Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.
To evaluate the efficacy ...of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.
This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr interquartile range, 66-76 yr; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring 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.
Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017).
In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registered with www.clinicaltrials.gov (NCT 01960907).
The effectiveness of treatment depends on the patient’s ability to manage in the everyday life his/her chronic health status in accordance with the medical prescriptions outside the hospital ...settings. For this reason, the European Commission promotes research in tele-health applications, such as Chronious “An Open, Ubiquitous and Adaptive Chronic Disease Management Platform for COPD and Renal Insufficiency”. The aim is the improvement of healthcare service by offering an online health management solution that addresses the patient-professional interaction, personal data security, reduction of hospitalization and related costs. Chronious implements a modular hardware-software system that integrates existing healthcare legacy system, biomedical sensors, user interfaces and multi-parametric data processing with decision support system for patients and health professionals. Nowadays, very few of chronic disease management tools commercially available are accompanied with patient-professional interfaces for communication and education purposes. As added value, Chronious proposes lifestyle and mental support tools for the patients and ontological cross-lingual information retrieval system for clinicians for faster and easier queries to medical knowledge. The patient at home is equipped with a T-shirt able to record cardiac/respiratory/audio and activity signs, external devices (weight scale, glucometer, blood pressure monitoring device, spirometer, air quality sensor) and a touch-screen computer to send reminders on drugs intake and to collect information on dietary habits and mental status. All information are automatically transmitted via IP/GPRS to the Central System, that using a web-interface and ruled based algorithms allows clinicians to monitor patients status and give suggestions for acting in case of worsening trend or risk situation. As consequence, critical procedures that are quite complicated for the patient such as frequent/continuous monitoring, visits to hospitals, self-care are becoming straightforward and simpler. In addition, the information of the clinician is more direct, accurate and complete improving the prognosis for the chronic diseases and the selection of the most appropriate treatment planning. For validation purposes, Chronious is focused on chronic obstructive pulmonary disease and chronic kidney disease, being these widespread and highly expensive in terms of social and economic costs. The validation protocol considers also the most frequent related comorbidities, such as diabetes, involving the patients category which will take advantage of the highest foreseen benefits. This enables an open architecture for further applications. Project validation is divided in two progressive phases: the first one in hospital setting was aimed to verify on 50 patients if the delivered prototypes met the user requirements, the ergonomic and functional specifications. The second phase has observational features. The improved system is currently applied at home on 60 selected patients. Patients are instructed to use the system independently for an expected duration of 4 months each. In parallel, the patient is monitored with standard periodic outpatient checks. At the end, customer satisfaction and the predictive ability of the system in the evolution of the disease will be evaluated. First feedbacks are encouraging because Chronious monitoring provides friendly approaches to new technologies and reassures patients reducing the intervention time in critical situation.
CHRONIOUS project contributions supports the design and the development of an open architecture monitoring platform aiming on the detailed description of patient's health status focusing on people ...with chronic diseases. Essential modules of the CHRONIOUS system are the wearable platform responsible for the collection of several vital body signs, environmental, context and patient's activity signals. These data together with the description of patients' drug intake and dietary habits are analyzed by the CHRONIOUS intelligent module. The patient's history and his demographic data are processed along with the rest of the signals, concluding in the description of his recent health condition and the estimation of his severity status. As pilot studies for the development and the evaluation of the CHRONIOUS system, two of the most frequent chronic diseases have been selected: the Chronic Obstructive Pulmonary Disease (COPD) and the Chronic Kidney Disease (CKD). The architecture of the CHRONIOUS platform as well as some of the initial results are presented in this paper.
Chronious is an Open, Ubiquitous and Adaptive Chronic Disease Management Platform for Chronic Obstructive Pulmonary Disease(COPD) Chronic Kidney Disease (CKD) and Renal Insufficiency. It consists of ...several modules: an ontology based literature search engine, a rule based decision support system, remote sensors interacting with lifestyle interfaces (PDA, monitor touch-screen) and a machine learning module. All these modules interact each other to allow the monitoring of two types of chronic diseases and to help clinician in taking decision for care purpose. This paper illustrates how the ontology search engine was created and fed and how some comparative test indicated that the ontology based approach give better results, on some estimation parameters, than the main reference web search engine.
CHRONIOUS is an Open, Ubiquitous and Adaptive Chronic Disease Management Platform for Chronic Obstructive Pulmonary Disease(COPD) Chronic Kidney Disease (CKD) and Renal Insufficiency. It consists of ...several modules: an ontology based literature search engine, a rule based decision support system, remote sensors interacting with lifestyle interfaces (PDA, monitor touchscreen) and a machine learning module. All these modules interact each other to allow the monitoring of two types of chronic diseases and to help clinician in taking decision for cure purpose. This paper illustrates how some machine learning algorithms and a rule based decision support system can be used in smart devices, to monitor chronic patient. We will analyse how a set of machine learning algorithms can be used in smart devices to alert the clinician in case of a patient health condition worsening trend.
Among the initiatives aiming to improve the health status monitoring technologies, the European Commission promotes CHRONIOUS, a 42 months project, started on February 1 st 2008, which involves 19 ...partners from several countries. The CHRONIOUS project works on an innovative system with intelligent sensors and decision support system for patients and healthcare professionals in the area of chronic diseases. The CHRONIOUS system will monitor patients' vital body parameters, context and environmental variables and patient motion and other activities such as drug intake and dietary habits. The system will assist health care experts and patients by providing tools for health status monitoring and decision support. This paper presents a description of the goal of the project and its background the system architecture and a first prototype with preliminary results and the expected impact.
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