Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits: a single-center prospective and randomized study

Few data are available on actual follow-up costs of remote monitoring (RM) of implantable defibrillators (ICD). Our study aimed at assessing current direct costs of 1-year ICD follow-up based on RM compared with conventional quarterly in-hospital follow-ups. Methods and results Patients (N=233) with indications for ICD were consecutively recruited and randomized at implant to be followed up for 1 year with standard quarterly inhospital visits or by RM with one in-hospital visit at 12 months, unless additional in-hospital visits were required due to specific patient conditions or RM alarms. Costs were calculated distinguishing between provider and patient costs, excluding RM device and service cost. The frequency of scheduled in-hospital visits was lower in the RM group than in the control arm. Follow-up required 47 min per patient/year in the RM arm versus 86 min in the control arm (p=0.03) for involved physicians, generating cost estimates for the provider of USD 45 and USD 83 per patient/- year, respectively. Costs for nurses were comparable. Overall, the costs associated with RM and standard follow-up were USD 103±27 and 154±21 per patient/year, respectively (p=0.01). RM was cost-saving for the patients: USD 97±121 per patient/year in the RM group versus 287± 160 per patient/year (p=0.0001). Conclusion The time spent by the hospital staff was significantly reduced in the RM group. If the costs for the device and service are not charged to patients or the provider, patients could save about USD 190 per patient/year while the hospital could save USD 51 per patient/year

Postural counseling represents a novel option in pain management of fibromyalgia patients

Background: Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM. Patients and methods: This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score. Results: Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC. Conclusion: Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM

Entanglement Dynamics after a Quench in Ising Field Theory: A Branch Point Twist Field Approach

We extend the branch point twist field approach for the calculation of entanglement entropies to time-dependent problems in 1+1-dimensional massive quantum field theories. We focus on the simplest example: a mass quench in the Ising field theory from initial mass m0 to final mass m. The main analytical results are obtained from a perturbative expansion of the twist field one-point function in the post-quench quasi-particle basis. The expected linear growth of the Rényi entropies at large times mt ≫ 1 emerges from a perturbative calculation at second order. We also show that the Rényi and von Neumann entropies, in infinite volume, contain subleading oscillatory contributions of frequency 2m and amplitude proportional to (mt)−3/2. The oscillatory terms are correctly predicted by an alternative perturbation series, in the pre-quench quasi-particle basis, which we also discuss. A comparison to lattice numerical calculations carried out on an Ising chain in the scaling limit shows very good agreement with the quantum field theory predictions. We also find evidence of clustering of twist field correlators which implies that the entanglement entropies are proportional to the number of subsystem boundary points

From the quantum transfer matrix to the quench action: the Loschmidt echo in XXZ Heisenberg spin chains

We consider the computation of the Loschmidt echo after quantum quenches in the interacting XXZ Heisenberg spin chain both for real and imaginary times. We study two-site product initial states, focusing in particular on the N\ue9el and tilted N\ue9el states. We apply the Quantum Transfer Matrix (QTM) approach to derive generalized TBA equations, which follow from the fusion hierarchy of the appropriate QTM's. Our formulas are valid for arbitrary imaginary time and for real times at least up to a time t0, after which the integral equations have to be modified. In some regimes, t0 is seen to be either very large or infinite, allowing to explore in detail the post-quench dynamics of the system. As an important part of our work, we show that for the N\ue9el state our imaginary time results can be recovered by means of the quench action approach, unveiling a direct connection with the quantum transfer matrix formalism. In particular, we show that in the zero-time limit, the study of our TBA equations allows for a simple alternative derivation of the recently obtained Bethe ansatz distribution functions for the N\ue9el, tilted N\ue9el and tilted ferromagnet states

RUOLO DELLA RM-DWI INTEGRATA DAL PARAMETRO ADC NELLO STUDIO DEL COLESTEATOMA

: La Risonanza Magnetica pesata in diffusione (RM-DWI) distingue qualitativamente il colesteatoma dal tessuto di granulazione nei pazienti con otite media cronica. Il calcolo del coefficiente di diffusione apparente (ADC) consente un'analisi quantitativa identificando un cut-off numerico che differenzia le due tipologie tissutali. MATERIALI E METODI: lo studio retrospettivo ha riguardato 100 pazienti sottoposti a Timpanoplastica per colesteatoma primario o residuo/recidivante. Tutti i pazienti sono stati sottoposti a RM-DWI preoperatoria tra Aprile 2015 e Marzo 2019, con calcolo di ADC (R-version 3.2.5). La presenza di colesteatoma è stata accertata intraoperatoriamente e confermata istologicamente. RISULTATI: i reperti chirurgici di 100 pazienti sono stati confrontati con i valori medi ADC ed analizzata la distribuzione di quest’ultimi per colesteatoma/tessuto di granulazione, evidenziando due gruppi. La differenza nel valore medio di ADC tra colesteatoma (0,86 × 10-3mm2/s) e tessuto di granulazione (2.22×10-3mm2/s) ha rilevato una differenza statisticamente significativa di ADC per i pazienti con/senza colesteatoma (p <2.2 × 10-16). Il modello binomiale di regressione logistica prevede la probabilità dello stato patologico, mediante ADC. Il potere predittivo di questo modello è stato misurato mediante curva ROC e applicando la statistica Youden J sulla curva abbiamo stabilito un valore di probabilità di ~ 0,6 per definire un cut-off (specificità = 1.0 sensibilità = 0.9861111) pari a ADC=1,71×10-3mm2/s. CONCLUSIONI: lo studio ha evidenziato che è possibile stabilire un cut-off di ADC per identificare pre-operatoriamente con elevata significatività statistica la presenza di matrice colesteatomatosa. In tal modo la RM-DWI diviene una “tool diagnostico” utile ed affidabile in quei casi in cui il colesteatoma non è certamente evidenziabile in otomicroscopia e/o nel follow-up di pazienti già sottoposti a primo tempo chirurgico

From the sinh-Gordon field theory to the one-dimensional Bose gas: exact local correlations and full counting statistics

We derive exact formulas for the expectation value of local observables in a one-dimensional gas of bosons with point-wise repulsive interactions (Lieb-Liniger model). Starting from a recently conjectured expression for the expectation value of vertex operators in the sinh-Gordon field theory, we derive explicit analytic expressions for the one-point K-body correlation functions \u27e8(\u3a8\u2020)K(\u3a8)K\u27e9 in the Lieb-Liniger gas, for arbitrary integer K. These are valid for all excited states in the thermodynamic limit, including thermal states, generalized Gibbs ensembles and non-equilibrium steady states arising in transport settings. Our formulas display several physically interesting applications: most prominently, they allow us to compute the full counting statistics for the particle-number fluctuations in a short interval. Furthermore, combining our findings with the recently introduced generalized hydrodynamics, we are able to study multi-point correlation functions at the Eulerian scale in non-homogeneous settings. Our results complement previous studies in the literature and provide a full solution to the problem of computing one-point functions in the Lieb Liniger model