective was to determine the effectiveness of DHIs on wound healing outcomes in adult patients with chronic wounds. The secondary objectives were to assess if there was any variation in wound healing outcomes across the various types of DHIs. METHODS In total, 9 databases were searched for the literature up to August 1, 2023. Randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies comparing the efficacy of DHIs with controls in improving wound outcomes in adult patients with chronic wounds were included. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 reviewers. We assessed the quality of each RCT, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Relative risks (RRs) and 95% CIs were pooled using the random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed. RESULTS A total of 25 studies with 8125 patients were included in this systematic review, while only 20 studies with 6535 patients were included in the meta-analysis. Efficacy outcomes in RCTs showed no significant differences between the DHIs and control groups in terms of wound healing (RR 1.02, 95% CI 0.93-1.12; P=.67) and all-cause mortality around 1 year (RR 1.08, 95% CI 0.55-2.12; P=.83). Compared with the control group, the use of DHIs was associated with significant changes in adverse events (RR 0.44, 95% CI 0.22-0.89; P=.02). Subgroup analysis suggested a positive effect of the digital platforms in improving wound healing (RR 2.19, 95% CI 1.35-3.56; P=.002). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that DHIs were not inferior to usual care in managing chronic wounds. CONCLUSIONS The findings of our study demonstrate the viability of adopting DHIs to manage chronic wounds. However, more prominent, high-quality RCTs are needed to strengthen the evidence, and more detailed clinical efficacy research is required. TRIAL REGISTRATION PROSPERO CRD42023392415; https://tinyurl.com/4ybz6bs9.
Collapse
Affiliation(s)
- Xinrui Bai
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yanxia Jiao
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Chenlu Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| |
Collapse
|
4
|
Sun L, Yang B, Kindt E, Chu J. Privacy Barriers in Health Monitoring: Scoping Review. JMIR Nurs 2024; 7:e53592. [PMID: 38723253 PMCID: PMC11117136 DOI: 10.2196/53592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Health monitoring technologies help patients and older adults live better and stay longer in their own homes. However, there are many factors influencing their adoption of these technologies. Privacy is one of them. OBJECTIVE The aim of this study was to provide an overview of the privacy barriers in health monitoring from current research, analyze the factors that influence patients to adopt assisted living technologies, provide a social psychological explanation, and propose suggestions for mitigating these barriers in future research. METHODS A scoping review was conducted, and web-based literature databases were searched for published studies to explore the available research on privacy barriers in a health monitoring environment. RESULTS In total, 65 articles met the inclusion criteria and were selected and analyzed. Contradictory findings and results were found in some of the included articles. We analyzed the contradictory findings and provided possible explanations for current barriers, such as demographic differences, information asymmetry, researchers' conceptual confusion, inducible experiment design and its psychological impacts on participants, researchers' confirmation bias, and a lack of distinction among different user roles. We found that few exploratory studies have been conducted so far to collect privacy-related legal norms in a health monitoring environment. Four research questions related to privacy barriers were raised, and an attempt was made to provide answers. CONCLUSIONS This review highlights the problems of some research, summarizes patients' privacy concerns and legal concerns from the studies conducted, and lists the factors that should be considered when gathering and analyzing people's privacy attitudes.
Collapse
Affiliation(s)
- Luyi Sun
- Department of Information Security and Communication Technology, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Bian Yang
- Department of Information Security and Communication Technology, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Els Kindt
- Centre for IT & IP Law, Faculty of Law and Criminology, KU Leuven, Leuven, Belgium
| | - Jingyi Chu
- Administrative Law, Faculty of Law, China University of Political Science and Law, Beijing, China
| |
Collapse
|
5
|
Jiang W, Jin X, Du C, Gu W, Gao X, Zhou C, Tu C, Chen H, Li H, Shen Y, Zhang Y, Ge X, Sun Y, Zhou L, Yu S, Zhao K, Cheng Q, Zhu X, Liao H, Bai C, Song Y. Internet of things-based management versus standard management of home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: a multicentre randomized controlled non-inferiority trial. EClinicalMedicine 2024; 70:102518. [PMID: 38495520 PMCID: PMC10940131 DOI: 10.1016/j.eclinm.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Background Effective monitoring and management are crucial during long-term home noninvasive positive pressure ventilation (NPPV) in patients with hypercapnic chronic obstructive pulmonary disease (COPD). This study investigated the benefit of Internet of Things (IOT)-based management of home NPPV. Methods This multicenter, prospective, parallel-group, randomized controlled non-inferiority trial enrolled patients requiring long-term home NPPV for hypercapnic COPD. Patients were randomly assigned (1:1), via a computer-generated randomization sequence, to standard home management or IOT management based on telemonitoring of clinical and ventilator parameters over 12 months. The intervention was unblinded, but outcome assessment was blinded to management assignment. The primary outcome was the between-group comparison of the change in health-related quality of life, based on severe respiratory insufficiency questionnaire scores with a non-inferiority margin of -5. This study is registered with Chinese Clinical Trials Registry (No. ChiCTR1800019536). Findings Overall, 148 patients (age: 72.7 ± 6.8 years; male: 85.8%; forced expiratory volume in 1 s: 0.7 ± 0.3 L; PaCO2: 66.4 ± 12.0 mmHg), recruited from 11 Chinese hospitals between January 24, 2019, and June 28, 2021, were randomly allocated to the intervention group (n = 73) or the control group (n = 75). At 12 months, the mean severe respiratory insufficiency questionnaire score was 56.5 in the intervention group and 50.0 in the control group (adjusted between-group difference: 6.26 [95% CI, 3.71-8.80]; P < 0.001), satisfying the hypothesis of non-inferiority. The 12-month risk of readmission was 34.3% in intervention group compared with 56.0% in the control group, adjusted hazard ratio of 0.56 (95% CI, 0.34-0.92; P = 0.023). No severe adverse events were reported. Interpretation Among stable patients with hypercapnic COPD, using IOT-based management for home NPPV improved health-related quality of life and prolonged the time to readmission. Funding Air Liquide Healthcare (Beijing) Co., Ltd.
Collapse
Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Jin
- Department of Pulmonary Medicine, Tong Ren Hospital, Jiaotong University, Shanghai, China
| | - Chunling Du
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenchao Gu
- Department of Pulmonary Medicine, Pudong New Area People's Hospital, Shanghai, China
| | - Xiwen Gao
- Department of Pulmonary Medicine, Minhang Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenjun Zhou
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chunlin Tu
- Department of Pulmonary Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Hongqun Chen
- Department of Pulmonary Medicine, Zhongshan Xuhui Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Pulmonary Medicine, Traditional Chinese Medicine Hospital of Kunshan, Jiangsu, China
| | - Yao Shen
- Department of Pulmonary Medicine, Pudong Hospital, Shanghai, China
| | - Yunfeng Zhang
- Department of Pulmonary Medicine, Putuo District Liqun Hospital, Shanghai, China
| | - Xiahui Ge
- Department of Pulmonary Medicine, Shanghai Ninth People's Hospital, Jiaotong University, Shanghai, China
| | - Yingxin Sun
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Suyun Yu
- Department of Pulmonary Medicine, Minhang Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kaishun Zhao
- Department of Pulmonary Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Qing Cheng
- Department of Pulmonary Medicine, Pudong Hospital, Shanghai, China
| | - Xiaodan Zhu
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chunxue Bai
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Fudan University, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
6
|
Dale CM, Ambreen M, Kang S, Buchanan F, Pizzuti R, Gershon AS, Rose L, Amin R. Acceptability of the Long-Term In-Home Ventilator Engagement virtual intervention for home mechanical ventilation patients during the COVID-19 pandemic: A qualitative evaluation. Digit Health 2024; 10:20552076241228417. [PMID: 38282921 PMCID: PMC10822085 DOI: 10.1177/20552076241228417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
Background Clinical management of ventilator-assisted individuals (VAIs) was challenged by social distancing rules during the COVID-19 pandemic. In May 2020, the Long-Term In-Home Ventilator Engagement (LIVE) Program was launched in Ontario, Canada to provide intensive digital care case management to VAIs. The purpose of this qualitative study was to explore the acceptability of the LIVE Program hosted via a digital platform during the COVID-19 pandemic from diverse perspectives. Methods We conducted a qualitative descriptive study (May 2020-April 2021) comprising semi-structured interviews with participants from eight home ventilation specialty centers in Ontario, Canada. We purposively recruited patients, family caregivers, and providers enrolled in LIVE. Content analysis and the theoretical concepts of acceptability, feasibility, and appropriateness were used to interpret findings. Results A total of 40 individuals (2 VAIs, 18 family caregivers, 20 healthcare providers) participated. Participants described LIVE as acceptable as it addressed a longstanding imperative to improve care access, ease of use, and training provided; feasible for triaging problems and sharing information; and appropriate for timeliness of provider responses, workflows, and perceived value. Negative perceptions of acceptability among healthcare providers concerned digital workload and fit with existing clinical workflows. Perceived benefits accorded to LIVE included enhanced physical and psychological safety in the home, patient-provider relations, and VAI engagement in their own care. Conclusions Study findings identify factors influencing the LIVE Program's acceptability by patients, family caregivers, and healthcare providers during pandemic conditions including enhanced access to care, ease of case management triage, and VAI safety. Findings may inform the implementation of digital health services to VAIs in non-pandemic circumstances.
