Telemedicine in chronic disease management: a Public Health perspective

Introduction In 2014, the School of Hygiene of the University of Padua carried out an evaluation of home telemonitoring (HTM) programs for the management of chronic diseases. Our aims were to verify their efficacy, and to identify a model of care that could be integrated into the current health system. Our analysis addressed both organizational and clinical matters. Methods Our evaluation involved 19 reviews and 53 randomized controlled trials (RCT). Main selection criteria were: papers published over the last 15 years, HTM performed through a sensor system, data sent remotely to physicians, health out-comes and monitored parameters clearly stated. Included diseases were: heart failure, hypertension, COPD, asthma and diabetes. Results Several critical issues were highlighted. Due to the general tendency in the scientific literature to report HTM efficacy, there is a lack of conclusive evidence whether telemedicine actually improves both clinical (e.g. decreased disease/all-cause mortality, drop in disease/all-cause hospitalization rates, improvement in biological parameters and quality of life) and organizational (decreased length of hospital stay, decreased emergency room/other service use, decreased costs) outcomes or not. Discussion From a Public Health perspective, discrepancies and weaknesses may affect published results, since the best method for organizing and delivering telemedicine programs has not yet been identified. There is still no consensus on the following topics: setting: which context expresses the potential of technology best? No studies were found comparing, e.g., rural with urban communities. Within urban scenarios, samples do not discriminate users by their capability to access the healthcare network (e.g. residents in peripheral areas with limited transportation resources, rather than users with reduced mobility); target: it is unclear which demographic or socioeconomic characteristics users should possess to gain most benefit from HTM; duration and frequency: there are significant differences in RCT (and HTM program) duration. It has not been established whether HTM is more effective when permanently implemented, or only in the early stages of disease (i.e. until stabilization). There is no agreement on the optimal HTM implementation frequency, nor whether the patients should also receive traditional interventions (e.g. nurse home visits);scope: it has not been determined whether measurements should be disclosed to patients as educational means to improve disease management. However, past literature does include some indications that the effectiveness of HTM programs may be attributable to care intensification (or to a perceived intensification by the patient, as per the \u201cHawthorne effect\u201d described in sociology) or to the empowerment process. Conclusions HTM management of chronic diseases is a promising and remarkable strategy, still flawed by the lack of evidence. Reported efficacy, although modest, probably has a multifactorial origin. Our hypothesis is that it may not result from the technology itself, but from the impact of such process on multiple components of care, emphasizing patients' involvement and autonomy, and improving monitoring intensity. Further studies are needed to clarify the role played by the different HTM components (target, setting, etc.). The application of HTM as a tool for prevention, empowerment and reduction of healthcare access remains little explored

Clustering verbal Objects: Manual and Automatic Procedures Compared

As highlighted by Pustejovsky (1995, 2002), the semantics of each verb is determined by the totality of its complementation patterns. Arguments play in fact a fundamental role in verb meaning and verbal polysemy, thanks to the sense co-composition principle between verb and argument. For this reason, clustering of lexical items filling the Object slot of a verb is believed to bring to surface relevant information about verbal meaning and the verb-Objects relation. The paper presents the results of an experiment comparing the automatic clustering of direct Objects operated by the agglomerative hierarchical algorithm of the Sketch Engine corpus tool with the manual clustering of direct Objects carried out in the T-PAS resource. Cluster analysis is here used to improve the semantic quality of automatic clusters against expert human intuition and as an investigation tool of phenomena intrinsic to semantic selection of verbs and the construction of verb senses in context

Mouse embryo assay to evaluate polydimethylsiloxane (PDMS) embryo-toxicity

In vitro embryo culture to support In Vitro Fertilization (IVF) procedures is a well-established but still critical technique. In the last decade first attempts to use microfluidic devices in IVF have shown positive results, enabling to control the culture conditions and to preserve the quality of the embryos during their development. In this study we completed an industry standard mouse embryo assay (MEA) to exclude potential toxic effects of PDMS

hbim in a semantic 3d gis database

Abstract. This work describes the different attempts and the consequent results derived from the integration of an HBIM model into an already structured spatial database (DB) and its 3D visualisation in a GIS project.This study is connected to the European ResCult (Increasing Resilience of Cultural Heritage) project where a DB for multiscale analyses was defined. To test the methodology proposed, the case study of Santa Maria dei Miracoli church in Venice was chosen since it represents a complex architectural heritage piece in a risk zone, it has been subject to a vast restoration intervention in the recent past but a digital documentation and model concerning it was missing.The 3D model of the church was structured in Revit as a HBIM, with the association of different kind of information and data related to the architectural elements by means of 'shared parameters' and 'system families'. This procedure allows to reach an even higher Level of Detail (LOD4), but lead to some issues related to the semantic and software interoperability. To solve these problems the existing DB for the resilience of cultural heritage was extended adding a new entity representing the architectural elements designed in the BIM project.The aim of the test is to understand how the data and attributes inserted in the HBIM are converted and handled when dealing with a GIS DB, stepping from the IFC to the CityGML standard, through the FME software.</p

From Collar to Coccyx: Truncal Movement Disorders: A Clinical Review

BACKGROUND: Movement disorders affecting the trunk remain a diagnostic challenge even for experienced clinicians. However, despite being common and debilitating, truncal movement disorders are rarely discussed and poorly reviewed in the medical literature. OBJECTIVES: To review common movement disorders affecting the trunk and provide an approach for clinicians based on the truncal region involved (shoulder, chest, diaphragm, abdomen, pelvis, and axial disorders). For each disorder, clinical presentation, etiologic differential diagnosis, and “clinical clues” are discussed. CONCLUSION: This review provides a clinically focused, practical approach to truncal movement disorders, which will be helpful for physicians in everyday practice

Consecutive episodes of heart and kidney failure in an "otherwise" healthy young man

Background: Acute renal failure is a rare occurrence in a patient with an unremarkable past medical history and should always lead to an in depth clinical study. The occurrence in the same healthy young subject, of consecutive episodes of heart failure and of acute renal failure is an even rarer event and should prompt diagnostic tests and restrict the diagnostic hypotheses. Case presentation: We present the case of a 28 year-old man who, while waiting to undergo assessment for a mild chronic kidney disease, was diagnosed with decompensated dilated cardiomyopathy and placed on diuretics and β-blockers. After few weeks he developed a non oligoanuric acute renal failure with a slight elevation of serum calcium. Renal biopsy proved suggestive for renal sarcoidosis; thus the hypothesis of systemic sarcoidosis with cardiac and renal involvement was possible avoiding further delay in initiation of therapy. Conclusions: Cardiac sarcoidosis is usually silent but the majority of cases are diagnosed when cardiac symptoms are present in a patient with systemic sarcoidosis. Renal involvement with granulomatous interstitial nephritis is also quite rare and can be an unexpected finding at kidney biopsy. This case highlights the need to evaluate thoroughly clinical problems that do not fit in a specific scenario and emphasizes the importance of performing a kidney biopsy in case of kidney failure of unknown etiology