An ICT-based closed-loop model to improve care for heart failure patients

Durante las últimas décadas se ha producido un fenómeno global de envejecimiento en la población. Esta tendencia se puede observar prácticamente en todos los países del mundo y se debe principalmente a los avances en la medicina, y a los descensos en las tasas de fertilidad y mortalidad. El envejecimiento de la población tiene un gran impacto en la salud de los ciudadanos, y a menudo es la causa de aparición de enfermedades crónicas. Este tipo de enfermedades supone una amenaza y una carga importantes para la sociedad, especialmente en aspectos como la mortalidad o los gastos en los sistemas sanitarios. Entre las enfermedades cardiovasculares, la insuficiencia cardíaca es probablemente la condición con mayor prevalencia y afecta a 23-26 millones de personas en todo el mundo. Normalmente, la insuficiencia cardíaca presenta un mal pronóstico y una tasa de supervivencia bajas, en algunos casos peores que algún tipo de cáncer. Además, suele ser la causa de hospitalizaciones frecuentes y es una de las enfermedades más costosas para los sistemas sanitarios. La tendencia al envejecimiento de la población y la creciente incidencia de las enfermedades crónicas están llevando a una situación en la que los sistemas de salud no son capaces de hacer frente a la demanda de la sociedad. Los servicios de salud existentes tendrán que adaptarse para ser efectivos y sostenibles en el futuro. Es necesario identificar nuevos paradigmas de cuidado de pacientes, así como mecanismos para la provisión de servicios que ayuden a transformar estos sistemas sanitarios. En este contexto, esta tesis se plantea la búsqueda de soluciones, basadas en las Tecnologías de la Información y la Comunicación (TIC), que contribuyan a realizar la transformación en los sistemas sanitarios. En concreto, la tesis se centra en abordar los problemas de una de las enfermedades con mayor impacto en estos sistemas: la insuficiencia cardíaca. Las siguientes hipótesis constituyen la base para la realización de este trabajo de investigación: 1. Es posible definir un modelo basado en el paradigma de lazo cerrado y herramientas TIC que formalice el diseño de mejores servicios para pacientes con insuficiencia cardíaca. 2. El modelo de lazo cerrado definido se puede utilizar para definir un servicio real que ayude a gestionar la insuficiencia cardíaca crónica. 3. La introducción, la adopción y el uso de un servicio basado en el modelo definido se traducirá en mejoras en el estado de salud de los pacientes que sufren insuficiencia cardíaca. a. La utilización de un sistema basado en el modelo de lazo cerrado definido mejorará la experiencia del usuario de los pacientes. La definición del modelo planteado se ha basado en el estándar ISO / EN 13940- Sistema de conceptos para dar soporte a la continuidad de la asistencia. Comprende un conjunto de conceptos, procesos, flujos de trabajo, y servicios como componentes principales, y representa una formalización de los servicios para los pacientes con insuficiencia cardíaca. Para evaluar el modelo definido se ha definido un servicio real basado en el mismo, además de la implementación de un sistema de apoyo a dicho servicio. El diseño e implementación de dicho sistema se realizó siguiendo la metodología de Diseño Orientado a Objetivos. El objetivo de la evaluación consistía en investigar el efecto que tiene un servicio basado en el modelo de lazo cerrado sobre el estado de salud de los pacientes con insuficiencia cardíaca. La evaluación se realizó en el marco de un estudio clínico observacional. El análisis de los resultados ha comprendido métodos de análisis cuantitativos y cualitativos. El análisis cuantitativo se ha centrado en determinar el estado de salud de los pacientes en base a datos objetivos (obtenidos en pruebas de laboratorio o exámenes médicos). Para realizar este análisis se definieron dos índices específicos: el índice de estabilidad y el índice de la evolución del estado de salud. El análisis cualitativo ha evaluado la autopercepción del estado de salud de los pacientes en términos de calidad de vida, auto-cuidado, el conocimiento, la ansiedad y la depresión, así como niveles de conocimiento. Se ha basado en los datos recogidos mediante varios cuestionarios o instrumentos estándar (i.e. EQ-5D, la Escala de Ansiedad y Depresión (HADS), el Cuestionario de Cardiomiopatía de Kansas City (KCCQ), la Escala Holandesa de Conocimiento de Insuficiencia Cardíaca (DHFKS), y la Escala Europea de Autocuidado en Insuficiencia Cardíaca (EHFScBS), así como cuestionarios dedicados no estandarizados de experiencia de usuario. Los resultados obtenidos en ambos análisis, cuantitativo y cualitativo, se compararon con el fin de evaluar la correlación entre el estado de salud objetivo y subjetivo