Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Rationale: Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation. Objectives: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities. Methods: This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49.6% grade II, 50.4% grade III-IV), with a history of exacerbation in the previous year and at least one non-pulmonary co-morbidity. Patients were randomised to usual care (n=158) or tele-monitoring (n=154) and followed for 9 months. All tele-monitoring patients self-assessed lung mechanics daily and in a subgroup with congestive heart failure (n=37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. Measurements and Main results: Primary outcomes were time to first hospitalisation (TTFH) and change in EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescriptions, hospitalisation, CAT, PHQ-9 and MLHF questionnaire scores, quality-adjusted life years and healthcare costs. Tele-monitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores. In an exploratory analysis, tele-medicine was associated with fewer repeat hospitalizations (-54%, p=0.017). Conclusions: In older COPD patients with co-morbidities remote monitoring of lung function by FOT and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01960907

Context-aware QoS provisioning for an M-health service platform

Inevitably, healthcare goes mobile. Recently developed mobile healthcare (i.e., m-health) services allow healthcare professionals to monitor mobile patient's vital signs and provide feedback to this patient anywhere at any time. Due to the nature of current supporting mobile service platforms, m-health services are delivered with a best-effort, i.e., there are no guarantees on the delivered Quality of Service (QoS). In this paper, we argue that the use of context information in an m-health service platform improves the delivered QoS. We give a first attempt to merge context information with a QoS-aware mobile service platform in the m-health services domain. We illustrate this with an epilepsy tele-monitoring scenario

Smart homecare system for health tele-monitoring

© 2007 IEEE. An increasing aged population worldwide puts our medical capabilities to the test. Research and commercial groups are investigating novel ways to care for the aged and chronically ill both in their own homes and in care facilities. This paper describes a prototype we have developed for remote healthcare monitoring. This personalized smart homecare system uses smart phones, wireless sensors, web servers and IP webcams. To illustrate the functionality of the prototype we describe a series of typical tele-health monitoring scenarios

Perspectives of patients and healthcare professionals on the impact of telemetrically supported patient self-management for chronic obstructive pulmonary disease (COPD): a qualitative study nested in the TELESCOT trial

Background: Early identification of exacerbations reduces hospital admissions and may slow disease progression. The TELESCOTrandomised control trial based in Lothian, Scotland, is investigating the impact of a tele-monitoring service for COPD with the primaryaim of reducing hospitalisation.Aim: The nested qualitative study explored the views of patients and professionals on models of telemetric service delivery and theimpact on self-management.Method: We undertook semi-structured interviews with patient and professional participants at different time points in the TELESCOTCOPD trial. Transcribed, coded data were analysed thematically. Interpretation was supported by multidisciplinary discussion.Results: 38 patients (47% male, mean age 67.5 years) and 32 healthcare professionals provided 70 interviews. Both patients and professionals considered that home tele-monitoring had the potential to reduce the risk of hospital admission. Patients generally appreciated being ‘watched over’ by the tele-monitoring, which gave them confidence to manage their own condition. They used tele-data to improving their understanding of COPD, determine their current state of health and influence decisions about their daily activities. Numerical data (e.g. oxygen saturations) were particularly valued. Changes in readings validated their decisions to adjust treatment or seek timely professional advice, and eased access to clinical care. Patients valued the personalised care provided by tele-monitoring staff familiar with their circumstances and state of health. Professionals emphasised the potential role of telemetry in encouraging prompt compliance with medically defined behaviours and attitudes, though some doubted whether it would be sufficient to overcome a perceived reluctance on the part of patients to acknowledge and take ownership of the disease. There was also a concern that ‘fixation’ on monitoring physiological parameters (especially oxygen saturation levels), promoted a medical model of the disease and might increase dependence on services in some patients. The GPs and community nursing or physiotherapy teams who provided the supporting services emphasised the importance of ‘knowing the patient’ and ‘knowing what’s normal for the individual’ in using their clinical skills to interpret incoming tele-monitoring data Conclusion: Enthusiasm for tele-monitoring as a means of facilitating self-management and thereby reducing admissions is tempered byconcerns about increased medicalisation and dependence on support services. Tele-monitoring provides data which can be used to support self-management decisions and acts as a channel for seeking professional support. The patient-practitioner relationship, personalisation and continuity of care were prioritised as important elements in delivering clinical support for tele-monitoring services by patients and professionals

Sleeping activity recognition for an intelligent tele-monitoring system

Treballs Finals de Grau d'Enginyeria Informàtica, Facultat de Matemàtiques, Universitat de Barcelona, Any: 2016, Director: Petia I. RadevaPeople that need assistance, as for instance elderly or disabled people, may be affected by a decline in daily functioning that usually involves the reduction and discontinuity in daily routines, as well as, a worsening in the overall quality of life. Thus, there is the need to intelligent systems able to monitor indoor activities of users to detect emergencies, recognise activities, send notifications, and provide a summary of all the relevant information. In this TFG, a machine learning system is presented, it is aimed at improving the ruled-based system accuracy in detecting whether the user is performing their sleeping activity or not. It has been integrated in a sensor-based tele-monitoring and home support system. The data used to build and evaluate the system was obtained from a real-world environment with real end-users, thus ensuring the data reflect the complexities of the real-world

DESIGN OF A CONCEPTUAL FRAMEWORK FOR A MEDICAL TELE-MANAGEMENT SYSTEM (MTMS) IN RESOURCE-CONSTRAINED SETTINGS

Medical tele-management is an emerging field of study in tele-health that proposes an interactive and proactive disease management approach which combines tele-monitoring and tele-consultation services through an information and communications technology (ICT) supported partnership. It is aimed at minimizing the burden of health management both for the patient and physician, especially in developing countries. However, existing solutions in form of systems and frameworks exist singly either as tele-monitoring or tele-consultation systems and majorly in developed countries with dedicated and adequate ICT resources and infrastructure. Hence, this paper presents the design of a Medical Tele-Management System (MTMS) which serves as a framework that combines both tele-monitoring and tele-consultation services within an information and communication technology resource-constrained setting. &nbsp

Comparative effectiveness of tele-monitoring of users with pacemakers at 6 months after implant: the nordland study

Comunicación oral presentada en el 3er Congreso Internacional de Comunicación en Salud (3ICHC), celebrado los días 19 y 20 de octubre de 2017 en la Universidad Carlos III de Madrid.The main purpose of the present study was to assess the effectiveness of tele-monitoring (TM) in patients with pacemakers regarding reliability, safety and health-related quality of life, compared to traditional follow-up in outpatient clinic