Collapse
Affiliation(s)
- Craig M. Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Munazzah Ambreen
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sohee Kang
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Francine Buchanan
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Regina Pizzuti
- Live Program, Ontario Ventilator Equipment Pool, Kingston, ON, Canada
| | - Andrea S. Gershon
- Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
- Department of Critical Care and Lane Fox Unit, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Reshma Amin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Clinical Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| |
Collapse
|
7
|
Juarros Martínez SA, Andrés Porras MDP, del Olmo Chiches M, Muñoz Diez MI. Use of Telemonitoring for CPAP Therapy Control in OSA Patients: Impact on Cost and Process Improvements. OPEN RESPIRATORY ARCHIVES 2023; 5:100263. [PMID: 37743881 PMCID: PMC10511485 DOI: 10.1016/j.opresp.2023.100263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction In Spain, 2 million people are treated for obstructive sleep apnoea. Continuous positive airway pressure, the gold-standard therapy, requires regular follow-up and periodic evaluation of the efficacy of the treatment via a titration examination, i.e. autoCPAP test. Telemonitoring use is increasing and this study aims to evaluate the cost impact of its use for therapy evaluation instead of the standard ambulatory autoCPAP test. Methods This prospective observational study includes 100 OSA patients under CPAP therapy who volunteered to test telemonitoring as an alternative therapy control tool. Costs for both the patients and the Sleep Unit were calculated and compared for the standard of care (ambulatory autoCPAP (SoC)), vs alternative telemonitoring option (TM). Results More than half (54%) of the patients preferred the TM option vs only 47.5% of the SoC patients. Patients inclining towards telemonitoring option were mainly reported to be more than 10 years youngers, mainly active workers (63%), travelling more distance to the Sleep Unit (16 vs 8 km) and spending more expenses in travel than those who preferred SoC (median 30€). 29% of active workers left their jobs to attend the SoC. The costs related to the use of the Sleep Unit resources were found to be lower in the TM option compared to the SoC option (0.47 vs 3.09 euros per patient attended). Conclusions The use of TM for follow-up CPAP therapy enables the patient to save travel costs and to reduce absenteeism but also to save assistential burden and therefore to reduce the Sleep Unit workload and optimize the care activity.
Collapse
Affiliation(s)
- Santiago Antonio Juarros Martínez
- Respiratory Sleep Disorders Unit, Hospital Clínico Universitario de Valladolid, Spain
- Faculty of Medicine, University of Valladolid, Spain
| | | | | | | |
Collapse
|
8
|
Yeung AWK, Torkamani A, Butte AJ, Glicksberg BS, Schuller B, Rodriguez B, Ting DSW, Bates D, Schaden E, Peng H, Willschke H, van der Laak J, Car J, Rahimi K, Celi LA, Banach M, Kletecka-Pulker M, Kimberger O, Eils R, Islam SMS, Wong ST, Wong TY, Gao W, Brunak S, Atanasov AG. The promise of digital healthcare technologies. Front Public Health 2023; 11:1196596. [PMID: 37822534 PMCID: PMC10562722 DOI: 10.3389/fpubh.2023.1196596] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Digital health technologies have been in use for many years in a wide spectrum of healthcare scenarios. This narrative review outlines the current use and the future strategies and significance of digital health technologies in modern healthcare applications. It covers the current state of the scientific field (delineating major strengths, limitations, and applications) and envisions the future impact of relevant emerging key technologies. Furthermore, we attempt to provide recommendations for innovative approaches that would accelerate and benefit the research, translation and utilization of digital health technologies.
Collapse
Affiliation(s)
- Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Ali Torkamani
- Department of Integrative Structural and Computational Biology, Scripps Research Translational Institute, La Jolla, CA, United States
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin S. Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Björn Schuller
- Department of Computing, Imperial College London, London, United Kingdom
- Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Daniel S. W. Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - David Bates
- Department of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Hanchuan Peng
- Institute for Brain and Intelligence, Southeast University, Nanjing, China
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Jeroen van der Laak
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Josip Car
- Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Population Health Sciences, LKC Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kazem Rahimi
- Deep Medicine Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Roland Eils
- Digital Health Center, Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stephen T. Wong
- Department of Systems Medicine and Bioengineering, Houston Methodist Cancer Center, T. T. and W. F. Chao Center for BRAIN, Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX, United States
- Departments of Radiology, Pathology and Laboratory Medicine and Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| |
Collapse
|
9
|
van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on home mechanical ventilation. Eur Respir Rev 2023; 32:32/168/220207. [PMID: 37019457 PMCID: PMC10074164 DOI: 10.1183/16000617.0207-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 04/07/2023] Open
Abstract
There is a growing number of patients being treated with long-term home mechanical ventilation (HMV). This poses a challenge for the healthcare system because in-hospital resources are decreasing. The application of digital health to assist HMV care might help. In this narrative review we discuss the evidence for using telemonitoring to assist in initiation and follow-up of patients on long-term HMV. We also give an overview of available technology and discuss which parameters can be measured and how often this should be done. To get a telemonitoring solution implemented in clinical practice is often complex; we discuss which factors contribute to that. We discuss patients' opinions regarding the use of telemonitoring in HMV. Finally, future perspectives for this rapidly growing and evolving field will be discussed.
Collapse
Affiliation(s)
- Ries van den Biggelaar
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anda Hazenberg
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
Niu Y, Xi H, Zhu R, Guo Y, Wang S, Xiong X, Wang S, Guo L. Effects of telemedicine-based follow-up management on adults with obstructive sleep apnea: A systematic review and meta-analysis. Int J Med Inform 2023; 176:105108. [PMID: 37269609 DOI: 10.1016/j.ijmedinf.2023.105108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/03/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This meta-analysis aimed to investigate the effects of telemedicine-based follow-up management on adults with obstructive sleep apnea. METHODS Publications were searched in the Cochrane Library, PubMed, Scopus, Web of Science and Embase. Studies were selected according to the predefined screening criteria, and their qualities were assessed by the Revised Cochrane risk-of-bias tool for randomized trials. The statistical analyses were performed using Stata12.0 software. It was registered in PROSPERO with the number: CRD42021276414. RESULTS A total of 33 articles with 8,689 participants were included. Telemedicine-based follow-up management improved average daily continuous positive airway pressure usage by 36 min (weighted mean difference:0.61;95% confidence interval: 0.39 to 0.83), and the percentage of days with continuous positive airway pressure usage more than four hours by 10.67% in obstructive sleep apnea patients. The meta-analysis of good continuous positive airway pressure compliance showed telemedicine-based follow-up management did not lead to good continuous positive airway pressure compliance (odds ratio: 1.13;95% confidence interval: 0.72 to 1.76). The pooled mean difference of sleep quality was 0.15 (standardized mean difference:0.15; 95% confidence interval: -0.03 to 0.32), and daytime sleepiness was -0.26 (weighted mean difference: -0.26;95% confidence interval: -0.79 to 0.28). The pooled mean difference of apnea hypopnea index was -0.53 (95% confidence interval: -3.58 to 2.51). As for the overall quality of life, the pooled mean difference was -0.25 (standardized mean difference: -0.25;95% confidence interval: -0.25 to 0.76). CONCLUSION Telemedicine-based follow-up management was beneficial for continuous positive airway pressure compliance of obstructive sleep apnea patients within six months. However, it could not improve sleep quality, daytime sleepiness, the severity of obstructive sleep apnea, and quality of life in obstructive sleep apnea patients compared with traditional follow-up. Moreover, it was more cost-effective, but there was no consensus on whether it would increase the workload of medical staff.