de los pacientes. Los resultados de la validación demostraron que el modelo propuesto tiene efectos positivos en el cuidado de los pacientes con insuficiencia cardíaca y contribuye a mejorar su estado de salud. Asimismo, ratificaron al modelo como instrumento válido para la definición de servicios mejorados para la gestión de esta enfermedad. ABSTRACT During the last decades we have witnessed a global aging phenomenon in the population. This can be observed in practically every country in the world, and it is mainly caused by the advances in medicine, and the decrease of mortality and fertility rates. Population aging has an important impact on citizens’ health and it is often the cause for chronic diseases, which constitute global burden and threat to the society in terms of mortality and healthcare expenditure. Among chronic diseases, Chronic Heart Failure (CHF) or Heart Failure (HF) is probably the one with highest prevalence, affecting between 23 and 26 million people worldwide. Heart failure is a chronic, long-term and serious condition with very poor prognosis and worse survival rates than some type of cancers. Additionally, it is often the cause of frequent hospitalizations and one of the most expensive conditions for the healthcare systems. The aging trends in the population and the increasing incidence of chronic diseases are leading to a situation where healthcare systems are not able to cope with the society demand. Current healthcare services will have to be adapted and redefined in order to be effective and sustainable in the future. There is a need to find new paradigms for patients’ care, and to identify new mechanisms for services’ provision that help to transform the healthcare systems. In this context, this thesis aims to explore new solutions, based on ICT, that contribute to achieve the needed transformation within the healthcare systems. In particular, it focuses on addressing the problems of one of the diseases with higher impact within these systems: Heart Failure. The following hypotheses represent the basis to the elaboration of this research: 1. It is possible to define a model based on a closed-loop paradigm and ICT tools that formalises the design of enhanced healthcare services for chronic heart failure patients. 2. The described closed-loop model can be exemplified in a real service that supports the management of chronic heart failure disease. 3. The introduction, adoption and use of a service based on the outlined model will result in improvements in the health status of patients suffering heart failure. 4. The user experience of patients when utilizing a system based on the defined closed-loop model will be enhanced. The definition of the closed-loop model for health care support of heart failure patients have been based on the standard ISO/EN 13940 System of concepts to support continuity of care. It includes a set of concept, processes and workflows, and services as main components, and it represent a formalization of services for heart failure patients. In order to be validated, the proposed closed-loop model has been instantiated into a real service and a supporting IT system. The design and implementation of the system followed the user centred design methodology Goal Oriented Design. The validation, that included an observational clinical study, aimed to investigate the effect that a service based on the closed-loop model had on heart failure patients’ health status. The analysis of results comprised quantitative and qualitative analysis methods. The quantitative analysis was focused on determining the health status of patients based on objective data (obtained in lab tests or physical examinations). Two specific indexes where defined and considered in this analysis: the stability index and the health status evolution index. The qualitative analysis assessed the self-perception of patients’ health status in terms of quality of life, self-care, knowledge, anxiety and depression, as well as knowledge levels. It was based on the data gathered through several standard instruments (i.e. EQ-5D, the Hospital Anxiety and Depression Scale, the Kansas City Cardiomyopathy Questionnaire, the Dutch Heart Failure Knowledge Scale, and the European Heart Failure Self-care Behaviour Scale) as well as dedicated non-standardized user experience questionnaires. The results obtained in both analyses, quantitative and qualitative, were compared in order to assess the correlation between the objective and subjective health status of patients. The results of the validation showed that the proposed model contributed to improve the health status of the patients and had a positive effect on the patients’ care. It also proved that the model is a valid instrument for designing enhanced healthcare services for heart failure patients

