Telemedical monitoring and coaching improves survival and hospitalisation rates in heart failure

Aims

To investigate the effectiveness of a combined telemonitoring and telecoaching programme for chronic heart failure patients at high risk for hospitalisation compared to usual care in a real life setting. The applied telehealth programme consisted of regular individualised telecoaching sessions as well as daily remote telemonitoring of heart failure signs and symptoms.

Methods

Between January 2018 and September 2020, 6,065 heart failure patients were enrolled in a combined telehealth programme and retrospectively compared to a propensity matched usual care group (n=6,065). All participants were members of a statutory health insurance. Median follow-up was 442 days (IQR 309–681). Endpoints were all cause mortality, number and duration of hospitalisations.

Results

After 1 year the combined telecoaching and telemonitoring programme significantly reduced all-cause mortality probability compared to usual care (11.0 vs. 5.8%, p<0.001). The corresponding number-needed to treat to prevent one death in one year was 19.3. In addition, the number of hospitalisations for heart failure (17.9 vs. 21.8 per 100 patient years, p<0.001) and all cause hospitalisations (129.0 vs. 133.2, p=0.015), as well as their duration (2.0 vs. 2.6 days per year p<0.001, and 12.0 vs. 13.4 days per year p>0.001, respectivel y) were significantly lower in the telehealth group than in the usual care group.

Conclusion

In ambulatory heart failure patients at high risk for hospitalisation, a combined telemonitoring and telecoaching programme led to a reduction of heart failure hospitalisations and all-cause mortality compared to standard care.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Health Care Systems GmbH (HCSG), Pullach i. Isartal

Parallel Resolved Open Source CFD-DEM: Method, Validation and Application

In the following paper the authors present a fully parallelized Open Source method for calculating the interaction of immersed bodies and surrounding fluid. A combination of computational fluid dynamics (CFD) and a discrete element method (DEM) accounts for the physics of both the fluid and the particles. The objects considered are relatively big compared to the cells of the fluid mesh, i.e. they cover several cells each. Thus this fictitious domain method (FDM) is called resolved. The implementation is realized within the Open Source framework CFDEMcOupling ( www.cfdem.com ), which provides an interface between OpenFOAM® based CFD-solvers and the DEM software LIGGGHTS ( www.liggghts.com ). While both LIGGGHTS and OpenFOAM® were already parallelized, only a recent improvement of the algorithm permits the fully parallel computation of resolved problems. Alongside with a detailed description of the method, its implementation and recent improvements, a number of application and validation examples is presented in the scope of this paper.

Prevalence of fractures in women with intellectual disabilities: a chart review

BACKGROUND

Numerous studies have demonstrated high rates of osteoporosis and fractures in women with intellectual disabilities (IDs). All of the studies use either institutionalized women or women in the community recruited at adult day-care centres or specialty clinics. We examined the prevalence of fractures in women with IDs who attend a primary care clinic, and assessed osteoporosis-prevention/intervention activities.

METHODS

This was a chart review study. Charts were identified of women with an ICD-9 diagnosis code for ID, Down syndrome or developmental disabilities. All charts reviewed were patients of one of 13 family medicine clinics affiliated with Department of Family Medicine, the University of Wisconsin.

RESULTS

A total of 93 charts were reviewed. More than 32% (30/93) of the charts contained a history of an adult-onset fracture. Increasing age, being postmenopausal and taking anticonvulsant medications were significantly associated with having a fracture. The average age of first fracture was 41.7 years. Of the women with a fracture, 35.5% were placed on a medication to maintain bone density, 67.7% received a recommendation for a calcium supplement, and 38.7% obtained a bone density test.

DISCUSSION

The prevalence of fractures in women with IDs attending a family medicine clinic was very high, and fractures occurred at young ages. Primary care providers need to consider women with IDs at a high risk for fractures and begin preventive counselling in young women.