Collapse
Affiliation(s)
- Yirou Niu
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China
| | - Huihui Xi
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China
| | - Ruiting Zhu
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China
| | - Yingze Guo
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China
| | - Shuhan Wang
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China
| | - Xuance Xiong
- Medical College, Beihua University, 3999 Huashan Street, Fengman District, Jilin, Jilin Province, China
| | - Shuang Wang
- Department of Dermatology, Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin Province, China.
| | - Lirong Guo
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, Jilin Province, China.
| |
Collapse
|
11
|
Owens RL, Derom E, Ambrosino N. Supplemental oxygen and noninvasive ventilation. Eur Respir Rev 2023; 32:220159. [PMID: 36948502 PMCID: PMC10032613 DOI: 10.1183/16000617.0159-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 03/24/2023] Open
Abstract
The respiratory system attempts to maintain normal levels of oxygen and carbon dioxide. However, airflow limitation, parenchymal abnormalities and dysfunction of the respiratory pump may be compromised in individuals with advanced COPD, eventually leading to respiratory failure, with reduced arterial oxygen tension (hypoxaemia) and/or increased arterial carbon dioxide tension (P aCO2 ; hypercapnia). Hypoxaemia may persist in individuals with severe COPD despite smoking cessation and optimisation of pharmacotherapy. Long-term oxygen therapy (LTOT) can improve survival in those with severe daytime hypoxaemia, whereas those with less severe hypoxaemia may only have improved exercise capacity and dyspnoea. Changes in respiratory physiology that occur during sleep further predispose to hypoxaemia, particularly in individuals with COPD. However, the major cause of hypoxaemia is hypoventilation. Noninvasive ventilation (NIV) may reduce mortality and need for intubation in individuals with COPD and acute hypercapnic respiratory failure. However, NIV may also improve survival and quality of life in individuals with stable, chronic hypercapnia and is now suggested for those with prolonged hypercapnia (e.g. P aCO2 >55 mmHg 2-6 weeks after hospital discharge) when clinically stable and after optimisation of medical therapy including LTOT if indicated. Many questions remain about the optimal mode, settings and goal of NIV therapy.
Collapse
Affiliation(s)
- Robert L Owens
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Montescano, Montescano, Italy
| |
Collapse
|
12
|
Vila M, Rosa Oliveira V, Agustí A. Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review. Med Clin (Barc) 2023; 160:355-363. [PMID: 36801105 DOI: 10.1016/j.medcli.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.
Collapse
Affiliation(s)
- Marc Vila
- Equipo de Asistencia Primaria Vic , Vic, Barcelona, España; Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España.
| | - Vinicius Rosa Oliveira
- Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España
| | - Alvar Agustí
- Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Instituto Respiratorio, Hospital Clínico, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; CIBER Enfermedades Respiratorias, España
| |
Collapse
|
13
|
Agusti A, Ambrosino N, Blackstock F, Bourbeau J, Casaburi R, Celli B, Crouch R, Negro RD, Dreher M, Garvey C, Gerardi D, Goldstein R, Hanania N, Holland AE, Kaur A, Lareau S, Lindenauer PK, Mannino D, Make B, Maltais F, Marciniuk JD, Meek P, Morgan M, Pepin JL, Reardon JZ, Rochester C, Singh S, Spruit MA, Steiner MC, Troosters T, Vitacca M, Clini E, Jardim J, Nici L, Raskin J, ZuWallack R. COPD: Providing the right treatment for the right patient at the right time. Respir Med 2023; 207:107041. [PMID: 36610384 DOI: 10.1016/j.rmed.2022.107041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.
Collapse
Affiliation(s)
- Alvar Agusti
- Clinic Barcelona Hospital University, Barcelona, Spain.
| | | | | | - Jean Bourbeau
- Department of Medicine, Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, CA, USA.
| | | | | | | | - Roberto Dal Negro
- National Centre for Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy.
| | - Michael Dreher
- Clinic of Cardiology, Angiology, Pneumology and Intensive Medicine, University Hospital Aachen, Aachen, 52074, DE, USA.
| | | | | | - Roger Goldstein
- Respiratory Rehabilitation Service, West Park Health Care Centre, Toronto, Ontario, CA, USA.
| | | | - Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Antarpreet Kaur
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA; University of Colorado School of Nursing, Aurora, CO, USA.
| | - Suzanne Lareau
- University of Colorado School of Nursing, Aurora, CO, USA.
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
| | | | - Barry Make
- National Jewish Health, Denver, CO, USA.
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, CA, USA.
| | - Jeffrey D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, CA, USA.
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA.
| | - Mike Morgan
- Dept of Respiratory Medicine, University Hospitals of Leicester, UK.
| | - Jean-Louis Pepin
- CHU de Grenoble - Clin Univ. de physiologie, sommeil et exercice, Grenoble, France.
| | - Jane Z Reardon
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA.
| | | | - Sally Singh
- Department of Respiratory Diseases, University of Leicester, UK.
| | | | - Michael C Steiner
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre, Professor, University of Leicester, UK.
| | - Thierry Troosters
- Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven: Leuven, Vlaanderen, Belgium.
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, ICS S. Maugeri Care and Research Institutes, IRCCS Pavia, Italy.
| | - Enico Clini
- University of Modena and Reggio Emilia, Italy.
| | - Jose Jardim
- Federal University of Sao Paulo Paulista, Brazil.
| | - Linda Nici
- nBrown University School of Medicine, USA.
| | | | - Richard ZuWallack
- Section of Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
| |
Collapse
|
14
|
Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Pediatric Assistance at Territorial Level: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020198. [PMID: 36836432 PMCID: PMC9964859 DOI: 10.3390/jpm13020198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | | | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Vai
- Alma Mater University, 40126 Bologna, Italy
| | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
15
|
Pierucci P. Tele-consultation: A new promised land? Pulmonology 2023; 29:2-3. [PMID: 36182660 PMCID: PMC9805545 DOI: 10.1016/j.pulmoe.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- P Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, Italy; Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Italy.
| |
Collapse
|
16
|
Teleconsultation in respiratory medicine - A position paper of the Portuguese Pulmonology Society. Pulmonology 2023; 29:65-76. [PMID: 35705437 PMCID: PMC9188666 DOI: 10.1016/j.pulmoe.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 01/06/2023] Open
Abstract
The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.
Collapse
|
17
|
Balañá A, Rubio M, Bertran B, Martínez Llorens J. Telematic adaptation to home mechanical ventilation in patients with amyotrophic lateral sclerosis. Neurologia 2023; 38:59-61. [PMID: 36462623 PMCID: PMC9710147 DOI: 10.1016/j.nrleng.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/01/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- A. Balañá
- Servicio de Neumología, Hospital del Mar, Cataluña, Spain,Unidad Multidisciplinar de ELA, Cataluña, Spain
| | - M.Á. Rubio
- Servicio de Neumología, Hospital del Mar, Cataluña, Spain,Unidad Multidisciplinar de ELA, Cataluña, Spain
| | - B. Bertran
- Servicio de Neumología, Hospital del Mar, Cataluña, Spain,Unidad Multidisciplinar de ELA, Cataluña, Spain
| | - J. Martínez Llorens
- Servicio de Neumología, Hospital del Mar, Cataluña, Spain,Unidad Multidisciplinar de ELA, Cataluña, Spain,CEXS, Universitat Pompeu Fabra, Cataluña, Spain,CIBER de Enfermedades Respiratorias (CIBERES), ISC III. Madrid, Spain,Corresponding author
| |
Collapse
|
18
|
[Telematic adaptation to home mechanical ventilation in patients with amyotrophic lateral sclerosis]. Neurologia 2023; 38:61-63. [PMID: 35233126 PMCID: PMC8874734 DOI: 10.1016/j.nrl.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
19
|
Gupta A, Singh A. Healthcare 4.0: recent advancements and futuristic research directions. WIRELESS PERSONAL COMMUNICATIONS 2022; 129:933-952. [PMID: 36594000 PMCID: PMC9795952 DOI: 10.1007/s11277-022-10164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
In recent years, Healthcare 4.0, the fourth healthcare revolution, has piqued the interest of numerous researchers around the world. Healthcare 4.0 is a relatively new term that has evolved from Industry 4.0 to meet diverse requirements in the healthcare domain. Healthcare 4.0 serves as a technological catalyst for accelerated growth by integrating cutting-edge industrial technologies. Despite the evolving nature of Healthcare 4.0 research, a complete and systematic survey of recent research on it has been scarce. Conspicuously, this study intends to present a systematic survey by investigating the recent trends, key constraints, and application areas of Healthcare 4.0. Further, a comprehensive survey of the research is used to identify the essential technologies required for the effective adoption of Healthcare 4.0. The research was conducted using the PRISMA methodology and an exhaustive search of all easily accessible libraries and academic repositories was made to obtain the relevant literature. At last, a diversity of outstanding issues are also presented to assist scholars and professionals who are interested in undertaking futuristic research in the current field.
