Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

The Role of the Internet of Things in Health Care: A Systematic and Comprehensive Study

The Internet of Things (IoT) is becoming an emerging trend and has significant potential to replace other technologies, where researchers consider it as the future of the internet. It has given tremendous support and become the building blocks in the development of important cyber-physical systems and it is being severed in a variety of application domains, including healthcare. A methodological evolution of the Internet of Things, enabled it to extend to the physical world beyond the electronic world by connecting miscellaneous devices through the internet, thus making everything is connected. In recent years it has gained higher attention for its potential to alleviate the strain on the healthcare sector caused by the rising and aging population along with the increase in chronic diseases and global pandemics. This paper surveys about various usages of IoT healthcare technologies and reviews the state of the art services and applications, recent trends in IoT based healthcare solutions, and various challenges posed including security and privacy issues, which researchers, service providers and end users need to pay higher attention. Further, this paper discusses how innovative IoT enabled technologies like cloud computing, fog computing, blockchain, and big data can be used to leverage modern healthcare facilities and mitigate the burden on healthcare resources

Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors

Peters C, Drees A, Leppert F, et al. Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors. In: Ganz W, Kicherer F, Schletz A, eds. Productivity of services NextGen : beyond output/input ; RESER 2011, conference proceedings, September 8th - 9th 2011, Hamburg, Germany. Stuttgart: Fraunhofer-Verl.; 2011

Outlier detection of vital sign trajectories from COVID-19 patients

There is growing interest in continuous wearable vital sign sensors for monitoring patients remotely at home. These monitors are usually coupled to an alerting system, which is triggered when vital sign measurements fall outside a predefined normal range. Trends in vital signs, such as an increasing heart rate, are often indicative of deteriorating health, but are rarely incorporated into alerting systems. In this work, we present a novel outlier detection algorithm to identify such abnormal vital sign trends. We introduce a distance-based measure to compare vital sign trajectories. For each patient in our dataset, we split vital sign time series into 180 minute, non-overlapping epochs. We then calculated a distance between all pairs of epochs using the dynamic time warp distance. Each epoch was characterized by its mean pairwise distance (average link distance) to all other epochs, with large distances considered as outliers. We applied this method to a pilot dataset collected over 1561 patient-hours from 8 patients who had recently been discharged from hospital after contracting COVID-19. We show that outlier epochs correspond well with patients who were subsequently readmitted to hospital. We also show, descriptively, how epochs transition from normal to abnormal for one such patient.Comment: 4 pages, 4 figures, 1 table. Submitted to IEEE BHI 2022, decision pendin

Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke

Aims: After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke. Methods and results: Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA2DS2-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM. Conclusion: Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only

Southwest Research Institute assistance to NASA in biomedical areas of the technology

Significant applications of aerospace technology were achieved. These applications include: a miniaturized, noninvasive system to telemeter electrocardiographic signals of heart transplant patients during their recuperative period as graded situations are introduced; and economical vital signs monitor for use in nursing homes and rehabilitation hospitals to indicate the onset of respiratory arrest; an implantable telemetry system to indicate the onset of the rejection phenomenon in animals undergoing cardiac transplants; an exceptionally accurate current proportional temperature controller for pollution studies; an automatic, atraumatic blood pressure measurement device; materials for protecting burned areas in contact with joint bender splints; a detector to signal the passage of animals by a given point during ecology studies; and special cushioning for use with below-knee amputees to protect the integrity of the skin at the stump/prosthesis interface

The County-Level Impact of Telemedicine: A Difference-in-Differences Analysis of the University of Mississippi Medical Center’s Telemedicine Initiatives

Mississippi has the fewest active physicians per capita of any state, consistently struggles with high rates of acute and chronic illness, and over half of its residents live in rural areas lacking specialty medical care. In an effort to bridge the state’s geographical gap in access to healthcare, the University of Mississippi Medical Center (UMMC) has introduced telemedicine. This study conducts an analysis of some of the societal benefits of UMMC’s telemedicine initiatives using a difference-in-differences identification strategy. This model attempts to obtain the county-level causal effects of implementing telemedicine by evaluating the resulting changes in length of life, quality of life, and other relevant health outcomes. Though this study does not find any statistically significant results, many of the estimates of these changes do indicate movement in the direction of improved county health. This is encouraging given that telemedicine’s widespread use is relatively recent and the analysis may be suffering from a low incidence rate. Some of the estimates are also large with large standard errors, indicating that some telemedicine programs may have a great impact though this model is not able to accurately estimate that impact. These results provide hope that as the use of telemedicine continues to expand in the state of Mississippi collection of related data will enable further and more accurate analysis

Personal Health Technology: CPN based Modeling of Coordinated Neighborhood Care Environments (Hubs) and Personal Care Device Ecosystems

Healthcare supported by mobile devices, or “mHealth,” has rapidly emerged as a very broad ecosystem that can empower safer, more affordable, and more comfortable independent living environments and assist residents to age in place with a variety of well-understood chronic diseases. mHealth ecosystems leverage every available type of regulated medical and consumer-grade Patient Care Devices (or PCDs). mHealth technologies can also support innovative care and reimbursement models like the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs). Although consumer-grade PCDs are becoming ubiquitous, they typically do not provide a large variety of integrated system options for care coordination beyond single individuals. Understanding how to safely implement and use those devices to support heterogeneous mixes of patients, illnesses, devices, medications, and situations in neighborhood contexts is still a case-by-case challenge. By utilizing a well-formalized Colored Petri Nets (CPNs) based approach, this paper provides a proof-of-concept simulation framework for modeling and designing coordinated community care hubs

The Health Disparities Myth

Many experts today insist that bias in the doctor's office will lead to poorer treatment of minority patients. A new monograph by Jonathan Klick of Florida State University and AEI's Sally Satel, The Health Disparities Myth: Diagnosing the Treatment Gap (AEI Press, 2006) found no evidence to support the idea that racially biased doctors are a cause of poor minority health