Patient activation and health-related quality-of-life in association with smartwatch alerts for atrial fibrillation detection

Background

Smartwatches with various alert systems are becoming increasingly popular in the detection of atrial fibrillation (AF) post stroke, however their impact on psychological well-being remains unknown.

Purpose

Assess the association between smartwatch alerts for detected atrial fibrillation in older stroke survivors and patient activation as well as health-related quality-of-life.

Methods

Data were used from the Pulsewatch study, a multiphase, randomized controlled trial, which enrolled older adults (≥50 years of age) from the UMass Memorial Health System with history of a stroke and no contraindications to anticoagulation, who were given a smartwatch for AF detection. In Phase I, participants were randomized 3:1 (intervention:control) to receive a smartwatch/smartphone pair and an FDA-approved cardiac patch monitor or only the patch (control) to monitor for AF for 14 days. In Phase II, participants were re-randomized 1:1, with the intervention group being offered the smartwatch/smartphone pair for an extra 30 days. Participants were grouped into those receiving at least one alert of a possible abnormal rhythm versus those who did not receive any alerts from their smartwatch. At baseline, 14 days, and 44 days the Consumer Health Activation Index was used to assess patient activation and the Physical and Mental Component Summary of Short-Form Health Survey were utilized to evaluate physical and mental health-related quality-of-life, respectively. Mixed-effects repeated measures linear regression models were used to examine changes in patient activation and physical and mental health-related quality-of-life, in relation to alerts, adjusting for confounding variables including age, sex, race, history of arrhythmias, history of congestive heart failure, history of coronary artery disease, baseline depression, and baseline cognitive impairment, over the study period.

Results

94 participants (64.6±9.1 years of age, 87.2% non-Hispanic white, and 43.6% female) were included in the analysis; 16 of whom received at least one alert. Specifically, twelve participants received 1 to 3 alerts, three participants received 11 to 18, and one participant received 226. In fully adjusted models, receiving alerts was not associated with changes in patient activation or mental health-related quality-of-life (β −1.70, p-value 0.60 and β 2.85, p-value 0.09 respectively), but was associated with a significant reduction in physical health-related quality-of-life (β −4.67, p-value 0.04).

Conclusions

In a cohort of older stroke survivors who wore smartwatches for up to 44 days, reception of alerts was not significantly associated with changes in patient activation or mental health-related quality-of-life but was significantly related to a decline in physical health-related quality-of-life. Further studies are necessary to explore the use of smartwatches in AF screening and their impact on psychological health and quality-of-life.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): R01HL137734 from the National Heart, Lung, and Blood Institute

Primary Hodgkin's Lymphoma of bone in 7-year-old- an exceptional case report of youngest child in literature

Hodgkin lymphoma (HL) is mainly considered a nodal disease but extra nodal involvement can also be seen with variable frequency. Solitary bone involvement in HL known as Primary osseous hodgkin lymphoma (POHL) is very rare. It is defined as a lymphoma that is restricted to the bone without any simultaneous organ or lymph node involvement at the time of initial diagnosis. Primary Hodgkin lymphoma of the bone can be very challenging to diagnose because of its rarity especially in children and its variable presentation. Here we report the youngest case of POHL in a girl 7 years of age. She presented with the left leg pain and B-symptoms of fever and weight loss. Initial workup and imaging were suggestive of infection or a bone tumor. Bone biopsy of left hip joint after the multiple courses of antibiotics revealed Reed Sternberg cells in the mixed inflammatory background with CD30 and PAX-5 immunohistochemical positivity confirming classical hodgkin lymphoma, mixed cellularity type. CD99 and CD1a were negative excluding ewing sarcoma and langerhan cell Histiocytosis respectively. Absence of significant lymphadenopathy or visceromegaly on staging computerized tomography (CT) scan confirmed a very rare POHL. She received standard conventional chemotherapy with radiation. Our patient is in remission for five years after treatment.

Start-up designs for response-adaptive randomization procedures with sequential estimation

Response-adaptive randomization procedures are appropriate for clinical trials in which two or more treatments are to be compared, patients arrive sequentially and the response of each patient is recorded before the next patient arrives. However, for those procedures that involve sequential estimation of model parameters, start-up designs are commonly required in order to provide initial estimates of the parameters. In this paper, a suite of such start-up designs for two treatments and binary patient responses are considered and compared in terms of the numbers of patients required in order to give meaningful parameters estimates, the number of patients allocated to the better treatment, and the bias in the parameter estimates. It is shown that permuted block designs with blocks of size 4 are to be preferred over a wide range of parameter values. For the case of two treatments, normal responses and selected start-up procedures, a design incorporating complete randomization followed appropriately by repeats of one of the treatments yields the minimum expected number of patients and is to be preferred.

Paediatric day case tonsillectomy: a safe, feasible and an economical way to treat patients – Yorkhill experience

Introduction

Day case surgery is widely encouraged as it has many benefits. In this study, we evaluate the feasibility of paediatric tonsillectomies as day case surgery procedures in a tertiary paediatric centre.

Methods

The outcome of paediatric tonsillectomy performed as day case procedures was studied for four months. We recorded complication rates in comparison to the standard in-patient practice.

Results

23 paediatric patients were included in this study. The age of the patients ranged from four to 11 years, with mean age of 6.5. No patients suffered post-operative complications within the first 24 h. Two patients were re-admitted due to a post-operative complication (8.6%) and one patient for a non-operative cause (4.3%) beyond the initial 24 h.

Conclusion

Paediatric Day Case Paediatric Tonsillectomy is a safe, feasible and an economical way to manage patients. It should be practised as a day case where appropriate and when criteria are met.

Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan?

As private medical practitioners play a major role of in providing care to pulmonary tuberculosis [TB] patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed [80%] and treated [83%] cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority [76%] used only clinical assessment

Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan?

As private medical practitioners play a major role of in providing care to pulmonary tuberculosis (TB) patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed (80%) and treated (83%) cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority (76%) used only clinical assessment.

Health care seeking behavior of pulmonary tuberculosis patients visiting TB Center Rawalpindi

OBJECTIVE

To determine the health care seeking behavior of TB patients in seeking care and health care providers for delivering care.

DESIGN

Cross sectional descriptive survey. The interviewers administered a standardized open-ended questionnaire after training and pre-testing.

SETTING

Federal Government TB Center, Rawalpindi. (specialized TB clinic).

SUBJECT

One hundred and sixty newly registered TB patients at TB Center, Rawalpindi between 20 November to 21 December 1998.

RESULTS

Prior to their consulting TB Center, 96% patients had already reported to a health care provider, i.e., to first, second or third health care providers. OF 154 patients, 48 were diagnosed as TB and only 29 (19%) of them received antituberculosis treatment. Most of the patients 118 (77%) consulted the health care provider within three weeks time.

CONCLUSION

Delay is more on part of health care providers than on patients. Proper implementation of guidelines of TB program with public-private sector collaboration and continuing education of health care providers is necessary.

Nasal leishmaniasis

Leishmaniasis is an uncommon condition in Western Europe, except around the Mediterranean coast. However, it may occasionally be seen in the United Kingdom, in patients who acquired the infection in foreign lands. An unusual case of localized cutaneous leishmaniasis recidiva affecting the nose after septal surgery is presented.