Collapse
Affiliation(s)
- Aditya Gupta
- Dr B.R. Ambedkar National Institute of Technology, Jalandhar, India
| | - Amritpal Singh
- Dr B.R. Ambedkar National Institute of Technology, Jalandhar, India
| |
Collapse
|
20
|
Ambrosino N, Aliverti A. Use of Technology in Respiratory Medicine. Arch Bronconeumol 2022; 59:197-198. [PMID: 36153215 DOI: 10.1016/j.arbres.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia, Italy.
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| |
Collapse
|
21
|
Kosky C, Madeira N, Boulton K, Hunter MT, Ling I, Reynor A, Sturdy G, Walsh J, Dhaliwal S, Singh B, Eastwood P, McArdle N. Telemedicine compared to standard face-to-face care for CPAP treatment: real-world Australian experience. Sleep 2022; 45:6643327. [PMID: 35830509 DOI: 10.1093/sleep/zsac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We tested a telemedicine model of care to initiate continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) living in remote Western Australia. METHODS A prospective study comparing telemedicine for CPAP initiation in a remote population versus standard face-to-face CPAP initiation in a metropolitan population. The primary outcome was average nightly CPAP use in the final week of a CPAP trial. RESULTS A total of 186 participants were allocated to either telemedicine (n=56) or standard care (n=130). The average distance from the study centre for the telemedicine group was 979 km (±792km) compared to 19km (±14km) for the standard care group. The CPAP trial duration in the standard care group was less than the telemedicine group (37.6 vs 69.9 days, p<0.001). CPAP adherence in the telemedicine group was not inferior to standard care (Standard 4.7±0.2 hours, Telemedicine 4.7±0.3 hours, p=0.86). No differences were found between groups in residual apnea-hypopnea index, symptom response, sleep specific quality of life at the end of the trial and continued CPAP use (3 to 6 months). Participant satisfaction was high in both groups. Total health care costs of the telemedicine model were less than the standard model of care. An estimated A$4,538 per participant in travel costs was saved within the telemedicine group by reducing the need to travel to the sleep center for in-person management. CONCLUSIONS In remote dwelling adults starting CPAP for the treatment of OSA, outcomes using telemedicine were comparable to in-person management in a metropolitan setting.
Collapse
Affiliation(s)
- Christopher Kosky
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Neill Madeira
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Kate Boulton
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Marie-Therese Hunter
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Ayesha Reynor
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Gavin Sturdy
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Jennifer Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Satvinder Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia.,Singapore University of Social Sciences, Office of the Provost. 463 Clementi Road, Singapore
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Peter Eastwood
- Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, South Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| |
Collapse
|
22
|
Jiang W, Song Y. Internet of things-based home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: study protocol for a randomized controlled trial. Trials 2022; 23:393. [PMID: 35551646 PMCID: PMC9097410 DOI: 10.1186/s13063-022-06372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Home noninvasive positive pressure ventilation (NIPPV) has become evidence-based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate follow-up, telemonitor, and management to ensure treatment effectiveness, compliance, and security and to improve quality of life. The Internet of things (IOT) is the name given to the network of devices and other “things” with built-in sensors, software, electronics, and network connectivity, communicating these objects over wireless networks and sending data to a cloud platform. The study aims to evaluate the effectiveness and safety of the IOT-based management of NIPPV for the COPD patients with hypercapnic chronic respiratory failure. Methods This multicenter, prospective, randomized controlled trial was conducted with a total of 200 COPD patients with chronic hypercapnic respiratory failure. Using a computer-generated randomization process, patients were randomized (in a 1:1 ratio) into the usual NIPPV (control group) or to receive additional IOT-based management (intervention group) for 12 months. The primary outcome was the Severe Respiratory Insufficiency (SRI) questionnaire. Secondary outcomes included compliance with the ventilator, gas exchange, lung function, health-related quality of life, hospitalization frequency, time to death within 1-year, all-cause mortality, safety analysis, and cost-effectiveness analysis. Discussion This study will be the first and largest randomized trial in China to evaluate the effectiveness and safety of the IOT-based management of NIPPV for COPD patients with chronic hypercapnic respiratory failure. The results will help to understand the current situation of IOT-based home ventilation and may provide new evidence for home NIPPV treatment and management in the future. Trial registration Chinese Clinical Trials Registry ChiCTR1800019536. Registered on 17 November 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06372-z.
Collapse
Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Respiratory Research Institute, Shanghai, 200032, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200000, China. .,Department of Pulmonary Medicine, Qingpu Branch, Zhongshan Hospital, Fudan University, Shanghai, 201700, China. .,Jinshan Hospital of Fudan University, Shanghai, 201508, China.
| |
Collapse
|
23
|
Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
24
|
Telemedicine as a Means to an End, Not an End in Itself. Life (Basel) 2022; 12:life12010122. [PMID: 35054515 PMCID: PMC8777880 DOI: 10.3390/life12010122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.
Collapse
|
25
|
Hernandez-Voth A, Sayas Catalan J, Corral Blanco M, Alonso Moralejo R, Perez Gonzalez V, De Pablo Gafas A, Castaño Menendez A, Juarros Monteagudo L, Villena Garrido V. Long-Term Effect of Noninvasive Ventilation on Diaphragm in Chronic Respiratory Failure. Int J Chron Obstruct Pulmon Dis 2022; 17:205-212. [PMID: 35082492 PMCID: PMC8784950 DOI: 10.2147/copd.s339498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Home non-invasive ventilation (NIV) is recommended in patients with COPD and hypercapnic chronic respiratory failure (HCRF). The mechanism by it can improve alveolar ventilation during spontaneous breathing is not yet completely explained. Our aim is to evaluate the impact of on diaphragm muscle function in a series of patients with HCRF. Patients and Methods Observational, longitudinal, prospective study of a series of patients with very severe chronic obstruction to airflow treated with home high imntensity NIV (HINIV). Patients underwent a baseline and after 12 months assessment including adherence to treatment, quality of life, respiratory function tests and diaphragmatic ultrasound. SPSS v.26 software was used for statistical analysis. Results We studied 30 patients, 63% male, the mean age was 60.8 (±6.4) years old. Patients had a severe obstructive ventilatory pattern [FEV1 21.8 (±6.1)%] and hypercapnia [pCO2 56.4 (±7.2) mmHg]. After 12 months of HINIV, we observed significant increases in FVC of 9.2% (p = 0.002), FEV1 of 3.5% (p = 0.04), MIP of 9.4% (p = 0.006), and 6-minute-walking test (6MWT) of 31.9 m (p = 0.001), as well as decreases in paCO2 of 12.5 mmHg (p = 0.001), HCO3 of 4.7 mmol/L (p = 0.001) and BODE index from 7 to 6. Diaphragmatic ultrasound demonstrated an increase in the thickening fraction of 14% (p = 0.002). Respiratory symptoms (p = 0.04), physical function (p = 0.03), and sleep (p = 0.04) also improved. Conclusion In patients with HCRF due to very severe chronic obstruction to airflow, long-term HINIV can improve respiratory performance by improving the function of the diaphragmatic musculature. Larger multicenter clinical trials are needed to confirm the results suggested in this study.
