Who approves/pays for additional monitoring?

Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems

Towards remote monitoring and remotely supervised training

The growing number of elderly and people with chronic disorders in our western society puts such pressure on our healthcare system that innovative approaches are demanded to make our health care more effective and more efficient. One way of innovation of healthcare can be obtained by introducing new services which enable less pressure on the intramural health care and support a more independent living and self efficacy of patients. Two of such services are Remote monitoring and remotely supervised training (RMT). Remote monitoring enables freedom to the patient with the assurance that assistance is possible whenever required. Remotely supervised treatment enables efficient and effective user-centred training anywhere and anytime with an intensity not feasible in an intramural setting. It is our vision that remote monitoring and remotely supervised treatment applications will become very important for patients (safety, more in control, convenience), health care insurances (efficiency, cost reduction) and healthcare service providers (more effective, innovative)

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed

Healthcare professional’s guide to cardiopulmonary exercise testing

Cardiopulmonary exercise testing (CPEX) is a valuable clinical tool that has proven indications within the fields of cardiovascular, respiratory and pre-operative medical care. Validated uses include investigation of the underlying mechanism in patients with breathlessness, monitoring functional status in patients with known cardiovascular disease and pre-operative functional state assessment. An understanding of the underlying physiology of exercise, and the perturbations associated with pathological states, is essential for healthcare professionals to provide optimal patient care. Healthcare professionals may find performing CPEX to be daunting, yet this is often due to a lack of local expertise and guidance with testing. We outline the indications for CPEX within the clinical setting, present a typical protocol that is easy to implement, explain the key underlying physiological changes assessed by CPEX, and review the evidence behind its use in routine clinical practice. There is mounting evidence for the use of CPEX clinically, and an ever-growing utilisation of the test within research fields; a sound knowledge of CPEX is essential for healthcare professionals involved in routine patient care

A Comprehensive Ubiquitous Healthcare Solution on an Android™ Mobile Device

Provision of ubiquitous healthcare solutions which provide healthcare services at anytime anywhere has become more favorable nowadays due to the emphasis on healthcare awareness and also the growth of mobile wireless technologies. Following this approach, an Android™ smart phone device is proposed as a mobile monitoring terminal to observe and analyze ECG (electrocardiography) waveforms from wearable ECG devices in real time under the coverage of a wireless sensor network (WSN). The exploitation of WSN in healthcare is able to substitute the complicated wired technology, moving healthcare away from a fixed location setting. As an extension to the monitoring scheme, medicine care is taken into consideration by utilizing the mobile phone as a barcode decoder, to verify and assist out-patients in the medication administration process, providing a better and more comprehensive healthcare service

Home Telemonitoring in Heart Failure

Heart failure (HF) exacerbation is a major source of hospitalization, mortality, and healthcare cost to home health agencies. Unmonitored accumulative fluid retention between skilled nurse visits, base knowledge deficits in HF pathophysiology and dietary restrictions, and lack of basic monitoring equipment such weighing scales are primary contributors to HF related hospitalizations in the home health setting. It has been discovered that early recognition of decompensating HF can reduce or eliminate HF related hospitalization, mortality, and healthcare costs associated with the management of exacerbation. When a patient is sent to the emergency room (ER) for fluid overload secondary to HF, massive costs are generated including ER transportation, ER consultation fees, hospital stay fee if admitted, and increased home health visit fees for adding additional skilled nurse visits for follow up assessments. Having a method of filling in the monitoring gaps of this patient population can reduce negative outcomes associated with managing HF in home health. The current method of monitoring weekly or bi-weekly by a skilled nurse in these complex HF patients is not best practice. For patients to receive improved and effective HF monitoring on non-skilled nurse days, additional monitoring options should be implemented. Technological advancement in modern healthcare allows the integration of technology to aide in reducing the negative impact HF exacerbation has on home health agencies. Telemonitoring (TM) heart failure in the home health setting is an evidence-based implementation option to reduce patient mortality, decrease healthcare costs, and assist healthcare providers in accessing current and relevant data for point-of-care decision making. TM devices should be installed in the homes of patients who meet the HF exacerbation risk criteria to reduce hospitalization, mortality, and healthcare costs

Pharmacist intervention in patient monitoring in a psychiatric setting

OBJECTIVES: To develop a ‘Patient Monitoring Tool’ (PMT) to evaluate the quality of pharmaceutical care provided to patients in a psychiatric setting and to determine benefits of ward-based pharmacist services in this setting. METHOD: A PMT consisting of ‘Patient Monitoring Guidelines’ (PMG) and a ‘Pharmaceutical Care Issues Documentation Sheet’ (PCIDS) was developed. The tool was tested for validity, applicability, practicality and reliability and used to monitor 30 patients in an acute psychiatric ward. The PMT was implemented and evaluation was carried out after 4 weeks using a self-administered evaluation questionnaire. KEY FINDINGS: The developed PMT was found to be valid, applicable, practical and reliable for use in the psychiatric setting. A total of 75 pharmaceutical care issues (PCIs) were identified; 55 involved psychotropic medications. A positive evaluation of the tool was obtained. CONCLUSION: This study demonstrated that the proposed tool can be implemented in an acute psychiatric setting and patient monitoring may lead to optimisation of patient care. Pharmacist incorporation into the multidisciplinary healthcare team and direct patient involvement may further enhance the value of such services.peer-reviewe

Under the Cover Infant Pose Estimation using Multimodal Data

Infant pose monitoring during sleep has multiple applications in both healthcare and home settings. In a healthcare setting, pose detection can be used for region of interest detection and movement detection for noncontact based monitoring systems. In a home setting, pose detection can be used to detect sleep positions which has shown to have a strong influence on multiple health factors. However, pose monitoring during sleep is challenging due to heavy occlusions from blanket coverings and low lighting. To address this, we present a novel dataset, Simultaneously-collected multimodal Mannequin Lying pose (SMaL) dataset, for under the cover infant pose estimation. We collect depth and pressure imagery of an infant mannequin in different poses under various cover conditions. We successfully infer full body pose under the cover by training state-of-art pose estimation methods and leveraging existing multimodal adult pose datasets for transfer learning. We demonstrate a hierarchical pretraining strategy for transformer-based models to significantly improve performance on our dataset. Our best performing model was able to detect joints under the cover within 25mm 86% of the time with an overall mean error of 16.9mm. Data, code and models publicly available at https://github.com/DanielKyr/SMa

What We Know So Far: Artificial Intelligence in African Healthcare

Healthcare in Africa is a complex issue influenced by many factors including poverty, lack of infrastructure, and inadequate funding. However, Artificial intelligence (AI) applied to healthcare, has the potential to transform healthcare in Africa by improving the accuracy and efficiency of diagnosis, enabling earlier detection of diseases, and supporting the delivery of personalized medicine. This paper reviews the current state of how AI Algorithms can be used to improve diagnostics, treatment, and disease monitoring, as well as how AI can be used to improve access to healthcare in Africa as a low-resource setting and discusses some of the critical challenges and opportunities for its adoption. As such, there is a need for a well-coordinated effort by the governments, private sector, healthcare providers, and international organizations to create sustainable AI solutions that meet the unique needs of the African healthcare system.Comment: 8 pages, 1 figure, AAAI-23 conference in Washington, DC, International Workshop on the Social Impact of AI for Africa(SIAIA

Electrocardiographic patch devices and contemporary wireless cardiac monitoring.

Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable “on-body” ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery