Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database

Objective/background: This study investigated the addition of a real-time feedback patient engagement tool on positive airway pressure (PAP) adherence when added to a proactive telemedicine strategy. Patients/methods: Data from a German healthcare provider (ResMed Healthcare Germany) were retrospectively analyzed. Patients who first started PAP therapy between 1 September 2009 and 30 April 2014, and were managed using telemedicine (AirView™; proactive care) or telemedicine + patient engagement tool (AirView™ + myAir™; patient engagement) were eligible. Patient demographics, therapy start date, sleep- disordered breathing indices, device usage hours, and therapy termination rate were obtained and compared between the two groups. Results: The first 500 patients managed by telemedicine-guided care and a patient engagement tool were matched with 500 patients managed by telemedicine-guided care only. The proportion of nights with device usage ≥4 h was 77 ± 25% in the patient engagement group versus 63 ± 32% in the proactive care group (p < 0.001). Therapy termination occurred less often in the patient engagement group (p < 0.001). The apnea-hypopnea index was similar in the two groups, but leak was significantly lower in the patient engagement versus proactive care group (2.7 ± 4.0 vs 4.1 ± 5.3 L/min; p < 0.001). Conclusions: Addition of a patient engagement tool to telemonitoring-guided proactive care was associated with higher device usage and lower leak. This suggests that addition of an engagement tool may help improve PAP therapy adherence and reduce mask leak

Milk coagulation properties and methods of detection

ABSTRACT: One of the most crucial steps in cheesemaking is the coagulation process, and knowledge of the parameters involved in the clotting process plays an important technological role in the dairy industry. Milk of different ruminant species vary in terms of their coagulation capacities because they are influenced by the milk composition and mainly by the milk protein genetic variants. The milk coagulation capacity can be measured by means of mechanical and/or optical devices, such as Lactodynamographic Analysis and Near-Infrared and Mid-Infrared Spectroscopy

Mask humidity during CPAP: influence of ambient temperature, heated humidification and heated tubing

Georg Nilius,1,2 Ulrike Domanski,1 Maik Schroeder,1 Holger Woehrle,3,4 Andrea Graml,4 Karl-Josef Franke,1,2 1Helios Klinik Hagen-Ambrock, Department of Pneumology, Hagen, Germany; 2Department of Internal Medicine, Witten-Herdecke University, Witten, Germany; 3Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany; 4ResMed Science Center, ResMed Germany, Martinsried, Germany Purpose: Mucosal drying during continuous positive airway pressure (CPAP) therapy is problematic for many patients. This study assessed the influence of ambient relative humidity (rH) and air temperature (T) in winter and summer on mask humidity during CPAP, with and without mask leak, and with or without heated humidification &plusmn; heated tubing. Methods: CPAP (8 and 12 cmH2O) without humidification (no humidity [nH]), with heated humidification controlled by ambient temperature and humidity (heated humidity [HH]) and HH plus heated tubing climate line (CL), with and without leakage, were compared in 18 subjects with OSA during summer and winter. Results: The absolute humidity (aH) and the T inside the mask during CPAP were significantly lower in winter versus summer under all applied conditions. Overall, absolute humidity differences between summer and winter were statistically significant in both HH and CL vs. nH (p&nbsp;&lt;&nbsp;0.05) in the presence and absence of mouth leak. There were no significant differences in aH between HH and CL. However, in-mask temperature during CL was higher (p &lt; 0.05) and rH lower than during HH. In winter, CPAP with CL was more likely to keep rH constant at 80% than CPAP without humidification or with standard HH. Conclusion: Clinically-relevant reductions in aH were documented during CPAP given under winter conditions. The addition of heated humidification, using a heated tube to avoid condensation is recommended to increase aH, which could be useful in CPAP users complaining of nose and throat symptoms. Keywords: continuous positive airway pressure, humidification, temperature, leakag

The DLR Static Multisensor Surface Radar for Surveillance of Ground Traffic on Airports.

The functional characteristics and the structure of a single radar station of the modular structered DLR Near-Range Radar Network NRN will be discussed. From the complex valued echo profiles, measured by the four stations of an NRN module, the so-called rolling status for a plurality of targets including classification can be derived. The field test of a basic part of a prototype module is presently in progress. The actual status of the development will be presented and an outlook to the remaining work will be given

Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider

Abstract Background There is a lack of robust data about factors predicting continuation (or termination) of positive airway pressure therapy (PAP) for sleep apnea. This analysis of big data from a German homecare provider describes patients treated with PAP, analyzes the therapy termination rate over the first year, and investigates predictive factors for therapy termination. Methods Data from a German homecare service provider were analyzed retrospectively. Patients who had started their first PAP therapy between September 2009 and April 2014 were eligible. Patient demographics, therapy start date, and the date of and reason for therapy termination were obtained. At 1 year, patients were classified as having compliance-related therapy termination or remaining on therapy. These groups were compared, and significant predictors of therapy termination determined. Results Of 98,329 patients included in the analysis, 11,702 (12%) terminated PAP therapy within the first year (after mean 171 ± 91 days). There was a U-shaped relationship between therapy termination and age; therapy termination was higher in the youngest (< 30 years, 15.5%) and oldest (≥ 80 years, 19.8%) patients, and lower in those aged 50–59 years (9.9%). Therapy termination was significantly more likely in females versus males (hazard ratio 1.48, 95% confidence interval 1.42–1.54), in those with public versus private insurance (1.75, 1.64–1.86) and in patients whose first device was automatically adjusting or fixed-level continuous positive airway pressure versus bilevel or adaptive servo-ventilation (1.28, 1.2–1.38). Conclusions This analysis of the largest dataset investigating PAP therapy termination identified a number of predictive factors. These can help health care providers chose the most appropriate PAP modality, identify specific patient phenotypes at higher risk of stopping PAP and target interventions to support ongoing therapy to these groups, as well as allow them to develop a risk stratification tool

Ergebnisse der stadienadaptierten chirurgischen Therapie von Pleuraempyemen

Background: The surgical treatment of pleural empyema should be carried out depending on the stage of the disease and the patient's symptoms. The aim of this study was to evaluate the outcomes of surgical pleural empyema treatment. Patients and Methods: Retrospective analysis of all patients with pleural empyema treated surgically between January 2008 and December 2013. The primary endpoint of the study was inpatient lethality. Secondary endpoints included duration of inpatient stay, type of treatment (surgical/conservative), proof of pathogen and type, alteration and duration of antibiotic therapy. Results: Of 359 patients, 0.8% (n = 3) had stage I empyema, 50.4% (n = 181) had stage II and 48.7% (n = 175) had stage III. The most frequent causes (32.4%) included acute pneumonia (parapneumonic pleural empyema), surgery (usually thoracic) in 18.0% of cases and previous pneumonia (postpneumonic pleural empyema) in 15.4%. Surgery was performed in 86% of cases (operative procedures: open thoracotomy 85%, VATS 15%). The average duration of inpatient staywas 20 days for stages II and III. Recovery following VATS was significantly shorter in stage II compared to thoracotomy (p = 0.022). Hospital lethality amounted to 7.0% (25 patients). The lethality rate was 5.5% (10/185) in stage II and 8.6% (15/175) in stage III. Patients with confirmed pathogens had a significantly worse mortality rate across all stages (9.8%) than patients with no confirmed pathogens (4.0%, p = 0.034). Age, malignant underlying disease, multiple comorbidities, immunosuppression, a change in antibiotic regimens and sepsis were significant risk factors. Conclusion: The inpatient lethality of patients with pleural empyema correlates with the stage of the condition. Positive confirmation of pathogens, sepsis, a higher age, multiple comorbidities, malignant tumour disease, immunosuppression and a change of antibiotics are negative prognostic factors