Collapse
Affiliation(s)
- Ana Hernandez-Voth
- Department of Pneumology, Mechanical Ventilation Unit, 12 de Octubre University Hospital, Madrid, Spain
- Correspondence: Ana Hernandez-Voth Department of Pneumology, Mechanical Ventilation Unit, 12 de Octubre University Hospital, Madrid, SpainTel +34681060165 Email
| | - Javier Sayas Catalan
- Department of Pneumology, Mechanical Ventilation Unit, 12 de Octubre University Hospital, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Corral Blanco
- Department of Pneumology, Mechanical Ventilation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Rodrigo Alonso Moralejo
- Department of Pneumology, Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Virginia Perez Gonzalez
- Department of Pneumology, Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Alicia De Pablo Gafas
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Department of Pneumology, Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Alba Castaño Menendez
- Department of Pneumology, Mechanical Ventilation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Lourdes Juarros Monteagudo
- Department of Rehabilitation, Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Victoria Villena Garrido
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Department of Rehabilitation, Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
- Department of Pneumology, 12 de Octubre University Hospital, Madrid, Spain
- Department of Research. Center for Biomedical Research on Respiratory Diseases (CIBERES), Madrid, Spain
| |
Collapse
|
26
|
Mbunge E, Muchemwa B, Batani J. Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems. SENSORS INTERNATIONAL 2021; 3:100152. [PMID: 34901894 PMCID: PMC8648577 DOI: 10.1016/j.sintl.2021.100152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/14/2023] Open
Abstract
Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.
Collapse
Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - Benhildah Muchemwa
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - John Batani
- Faculty of Engineering and Technology, Botho University, Maseru, Lesotho
| |
Collapse
|
27
|
Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure. Life (Basel) 2021; 11:life11111113. [PMID: 34832989 PMCID: PMC8620445 DOI: 10.3390/life11111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Advances in management have improved mortality of individuals with chronic respiratory failure (CRF), leading to an increase in need for long-term oxygen therapy and/or ventilatory support. These individuals require frequent visits and monitoring of their physiological parameters as well as of the functioning of their devices, such as ventilators or oxygen concentrators. Telemedicine is a clinical application of Information Communication Technology connecting patients to specialised care consultants. This narrative review aims to explore the current available telemonitoring options for individuals with CRF and reported or potential results. Methods: The research focused on EMBASE, CINALH, PubMed, and Scopus databases. Papers published between 2003 and 2021 in English were considered. Results: Different sensors, transmission devices and systems, and interventions are used with promising but not conclusive clinical results. However, legal problems are still unsolved, and economic advantages for health care systems, although potentially high, are still under debate. Conclusions: Telemonitoring systems for individuals with CRF are increasingly used; with promising results still to be clarified, legal, economical and organisational issues must be defined.
Collapse
|
28
|
Higami Y, Higuchi A, Tanaka H, Moriki Y, Utsumi M, Yamakawa M, Ito Y, Hatano Y, Maeda I, Fukui S. Nonwearable actigraphy to assess changes in motor activity before and after rescue analgesia in terminally ill patients with cancer: A pilot study. Int J Nurs Pract 2021; 28:e13019. [PMID: 34651388 DOI: 10.1111/ijn.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/16/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to investigate the usefulness of nonwearable actigraphy to assess changes in motor activity before and after rescue analgesic administration in terminally ill cancer patients. BACKGROUND Evaluating pain in terminally ill cancer patients is difficult; pain assessment tools are needed. METHODS This was an exploratory descriptive study conducted within a palliative care unit. A nonwearable actigraph was used to measure the activity score and movement index of terminally ill patients with weeks-long prognosis and pain. The actigraph and medical data were integrated, and data were compared 6 h before and after rescue analgesic administration. RESULTS Among 10 patients (age: 75.8 ± 12.3 years; six men), we evaluated 28 pain episodes (mean activity score: 130.9 ± 180.5 counts per minute; movement index: 68.8%). When pain was relieved at night following rescue analgesic administration, activity score and movement index decreased significantly (6 h before vs. 6 h after analgesics, respectively: 113.1 to 69.7 counts per minute; 64.3% to 41.8%; both p < 0.0001). With no relief after rescue analgesic administration, activity score did not differ significantly 6 h before and after analgesics: 147.3 to 137.7 counts per minute. CONCLUSION Pain in terminally ill cancer patients could be assessed using a nonwearable actigraph to capture motor activity and improve pain assessment.
Collapse
Affiliation(s)
- Yoko Higami
- Department of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akarai Higuchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruka Tanaka
- Department of Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Yuki Moriki
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Momoe Utsumi
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Miyae Yamakawa
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Toyonaka, Osaka, Japan
| | - Sakiko Fukui
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.,Department of Health Sciences, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
29
|
Mansell SK, Kilbride C, Wood MJ, Gowing F, Mandal S. Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study. BMJ Open Respir Res 2021; 7:7/1/e000510. [PMID: 32161065 PMCID: PMC7066605 DOI: 10.1136/bmjresp-2019-000510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients’ homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV. Methods A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Five main themes were identified. ‘Surveillance: a paradox of findings’: HCPs were concerned about unduly scrutinising patients’ lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. ‘Sanctions’: HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. ‘Complacency and ethics’: HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. ‘Increased time for patient focused care’: HCPs in the focus groups described a number of ways in which using modems was more efficient. ‘Confidence: can be improved with technology’: patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence. Conclusion HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers. Trial registration number NCT03905382
Collapse
Affiliation(s)
- Stephanie K Mansell
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK .,Therapy Services, Royal Free London NHS Foundation Trust, London, UK
| | - Cherry Kilbride
- Therapy Services, Royal Free London NHS Foundation Trust, London, UK.,Department of Clinical Sciences, Brunel University, Uxbridge, Middlesex, UK
| | | | - Francesca Gowing
- Therapy Services, Royal Free London NHS Foundation Trust, London, UK
| | - Swapna Mandal
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK.,Department of Academic Respiratory Medicine, University College London, London, UK
| |
Collapse
|
30
|
Donner CF, ZuWallack R, Nici L. The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2021; 57:medicina57070726. [PMID: 34357007 PMCID: PMC8307990 DOI: 10.3390/medicina57070726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023]
Abstract
Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.
Collapse
Affiliation(s)
- Claudio F. Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021 Borgomanero, Italy
- Correspondence:
| | - Richard ZuWallack
- Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT 06015, USA;
- University of CT, Farmington, CT 06030, USA
| | - Linda Nici
- Pulmonary and Critical Care Section, Providence Veterans Administration Medical Center, Brown University, Providence, RI 02908, USA;
| |
Collapse
|
31
|
Amin R, Pizzuti R, Buchanan F, Rose L. Soins virtuels innovants pour la ventilation mécanique à domicile. CMAJ 2021; 193:E1062-E1066. [PMID: 34253553 PMCID: PMC8342015 DOI: 10.1503/cmaj.202584-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Reshma Amin
- Division de pneumologie (Amin), Département de pédiatrie, Hôpital pour enfants malades de Toronto (SickKids); Institut de recherche du SickKids (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Centre des sciences de la santé de Kingston, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, Londres, R.-U.
| | - Regina Pizzuti
- Division de pneumologie (Amin), Département de pédiatrie, Hôpital pour enfants malades de Toronto (SickKids); Institut de recherche du SickKids (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Centre des sciences de la santé de Kingston, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, Londres, R.-U
| | - Francine Buchanan
- Division de pneumologie (Amin), Département de pédiatrie, Hôpital pour enfants malades de Toronto (SickKids); Institut de recherche du SickKids (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Centre des sciences de la santé de Kingston, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, Londres, R.-U
| | - Louise Rose
- Division de pneumologie (Amin), Département de pédiatrie, Hôpital pour enfants malades de Toronto (SickKids); Institut de recherche du SickKids (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Centre des sciences de la santé de Kingston, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, Londres, R.-U
| |
Collapse
|
32
|
Fukui S, Ikuta K, Maeda I, Hattori S, Hatano Y, Yamakawa M, Utsumi M, Higami Y, Tanaka H, Higuchi A. Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor. Support Care Cancer 2021; 30:77-86. [PMID: 34232391 DOI: 10.1007/s00520-021-06346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The present study aimed to explore the association between impending death and continual changes in respiratory and heart rates measured using a non-wearable monitor every minute for the final 2 weeks of life in dying cancer patients. METHODS In this longitudinal study, we enrolled patients in a palliative care unit and continuously measured their respiratory and heart rates via a monitor and additionally captured their other vital signs and clinical status from medical records. RESULT A dataset was created comprising every 24-h data collected from every-minute raw data, including information from 240 days prior to death from 24 patients (345,600 data); each patient's data were measured for 3-14 days until death. After confirming the associations between the respiratory and heat rate values on the day of death (n = 24) or other days (2-14 days before death, n = 216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24 h by univariate analyses, we conducted a repeated-measures logistic regression analysis using a generalized estimating equation. Finally, the maximum respiratory rate and mean heart rate were significantly associated with death occurring within the following 3 days (0-24 h, 0-48 h, and 0-72 h), except for the maximum respiratory rate that occurs within 0-24 h. CONCLUSION The maximum respiratory rate and mean heart rate measured every minute using a monitor can warn family caregivers and care staff, with the support of palliative care professionals, of imminent death among dying patients at home or other facilities.