HLA-A, B, Cw and DRB1, DRB3/4/5, DQB1, DPB1 frequencies in German immunoglobulin A-deficient individuals

HLA class I and II frequencies and haplotype frequencies were determined in 80 German immunoglobulin (Ig)A-deficient individuals and 157 healthy controls with normal IgA levels using serological and DNA typing methods. For several alleles, significant associations were found, which could be explained mainly in the context of a positive association with three different extended haplotypes (HLA-B*08:DRB1*0301: DQB1*0201, HLA-B*14:DRB1*0102:DQB1*0501 and HLA-B*44:DRB1*0701:DQB1*0202) and a negative association with a fourth haplotype (HLA-B*07:DRB1*1501:DQB1*0602). Furthermore, for the first time this study reports a positive association of IgA deficiency with DPB1 alleles. Homozygosity rate for the gene loci DRB1 and DQB1 was increased in IgA deficiency. Further analysis suggested a different pattern of HLA associations depending on the degree of IgA deficiency and the gender of the IgA-deficient individuals.

Survival of Trichomonas gallinae in white-winged dove carcasses

Survival of Trichomonas gallinae was examined in white-winged dove (Zenaida asiatica) carcasses to assess whether birds that have been dead up to 8 hr can be sampled reliably for this protozoan. Carcasses of 100 T. gallinae-positive white-winged doves were separated into four groups of 25 birds, representing 2, 4, 6, and 8 hr post mortem sampling intervals and placed into an environmental chamber maintained at 27 C and 75% relative humidity. Live T. gallinae were isolated in 96, 100, 100, and 92% of the carcasses at each of the respective post mortem intervals. The experiment was repeated with another 100 carcasses of T. gallinae-positive white-winged doves placed in the environmental chamber, this time maintained at 27 C and 40% relative humidity. Live T. gallinae occurred in 96, 100, 96, and 100% of the carcasses at each of the respective post mortem intervals. Across both trials, the overall ability to detect positive birds from sampling carcasses up to 8 hrs post mortem was 97%. An a posteriori experiment was conducted in which 23 and 18 carcasses from the second trial were maintained in the environmental chamber at 27 C and 40% relative humidity and resampled at 24 and 48 hr post mortem, respectively. Live trichomonads were isolated from 91 and 44% of the carcasses at 24 and 48 hr, respectively. Results suggest live T. gallinae can be obtained from dove carcasses reliably up to 8 hr and possibly up to 24 hr after host death. The ability for T. gallinae to survive within this time interval can aid wildlife personnel in monitoring this protozoan at hunter check stations or obtaining samples from recently killed birds.

Regulation of MCSF receptors on microglia in the normal and injured mouse central nervous system: a quantitative immunofluorescence study using confocal laser microscopy

The macrophage colony-stimulating factor (MCSF) is a 40-76-kD glycoprotein that plays an important role in the activation and proliferation of microglia both in vitro and in injured neural tissue. Here, we examined the regulation of MCSF receptor (MCSFR) and MCSF in the normal and injured mouse central nervous system (CNS) by using confocal laser microscopy, quantitative immunofluorescence, and reverse transcriptase-polymerase chain reaction (RT-PCR) techniques. Immunohistochemistry on fixed, floating tissue sections demonstrated low to moderate MCSFR immunoreactivity (MCSFR-IR) on microglia in the gray and white matter throughout the mouse CNS in the forebrain, brainstem, cerebellum, and spinal cord. High levels of MCSFR-IR were restricted to the superficial layer of the spinal cord dorsal horn, substantia nigra, and area postrema, a CNS region that lacks the blood-brain barrier. CNS injury led to a strong and specific increase in MCSFR-IR in the directly injured dorsal forebrain, in the cervical spinal cord (C2) after transection of the sensory, minor occipital nerve, and in the axotomized facial motor nucleus. Further investigation at the mRNA level in the facial nucleus model showed that this increase was accompanied by a rapid induction of the transcript for MCSFR, with a peak 1-2 days after injury, but only a constitutive expression of MCSF-mRNA. In summary, although normal levels of MCSF receptor in most microglia are low, microglial activation is accompanied by a rapid and massive increase. In view of the constitutive expression of MCSF, the early upregulation of the MCSF receptor may play a central role in preparing these macrophage-related cells to take part in the cellular response to CNS injury.