Clinical validation of a wearable system for emotional recognition based on biosignals.

The AUBADE system can be trained to classify a subject’s feelings into six different emotional classes, derived from three of the basic emotions (happiness, disgust and fear). The performance of different classifiers was examined. Biosignals were recorded from 24 healthy subjects who viewed pictures designed to invoke different emotional responses. A psychologist evaluated the emotional status of the subjects by looking at their faces. During the training stage, information from 15 subjects was used to teach the system how to discriminate the emotional status of the subject based on the biosignals provided as input. A subset of the data was used for comparing the performance of four different classifiers. They were evaluated using three different metrics: sensitivity, positive predictive accuracy and accuracy. Using the SVM classifier, the AUBADE system provided sensitivities in the range 63–81%. The positive predictive accuracy was in the range 71–95%. The accuracy was in the range 63–83%, depending on the emotional class considered. The work paves the way for remote telemonitoring of patients suffering from neurological diseases

HeartCycle: User interaction and patient education

Cardiovascular Diseases are the most prevalent and serious chronic conditions existing nowadays. They are the primary cause of death in the world and generate enormous expenditures to the health systems. Tele-monitoring and personal health systems have proven to be good options for tackling this situation; however they are still lacking many functionalities. It is necessary to find solutions that allow health professionals to follow up patients more closely and efficiently, while reducing the non-adherence of patients to the treatment regime. HeartCycle research project (partially funded by the European Commission) has developed a personal health system for cardiovascular diseases management with the aim to address this problem. This paper describes the Patient Loop of this solution, including the different components, the adopted user interaction, and the implemented patients education and coaching strategy

A platform for the development of patient applications in the domain of personalized health

Personalized health (p-health) systems can contribute significantly to the sustainability of healthcare systems, though their feasibility is yet to be proven. One of the problems related to their development is the lack of well-established development tools for this domain. As the p-health paradigm is focused on patient self-management, big challenges arise around the design and implementation of patient systems. This paper presents a reference platform created for the development of these applications, and shows the advantages of its adoption in a complex project dealing with cardio-vascular diseases

Diseño tecnológico para el aprovechamiento del camote (Ipomoea batatas L) en la elaboración de harina

El objetivo de la presente investigación fue evaluar el camote como materia prima para la elaboración de harina de manera integral, aprovechando el follaje y tubérculo, además se estudió las características bromatológicas y se diseñó el flujo del proceso, determinando las características y requerimientos de la planta y evaluando la factibilidad económica de la misma. Se realizó 2 tipos de harina tanto del follaje como del tubérculo, la etapa de secado se realizó en estufa sin circulación de aire, las características bromatológicas evaluadas de las harinas fueron ceniza y humedad, la capacidad de la planta se determinó mediante un requerimiento de la Asociación de productores. El producto obtenido cumple con las normas establecidas para la elaboración de harinas y presenta características nutricionales considerables para la alimentación animal

Ethical Decision Making in Iot Data Driven Research: A Case Study of a Large-Scale Pilot

[EN] IoT technologies generate intelligence and connectivity and develop knowledge to be used in the decision-making process. However, research that uses big data through global interconnected infrastructures, such as the `Internet of Things¿ (IoT) for Active and Healthy Ageing (AHA), is fraught with several ethical concerns. A large-scale application of IoT operating in diverse piloting contexts and case studies needs to be orchestrated by a robust framework to guide ethical and sustainable decision making in respect to data management of AHA and IoT based solutions. The main objective of the current article is to present the successful completion of a collaborative multiscale research work, which addressed the complicated exercise of ethical decision making in IoT smart ecosystems for older adults. Our results reveal that among the strong enablers of the proposed ethical decision support model were the participatory and deliberative procedures complemented by a set of regulatory and non-regulatory tools to operationalize core ethical values such as transparency, trust, and fairness in real care settings for older adults and their caregivers.This paper is part of the ACTIVAGE project that has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 732679.Segkouli, S.; Fico, G.; Vera-Muñoz, C.; Lecumberri, M.; Voulgaridis, A.; Triantafyllidis, A.; Sala-Soriano, P.... (2022). Ethical Decision Making in Iot Data Driven Research: A Case Study of a Large-Scale Pilot. Healthcare. 10(5):1-21. https://doi.org/10.3390/healthcare1005095712110

A Differential Signature of Circulating miRNAs and Cytokines Between COVID-19 and Community-Acquired Pneumonia Uncovers Novel Physiopathological Mechanisms of COVID-19