Collapse
Affiliation(s)
- Sakiko Fukui
- Department of Home Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-15 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Kasumi Ikuta
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan
| | - Satoshi Hattori
- Department of Biomedical Statistics, Graduate School of Medicine, and Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, 5-28 Sakaemachi, Kawanishi, Hyogo, Japan
| | - Miyae Yamakawa
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Momoe Utsumi
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoko Higami
- Department of Nursing, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Haruka Tanaka
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Akari Higuchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
33
|
Antón A, Díaz Lobato S, Guimarães MJ, Alonso-Álvarez ML, Correia S, Gonçalves MR. Home Mechanical Ventilation Practices in Spain and Portugal. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496771 PMCID: PMC10369612 DOI: 10.1016/j.opresp.2021.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Home mechanical ventilation (HMV) practice has changed with publication of new evidence and introduction of new technologies, and varies between countries. This study investigated current HMV use and practices in Spain and Portugal. Methods 94 healthcare professionals identified as regularly performing HMV-related activities were sent an e-mail link to an online questionnaire. The questionnaire included 40 items relating to responder demographics, non-invasive ventilation (NIV) care structure, ventilated patient profile, work habits, and potential future practice improvements. Results 66 questionnaires (70%) were returned (Spain, 36; Portugal, 30). The majority of respondents were physicians (Spain, 95%; Portugal, 63%). Overall, 83% of hospitals had a dedicated NIV unit (Spain, 100%; Portugal, 63%). The most common indication for HMV was neuromuscular disorders in Spain and obstructive diseases in Portugal. Homecare providers (HCPs) and pulmonologists were usually responsible for managing HMV; HCPs were involved more often in Portugal. Choice of ventilator was most often based on usage hours/day; the most important device features were 'ease of use' (Spain) and 'adjustment range' (Portugal). HMV monitoring practices varied between countries. Telemonitoring was used more often in Portugal (20%; vs. Spain, 3%). Follow-up frequency and practices also differed markedly between Spain and Portugal. Respondents highlighted identification of new patient groups and patient phenotyping to optimize treatment and personalize therapy as future HMV strategies. Conclusions Important differences in the management of HMV were observed between two similar European countries. Better understanding of clinical practices can facilitate targeted education and training to ensure optimal management of patients using HMV.
Collapse
|
34
|
Abstract
The recent advent of remote ventilator telemonitoring has the potential to revolutionize home-assisted ventilation care in the United States and elsewhere. Home ventilation machines (i.e., respiratory assist devices and portable ventilators) can now wirelessly transmit usage and performance data to cloud-based web servers for remote access by participating clinicians. In this Focused Review, we provide an update on available technology, suggest practical applications for clinical care and research, and review supporting literature. Remote monitoring permits early data review, refinement of device settings to optimize ventilatory function, and troubleshooting if a new problem arises after initial setup. Data from home spirometry and noninvasively measured blood gas tensions can complement ventilator data to reflect physiological response. Acknowledging a paucity of published outcome studies, remote telemonitoring may be a cost-effective strategy to reduce emergency room visits, urgent clinic appointments, and hospitalizations. Ongoing clinical trials in Europe aim to expand on the benefit of this rapidly evolving technology. However, several barriers may hinder widespread implementation, especially in the United States. Clinicians must familiarize themselves with each ventilator manufacturer’s proprietary software to safely leverage this technology for improving care. Legal and ethical considerations threaten clinician interest. Medical insurance payers must adapt a reimbursement scheme to incentivize clinicians and durable medical equipment companies to perform this time-consuming service. Cohort-level ventilator data will facilitate multicenter clinical trials focused on improving the respiratory care of this vulnerable population.
Collapse
|
35
|
Renda T, Scala R, Corrado A, Ambrosino N, Vaghi A. Adult Pulmonary Intensive and Intermediate Care Units: The Italian Thoracic Society (ITS-AIPO) Position Paper. Respiration 2021; 100:1027-1037. [PMID: 34102641 DOI: 10.1159/000516332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
The imbalance between the prevalence of patients with acute respiratory failure (ARF) and acute-on-chronic respiratory failure and the number of intensive care unit (ICU) beds requires new solutions. The increasing use of non-invasive respiratory tools to support patients at earlier stages of ARF and the increased expertise of non-ICU clinicians in other types of supportive care have led to the development of adult pulmonary intensive care units (PICUs) and pulmonary intermediate care units (PIMCUs). As in other European countries, Italian PICUs and PIMCUs provide an intermediate level of care as the setting designed for managing ARF patients without severe non-pulmonary dysfunction. The PICUs and PIMCUs may also act as step-down units for weaning patients from prolonged mechanical ventilation and for discharging patients still requiring ventilatory support at home. These units may play an important role in the on-going coronavirus disease 2019 pandemic. This position paper promoted by the Italian Thoracic Society (ITS-AIPO) describes the models, facilities, staff, equipment, and operating methods of PICUs and PIMCUs.
Collapse
Affiliation(s)
- Teresa Renda
- Cardio-Thoracic and Vascular Department, Respiratory and Critical Care Unit, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Cardio-Neuro-Thoracic and Metabolic Department, Pulmonology and Respiratory Intensive Care Unit, Arezzo, Italy
| | | | - Nicolino Ambrosino
- Respiratory Rehabilitation Unit of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Adriano Vaghi
- President of Italian Thoracic Society, Italian Association of Hospital Pulmonologists (ITS-AIPO), Milan, Italy
| | | |
Collapse
|
36
|
Onofri A, Pavone M, De Santis S, Verrillo E, Caggiano S, Ullmann N, Cutrera R. Telemedicine in children with medical complexity on home ventilation during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:1395-1400. [PMID: 33524228 PMCID: PMC8013575 DOI: 10.1002/ppul.25289] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
Children with medical complexity (CMC) are patients with one or more complex chronic conditions dependent on medical technologies. In our unit (Pediatric Pulmonology and Respiratory Intermediate Care Unit, Department of Pediatrics, "Bambino Gesù" Children's Hospital and Research Institute), we regularly follow-up CMC patients, particularly children on long-term, invasive (IMV) or noninvasive (NIV), ventilation. Children suffering from chronic diseases and with medical complexity have lost the possibility to go to the hospital during the COVID-19 pandemic. The aim of this article is to describe our experience with telemedicine (teleconsultation [TC] and telemonitoring of ventilator [TM]) in CMC on ventilation. We presented 21 children on long-term ventilation (NIV or IMV) whose planned hospital admission was postponed due to lockdown. A total of 12 healthcare problems were detected during scheduled TCs. Only one problem was not solved by our remote intervention. Specifically, TM has allowed us to change the ventilator parameters and to monitor patients on ventilation remotely. In conclusion, the use of telemedicine in CMC ventilated patients resulted in a feasible tool to avoid in-person visits during the pandemic.
Collapse
Affiliation(s)
- Alessandro Onofri
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone De Santis
- Clinical Technology Innovation Research Area, Health Technology Assessment Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisabetta Verrillo
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Serena Caggiano
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
37
|
Vitacca M, Ambrosino N. The cruel journey through the COVID-19 INFERNO. Pulmonology 2021; 27:281-282. [PMID: 34059470 DOI: 10.1016/j.pulmoe.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia, Italy
| |
Collapse
|
38
|
Tian M, Wang B, Xue Z, Dong D, Liu X, Wu R, Yu L, Xiang J, Zhang X, Zhang X, Lv Y. Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study. JMIR Med Inform 2021; 9:e27175. [PMID: 33999008 PMCID: PMC8167618 DOI: 10.2196/27175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (P=.17), the model for end-stage liver disease score (MELD, P=.14), operation time (P=.51), blood loss (P=.07), and transfusion volume (P=.13). The length and expenses of the initial hospitalization (P=.03 and P=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (P=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (P=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (P=.50). Conclusions Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.
Collapse
Affiliation(s)
- Min Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhao Xue
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dinghui Dong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuemin Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junxi Xiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaogang Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xufeng Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
39
|
Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
Collapse
Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| |
Collapse
|
40
|
Amin R, Pizzuti R, Buchanan F, Rose L. A virtual care innovation for home mechanical ventilation. CMAJ 2021; 193:E607-E611. [PMID: 33903132 PMCID: PMC8101977 DOI: 10.1503/cmaj.202584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine (Amin), Department of Pediatrics, The Hospital for Sick Children; SickKids Research Institute, (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Kingston Health Sciences Centre, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, London, UK
| | - Regina Pizzuti
- Division of Respiratory Medicine (Amin), Department of Pediatrics, The Hospital for Sick Children; SickKids Research Institute, (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Kingston Health Sciences Centre, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, London, UK
| | - Francine Buchanan
- Division of Respiratory Medicine (Amin), Department of Pediatrics, The Hospital for Sick Children; SickKids Research Institute, (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Kingston Health Sciences Centre, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, London, UK
| | - Louise Rose
- Division of Respiratory Medicine (Amin), Department of Pediatrics, The Hospital for Sick Children; SickKids Research Institute, (Amin, Buchanan), Toronto, Ont.; The Ontario Ventilator Equipment Pool (Pizzuti), Kingston Health Sciences Centre, Kingston, Ont.; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (Rose), King's College, London, UK
| |
Collapse
|
41
|
Paneroni M, Vitacca M, Bernocchi P, Bertacchini L, Scalvini S. Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia. Pulmonology 2021; 28:152-154. [PMID: 33893061 PMCID: PMC8045455 DOI: 10.1016/j.pulmoe.2021.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - M Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - P Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy.
| | - L Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - S Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| |
Collapse
|
42
|
Montserrat Canal JM, Suárez-Girón M, Egea C, Embid C, Matute-Villacís M, de Manuel Martínez L, Orteu Á, González-Cappa J, Tato Cerdeiras M, Mediano O. Spanish Society of Pulmonology and Thoracic Surgery positioning on the use of telemedine in sleep-disordered breathing and mechanical ventilation. Arch Bronconeumol 2021; 57:281-290. [PMID: 32646601 PMCID: PMC7338031 DOI: 10.1016/j.arbres.2020.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022]
Abstract
The rapid introduction of new information and communication technologies into medical practice has prompted Spanish Society of Pulmonology and Thoracic SurgeryR to publish a position paper on sleep-disordered breathing, especially in relation to positive pressure treatment. It should be pointed out that the scientific literature is to some extent controversial due to a paucity of large randomized multicenter studies with long-term follow-up. Moreover, the telematics devices and systems on the market vary widely. As a result, the recommendations are based primarily on a consensus of expert professionals. Another very important aspect addressed extensively in this document is the obvious lack of regulations on legal matters and the operations of commercial companies. The most important recommendations included in this position paper are that telemedicine is primarily advocated in subjects with travel problems or who live far from the hospital, in patients with poor CPAP compliance, and in most cases treated with non-invasive mechanical ventilation. A key element is patient individualization. It is imperative that the relevant technical, legal and ethical requirements (medical device regulations, data protection, and informed consent) are met. Finally, expert professionals from our society must contribute to and become involved in spearheading this technological change.
Collapse
Affiliation(s)
- Josep M Montserrat Canal
- Unidad Multidisciplinar de Patología del Sueño y VNID, Servei Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Universidad de Barcelona, Barcelona, España.
| | - Monique Suárez-Girón
- Unidad Multidisciplinar de Patología del Sueño y VNID, Servei Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Barcelona, España
| | - Carlos Egea
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria, España
| | - Cristina Embid
- Unidad Multidisciplinar de Patología del Sueño y VNID, Servei Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Barcelona, España; Universidad de Barcelona, Barcelona, España
| | - Mónica Matute-Villacís
- Unidad Multidisciplinar de Patología del Sueño y VNID, Servei Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Barcelona, España
| | - Luis de Manuel Martínez
- Ilustre Colegio de Abogados de Madrid (ICAM), Corte de Arbitraje de Responsabilidad Sanitaria, Madrid, España
| | - Ángel Orteu
- Consultor independiente ciencias de la salud y equipamiento médico, Proyecto Sleep Smart City Vitoria, Vitoria, España
| | | | | | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Sección de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares (Madrid), España
| |
Collapse
|
43
|
Jiang W, Chao Y, Wang X, Chen C, Zhou J, Song Y. Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:727-737. [PMID: 33790549 PMCID: PMC7997417 DOI: 10.2147/copd.s299819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Home noninvasive positive pressure ventilation (NPPV) can be considered not only as an evidence-based treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients, but also as a predictor for detecting severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods In this retrospective observational study, we collected clinical exacerbations information and daily NPPV-related data in a cohort of COPD patients with home NPPV for 6 months. Daily changes in NPPV-related parameters' variability prior to AECOPD were examined using two-way repeated measures ANOVA and individual abnormal values (>75th or <25th percentile of individual baseline parameters) were calculated during 7-day pre-AECOPD period. Multivariate logistic regression was used to identify the independent risk factors associated with AECOPD that then were incorporated into the nomogram. Results Between January 1, 2018, and January 1, 2020, a total of 102 patients were included and 31 (30.4%) participants experienced hospitalization (AECOPD group) within 6 months. Respiratory rate changed significantly from baseline at 1, 2 or 3 days prior to admission (p<0.001, respectively) in the AECOPD group. The number of days with abnormal values of daily usage, leaks, or tidal volume during the 7-day pre-AECOPD period in the AECOPD group was higher than in the stable group (p<0.001, respectively). On multivariate analysis, 7-day mean respiratory rate (OR 1.756, 95% CI 1.249-2.469), abnormal values of daily use (OR 1.918, 95% CI 1.253-2.934) and tidal volume (OR 2.081, 95% CI 1.380-3.140) within 7 days were independently associated with the risk of AECOPD. Incorporating these factors, the nomogram achieved good concordance indexes of 0.962. Conclusion Seven-day mean respiratory rate, abnormal values of daily usage, leaks, and tidal volume within the 7-day pre-AECOPD period may be biomarkers for detection of AECOPD.
Collapse
Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yencheng Chao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaoyue Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Cuicui Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jian Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Shanghai, 200032, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200000, People's Republic of China.,Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, 201700, People's Republic of China.,Department of Pulmonary Medicine, Jinshan Hospital of Fudan University, Shanghai, 201508, People's Republic of China
| |
Collapse
|
44
|
Ikuta K, Maeda I, Hatano Y, Mori I, Fukui S. Feasibility and Clinical Usefulness of a Novel Nonwearable Sheet-Type Monitor (Nemuri SCAN): Prognostic Value of Increased Respiratory Rate in Actively Dying Patients. J Palliat Med 2021; 24:1634-1640. [PMID: 33733880 DOI: 10.1089/jpm.2020.0508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to explore the feasibility of monitoring actively dying patients hospitalized in a palliative care unit using a nonwearable sheet-type monitor that measured the state of sleep and vital signs per minute. In addition, we aimed to clarify the incidence of increased respiratory rate and its relationship with survival time. Design and Measurement: This study was conducted at a 51-bed palliative care unit in Japan from April 2018 through October 2019. Actively dying patients hospitalized in the palliative care unit were eligible to participate. Increased respiratory rate was measured by Nemuri SCAN, and patient's information was extracted from their medical records. Results: In this study, 23 patients were monitored until death; 19 patients with an observational period of 7 days or longer (163 patient days in total) were included in this analysis. There were no adverse events due to use of the nonwearable device. The cumulative incidence of increased respiratory rate (defined as more than 30 respiratory rate per minute) was 63.16% during the observational period, and the mean time between appearance of increased respiratory rate and death was 4.17 ± 4.04 days. Conclusion: This study clearly shows that hospitalized actively dying patients can be monitored using a nonwearable sheet-type monitor that measures sleeping state and vital signs per minute. Further studies are needed to utilize these noninvasive continuous monitoring devices in daily clinical practice.