Coronavirus Disease 2019 (COVID-19) pneumonia is a life-threatening infectious disease, especially for elderly patients with multiple comorbidities. Despite enormous efforts to understand its underlying etiopathogenic mechanisms, most of them remain elusive. In this study, we compared differential plasma miRNAs and cytokines profiles between COVID-19 and other community-acquired pneumonias (CAP). A first screening and subsequent validation assays in an independent cohort of patients revealed a signature of 15 dysregulated miRNAs between COVID-19 and CAP patients. Additionally, multivariate analysis displayed a combination of 4 miRNAs (miR-106b-5p, miR-221-3p, miR-25-3p and miR-30a-5p) that significantly discriminated between both pathologies. Search for targets of these miRNAs, combined with plasma protein measurements, identified a differential cytokine signature between COVID-19 and CAP that included EGFR, CXCL12 and IL-10. Significant differences were also detected in plasma levels of CXCL12, IL-17, TIMP-2 and IL-21R between mild and severe COVID-19 patients. These findings provide new insights into the etiopathological mechanisms underlying COVID-19This study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/0371 to IG-Á, grant no. PI19/00549 to AA, and grant no. PDI-2020-120412RB-I00 to FSM) and co-funded by the European Regional Development Fund. The study was also funded by ”La Caixa Banking Foundation” (grant no. HR17-00016 to FSM), REACT-UE INMUNOVACTER-CM from Comunidad de Madrid, and ”Fondos Supera COVID19” by Banco de Santander and CRUE. The work of ERV has been funded by a Rio-Hortega grant from the Ministerio de Economı́a y Competitividad (grant no. CM19/00149 Instituto de Salud Carlos III) and co-funded by The European Regional Development Fund (ERDF) “A way to make Europe

Efecto repelente y tiempo de protección de aceites esenciales frente al estadio adulto de Aedes aegypti

The aim of this was to evaluate the repellent effect and protection time of essential oils against the adult Aedes aegypti mosquito. A completely randomized design was used with a factorial arrangement that included 10 essential oils (Minthostachys mollis, Schinus molle, Ruta graveolens, Piper aduncun, Myrica pubescens, Lippia alba, Mentha piperita, Lantana glutinosa, Cymbopogon citratus, Eucalyptus globulus and the DEET control. 10%) and four concentrations of the oils (125, 250, 500 and 1000 mg/ml). Each experimental group consisted of 50 adult female A. aegypti mosquitoes raised in the laboratory and the repellent effect and protection time were evaluated using a sedated animal bait (Rattus rattus) with applications of 0.1 ml of the oils on the legs, tail and face. The rats and mosquitoes were found in two communicating cages of 25x25x40 cm. The oils with the greatest repellent effect and protection time, respectively, were C. citratus (97.4%; 165 minutes), E. globulus (95.8%; 165 minutes), L. glutinosa (93.8%; 180 minutes) and M. piperite (93.5%; 180 minutes) in its highest concentration (1000 mg/l); with differences between oils and between concentrations (p<0.001). Likewise, DEET 10% obtained a repellency of 95.3% and a protection time of 173 minutes. It is concluded that the essential oils of C. citratus, E. globulus, L. glutinosa and M. piperita can be considered as having natural repellent potential for A. aegypti.El estudio tuvo como objetivo evaluar el efecto repelente y tiempo de protección de aceites esenciales frente al mosquito adulto de Aedes aegypti. Se trabajó con un diseño completamente al azar con arreglo factorial que incluyó 10 aceites esenciales (Minthostachys mollis, Schinus molle, Ruta graveolens, Piper aduncun, Myrica pubescens, Lippia alba, Mentha piperita, Lantana glutinosa, Cymbopogon citratus, Eucalyptus globulus y el control DEET 10%) y cuatro concentraciones de los aceites (125, 250, 500 y 1000 mg/ml). Cada grupo experimental se constituyó por 50 mosquitos hembra adultos de A. aegypti criados en laboratorio y el efecto repelente y tiempo de protección se evaluaron usando un cebo animal sedado (Rattus rattus) con aplicaciones de 0.1 ml de los aceites en patas, cola y cara. Las ratas y los mosquitos se encontraron en dos jaulas comunicadas de 25x25x40 cm. Los aceites con mayor efecto repelente y tiempo de protección, respectivamente, fueron: C. citratus (97.4%; 165 minutos), E. globulus (95.8%; 165 minutos), L. glutinosa (93.8%; 180 minutos) y M. piperita (93.5%; 180 minutos) en su concentración mayor concentración (1000 mg/l); con diferencias entre aceites y entre concentraciones (p<0.001). Asimismo, el DEET 10% obtuvo una repelencia de 95.3 % y tiempo de protección de 173 minutos. Se concluye que los aceites esenciales de C. citratus, E. globulus, L. glutinosa y M. piperita pueden considerarse con potencial repelente natural para A. aegypti

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years