Collapse
Affiliation(s)
- Kasumi Ikuta
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Ichiro Mori
- Palliative Care Surgery, Kawanishi Municipal Hospital, Kawanishi, Japan
| | - Sakiko Fukui
- Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
45
|
Jiang W, Wang L, Song Y. Titration and follow-up for home noninvasive positive pressure ventilation in chronic obstructive pulmonary disease: The potential role of tele-monitoring and the Internet of things. CLINICAL RESPIRATORY JOURNAL 2021; 15:705-715. [PMID: 33705593 DOI: 10.1111/crj.13352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Home noninvasive positive pressure ventilation (NIPPV) has become a well-established treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate titration of ventilator parameters, adequacy of follow-up, monitoring, and management at home to ensure effectiveness and security, and to improve quality of life. The Internet of Things (IoT) is the name given to the network of devices and other "things" with built-in sensors, software, electronics, and network connectivity, which can communicate these objects over wireless networks and then send data to a cloud platform. Reliable tele-monitoring and transmission of clinical parameters from home to hospitals have prompted the development of IoT-based home NIPPV. OBJECTIVES This review provides an overview of titration and follow-up of home NIPPV and focuses on different technologies, modalities, managements, and cost-effectiveness used in IoT-based tele-monitoring of home mechanical ventilation. DATA SOURCE Literature search of Web of Science, PubMed, and EMBASE was made to find relevant articles about tele-monitoring and the IoT in home mechanical ventilation over the last 15 years. We used the following search terms: NIPPV, COPD, home mechanical ventilation, telemedicine, tele-monitoring, and management. CONCLUSION IoT-based management of home NIPPV, such as home titration and follow-up with the use of tele-monitoring, are emerging and yielding positive findings. However, clear conclusions based on RCT of tele-monitoring in COPD patients with NIPPV at home are only a few and large-scale multicenter studies are required for replication and further validation.
Collapse
Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Linlin Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - YuanLin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Respiratory Research Institute, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, China.,Department of Pulmonary Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| |
Collapse
|
46
|
Jeganathan V, Rautela L, Conti S, Saravanan K, Rigoni A, Graco M, Hannan LM, Howard ME, Berlowitz DJ. Typical within and between person variability in non-invasive ventilator derived variables among clinically stable, long-term users. BMJ Open Respir Res 2021; 8:8/1/e000824. [PMID: 33664121 PMCID: PMC7934749 DOI: 10.1136/bmjresp-2020-000824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Despite increasing capacity to remotely monitor non-invasive ventilation (NIV), how remote data varies from day to day and person to person is poorly described. Methods Single-centre, 2-month, prospective study of clinically stable adults on long-term NIV which aimed to document NIV-device variability. Participants were switched to a ventilator with tele-monitoring capabilities. Ventilation settings and masking were not altered. Raw, extensible markup language data files were provided directly from Philips Respironics (EncoreAnywhere). A nested analysis of variance was conducted on each ventilator variable to apportion the relative variation between and within participants. Results Twenty-nine people were recruited (four withdrew, one had insufficient data for analyses; 1364 days of data). Mean age was 54.0 years (SD 18.4), 58.3% male with body mass index of 37.0 kg/m2 (13.7). Mean adherence was 8.53 (2.23) hours/day and all participants had adherence >4 hours/day. Variance in ventilator-derived indices was predominantly driven by differences between participants; usage (61% between vs 39% within), Apnoea–Hypopnoea Index (71% vs 29%), unintentional (64% vs 36%) and total leak (83% vs 17%), tidal volume (93% vs 7%), minute ventilation (92% vs 8%), respiratory rate (92% vs 8%) and percentage of triggered breaths (93% vs 7%). Interpretation In this clinically stable cohort, all device-derived indices were more varied between users than the day-to-day variation within individuals. We speculate that normative ranges and thresholds for clinical intervention need to be individualised, and further research is necessary to determine the clinically important relationships between clinician targets for therapy and patient-reported outcomes.
Collapse
Affiliation(s)
- Vishnu Jeganathan
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Linda Rautela
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
| | - Simon Conti
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Krisha Saravanan
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Alyssa Rigoni
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liam M Hannan
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Respiratory Medicine, Northern Health, Epping, Victoria, Australia
| | - Mark E Howard
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David J Berlowitz
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia .,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
47
|
Pierucci P, Santomasi C, Ambrosino N, Portacci A, Diaferia F, Hansen K, Odemyr M, Jones S, Carpagnano GE. Patient's treatment burden related to care coordination in the field of respiratory diseases. Breathe (Sheff) 2021; 17:210006. [PMID: 34295410 PMCID: PMC8291948 DOI: 10.1183/20734735.0006-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.
Collapse
Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Carla Santomasi
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Andrea Portacci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Fabrizio Diaferia
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Kjeld Hansen
- European Lung Foundation Chair, Sheffield, UK
- Dept of Technology, Kristiana University College Oslo, Norway
| | - Mikaela Odemyr
- European Lung Foundation Council Member and Patient Advisory Committee Chair, Sheffield, UK
| | - Steve Jones
- European Lung Foundation Council Member, Sheffield, UK
- Action for Pulmonary Fibrosis, Peterborough, UK
- EU IPFF, Brussels, Belgium
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| |
Collapse
|
48
|
Proietti S, Basulto-Martinez M, Pavia MP, Luciani L, Gaboardi F, Giusti G. Decision making and treatment options in endourology post-coronavirus disease 2019 - adapting to the future. Curr Opin Urol 2021; 31:109-114. [PMID: 33394610 DOI: 10.1097/mou.0000000000000857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe and critically discuss the most recent evidence regarding stone management during the coronavirus disease 2019 (COVID-19) and post-COVID-19 era. RECENT FINDINGS There is a need to plan for resuming the normal elective stone surgery in the post-COVID era, keeping a clear record of all surgeries that are being deferred and identifying subgroups of surgical priorities, for the de-escalation phase. Telehealth is very useful because it contributes to reduce virus dissemination guaranteeing at the same time an adequate response to patients' care needs. Once the pandemic is over, teleurology will continue to be utilized to offer cost-effective care to urological patients and it will be totally integrated in our clinical practice. SUMMARY This COVID-19 pandemic represents a real challenge for all national health providers: on the one hand, every effort should be made to assist COVID patients, while on the other hand we must remember that all other diseases have not disappeared in the meanwhile and they will urgently need to be treated as soon as the pandemic is more under control. A correct prioritization of cases when surgical activity will progressively return back to normality is of paramount importance.
Collapse
Affiliation(s)
- Silvia Proietti
- Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan
| | - Mario Basulto-Martinez
- Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan
| | - Maria Pia Pavia
- Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan
- Department of Urology, University Hospital 'Ospedale Riuniti', Marche Polytechnic University, Ancona
| | | | - Franco Gaboardi
- Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan
| | - Guido Giusti
- Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan
| |
Collapse
|
49
|
Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
Collapse
Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| |
Collapse
|
50
|
Ribeiro C, Conde S, Oliveira P, Nogueira C, Ferreira D, Adler D, Windisch W, Nunes R. Portuguese adaptation of the S3-non-invasive ventilation (S3-NIV) questionnaire for home mechanically ventilated patients. Pulmonology 2020; 28:262-267. [PMID: 33388296 DOI: 10.1016/j.pulmoe.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022] Open
Abstract
Short, valid and easy to use tools are needed to monitor non-invasive ventilation in clinical practice and for organization of home mechanical ventilation services. The aim of this study was to develop a professional translation and cultural adaptation of the Portuguese S3 non-invasive ventilation questionnaire. 234 stable patients (128 male patients, 53.8%) with a mean age of 69.3 years under long-term home non-invasive ventilation were recruited from a single-center outpatient clinic. The most frequent diagnostic groups were obesity hypoventilation syndrome, chronic obstructive pulmonary disease and restrictive chest wall disorders. The Portuguese version of the questionnaire was obtained using translation back-translation process with two professional translators. Internal consistency for the total score was good (Cronbach's α coefficient of 0.76) as well as for the "respiratory symptoms" and the "sleep and side effects" domains (Cronbach's α coefficient=0.68 and Cronbach's α coefficient=0.72, respectively). An exploratory factor analysis was performed leading to an explained variance of 54.6%, and resulted in 3 components. The Portuguese version of the S3-NIV questionnaire is a simple and valid tool for the routine clinical assessment of patients receiving home NIV.
Collapse
Affiliation(s)
- C Ribeiro
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
| | - S Conde
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - P Oliveira
- ISPUP-EPIUnit, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - C Nogueira
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - D Ferreira
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - D Adler
- Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - W Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - R Nunes
- Faculdade de Medicina da Universidade do Porto, Portugal
| |
Collapse
|