In recent years, there has been increasing interest in the development of telediagnosis and telemonitoring systems for Parkinson’s disease (PD) based on measuring the motor system disorders caused by ...the disease. As approximately 90% percent of PD patients exhibit some form of vocal disorders in the earlier stages of the disease, the recent PD telediagnosis studies focus on the detection of the vocal impairments from sustained vowel phonations or running speech of the subjects. In these studies, various speech signal processing algorithms have been used to extract clinically useful information for PD assessment, and the calculated features were fed to learning algorithms to construct reliable decision support systems. In this study, we apply, to the best of our knowledge for the first time, the tunable Q-factor wavelet transform (TQWT) to the voice signals of PD patients for feature extraction, which has higher frequency resolution than the classical discrete wavelet transform. We compare the effectiveness of TQWT with the state-of-the-art feature extraction methods used in diagnosis of PD from vocal disorders. For this purpose, we have collected the voice recordings of 252 subjects in the context of this study and extracted multiple feature subsets from the voice recordings. The feature subsets are fed to multiple classifiers and the predictions of the classifiers are combined with ensemble learning approaches. The results show that TQWT performs better or comparable to the state-of-the-art speech signal processing techniques used in PD classification. We also find that Mel-frequency cepstral and the tunable-Q wavelet coefficients, which give the highest accuracies, contain complementary information in PD classification problem resulting in an improved system when combined using a filter feature selection technique.
•The TQWT is applied to the voice signals of Parkinson’s Disease (PD) patients.•The effectiveness of TQWT is compared with the state-of-the-art feature extraction methods.•TQWT performed better or comparable to the state-of-the-art techniques in PD classification.•MFCC and the TQW coefficients contain complementary information in PD classification problem.
This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care.
A systematic literature ...search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.
This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis.
RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.
•Remote patient monitoring (RPM) can be effective in preventing escalation to acute care and has the potential to improve chronic disease management. There has also been a renewed interest in the cost-effectiveness of RPM since the onset of the coronavirus (COVID-19) pandemic. The cost and outcome evidence for RPM has been summarized for some disease-specific contexts (eg, heart failure); however, there are no existing summaries of the available health economic evidence of noninvasive RPM for chronic disease management.•This systematic review identified and summarized 34 articles that conducted economic evaluations of noninvasive RPM compared with usual care for chronic disease management. This review demonstrated that RPM can be cost-effective for chronic disease management, although the cost-effectiveness is dependent on capital investment, clinical context, willingness-to-pay thresholds, and the organizational processes involved in RPM implementation and provision.•Overarching health economic evidence of RPM is useful for decision makers that are contemplating RPM investment choices for chronic disease management. Compared with usual care, RPM was highly cost-effective for hypertension, where greater cost savings may be achieved in the long term because of prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings often differed according to disease severity. There was limited evidence for the cost-effectiveness of RPM for diabetes and other chronic diseases.
Introduction: Patients with cardiovascular disease require continuous monitoring throughout their lives. Studies have shown that remote monitoring improves assessments of these patients, leading to ...more accurate prevention and lower hospitalization rates. The aim of this study is to evaluate the impact of monitoring patients with heart failure (HF) using different devices and to make a comparison with standard clinical practice, mainly based on hospital readmissions and patients’ quality of life by improving their self-care strategy. Methods: The study involved 32 patients previously discharged from hospital, divided into two groups: a study group underwent telemonitoring for 3 months using their mobile phone and various portable devices, and a control group followed standard clinical practice for the same period. The physiological variables analyzed were heart rate, blood oxygen saturation, blood pressure, physical activity, sleep patterns, weight, height, and fluid intake. To assess the impact of monitoring on HF patients, the number of outpatient visits, emergency room visits, and hospital readmissions were taken into account. The impact on quality of life, self-care, and patient satisfaction was also assessed by analyzing patient reported outcomes measures and patient reported experience measures. Results: The results showed that the study group had a lower readmission rate than the control group (40% vs 60%) and fewer visits to the Emergency Department (relative risk 0.667). On the other hand, it is important to note that in the control group, 60% of patients were readmitted during the follow-up period, while in the experimental group, this percentage was reduced to 40%. At the same time, the telemonitored patients have improved their self-care, have greater adherence to the taking of constants, and feel more confident and calmer. In addition, professionals have been able to take different actions proactively, due to the possibility of obtaining information in real time. Conclusions: Telemonitoring patients have achieved a better quality of life and improved health status through continuous, real-time monitoring.
INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated ...through telemonitoring. OBJECTIVE: This study aimed to monitor the foot’s flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot’s flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.
Despite treatment advancements, HF mortality remains high, prompting interest in reducing HF-related hospitalizations through remote monitoring. These advances are necessary considering the rapidly ...rising prevalence and incidence of HF worldwide, presenting a burden on hospital resources. While traditional approaches have failed in predicting impending HF-related hospitalizations, remote hemodynamic monitoring can detect changes in intracardiac filling pressure weeks prior to HF-related hospitalizations which makes timely pharmacological interventions possible. To ensure successful implementation, structural integration, optimal patient selection, and efficient data management are essential. This review aims to provide an overview of the rationale, the available devices, current evidence, and the implementation of remote hemodynamic monitoring.
Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive ...telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation.
We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT.
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Current progress in wearable and implanted health monitoring technologies has strong potential to alter the future of healthcare services by enabling ubiquitous monitoring of patients. A typical ...health monitoring system consists of a network of wearable or implanted sensors that constantly monitor physiological parameters. Collected data are relayed using existing wireless communication protocols to a base station for additional processing. This article provides researchers with information to compare the existing low-power communication technologies that can potentially support the rapid development and deployment of WBAN systems, and mainly focuses on remote monitoring of elderly or chronically ill patients in residential environments.
Abstract Background Home Blood Pressure Telemonitoring (HBPT) has been proposed to improve drug adherence, blood pressure control, and efficient care delivery in patients with hypertension. Its ...adoption in GP practices however remains low. In this pilot study we evaluated barriers and facilitators for successful implementation, patient satisfaction, clinical effectiveness, and efficiency for a HBPT project in Dutch GP practices by means of the Quadruple Aim Model. Methods GP practices included patients with hypertension that were part of their regular cardiovascular disease program. We conducted semi-structured interviews at 3- and 6-months to identify barriers and facilitators for successful implementation. Patient satisfaction was measured with Telehealth Usability (TUQ)—and Mhealth App Usability (MAUQ) Questionnaires. A SPRINT-protocol blood pressure measurement was performed after the pilot project to assess clinical effectiveness. Efficiency data were collected on the number of registered consultations and practice measurements performed during the 6-month project. Results Three GP practices included 19 patients. Barriers for implementation were a lack of a reimbursement structure, lack of information technology (IT) system integration and increased experienced workload when using HBPT. Facilitators included the positive effects on blood pressure control, increased sense of safety for patient and care provider, and increased disease-insight. Median satisfaction scores for TUQ and MAUQ questionnaires (scale 1–7) were 6 (IQR 5–6) and 6 (IQR 5–7). At baseline, 16% of the patients had a blood pressure < 140/90 mmHg. Based on the performed SPRINT measurements, 68% had a well-controlled blood pressure (< 140/90 mmHg) after 6 months. Average blood pressure improved from 151/89 mmHg to 132/81 mmHg ( p = < 0.05). On average, one monthly contact moment related to hypertension between patient and GP practice was registered. Conclusions We found positive results following the introduction of HBPT in GP practices on clinical outcomes and patients’ satisfaction, however for large-scale implementation improvements with regards to organizational efficiency and a clear reimbursement structure are needed.
Multi-parametric assessment, including heart sounds in addition to conventional parameters, may enhance the efficacy of noninvasive telemonitoring for heart failure (HF). We sought to assess the ...feasibility of self-telemonitoring with multiple devices including a handheld heart sound recorder and its association with clinical events in patients with HF.
Ambulatory HF patients recorded their own heart sounds, mono‑lead electrocardiograms, oxygen saturation, body weight, and vital signs using multiple devices every morning for six months.
In the 77 patients enrolled (63 ± 13 years old, 84 % male), daily measurements were feasible with a self-measurement rate of >70 % of days in 75 % of patients. Younger age and higher Minnesota Living with Heart Failure Questionnaire scores were independently associated with lower adherence (p = 0.002 and 0.027, respectively). A usability questionnaire showed that 87 % of patients felt self-telemonitoring was helpful, and 96 % could use the devices without routine cohabitant support. Six patients experienced ten HF events of re-hospitalization and/or unplanned hospital visits due to HF. In patients who experienced HF events, a significant increase in heart rate and diastolic blood pressure and a decrease in the time interval from Q wave onset to the second heart sound were observed 7 days before the events compared with those without HF events.
Self-telemonitoring with multiple devices including a handheld heart sound recorder was feasible even in elderly patients with HF. This intervention may confer a sense of relief to patients and enable monitoring of physiological parameters that could be valuable in detecting the deterioration of HF.
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•Feasibility of multi-device self-telemonitoring in patients with heart failure (HF) was studied.•They self-measured blood pressure (BP), pulse rate, percutaneous oxygen saturation, body temperature, weight, and heart sound.•75 % of patients adhered over 70 % of days; younger age linked to lower adherence.•87 % of patients found telemonitoring helpful; 96 % operated devices independently.•Telemonitoring might detect early HF deterioration via heart rate, BP, heart sound.
Aims:
We aim to develope a system allowing the telemonitoring of the elderly health status. Medical telemonitoring can make life easy and safe for elderly. The goal of this project is the development ...of a medical telemonitoring application.
Background:
Medical telemonitoring can make life easy and safe for elderly.
Objective:
The goal of this project is the development of a medical telemonitoring application.
Methods:
In this paper we exposed the different steps of the developing of a medical telemonitoring system designed for the elderly. We studied the medical needs and the system specifications. We used the UML language. Then we detailed the designed system with a total respect to the standard for the interoperability of connected medical equipment, Continua. We presented printed screens of the realized interfaces.
Results:
We realized an application based on web development, more specifically development of a management application for medical telemonitoring.
Conclusion:
In terms of perspectives, we aim to integrate security protocols in the developed system, integrate the data sent from the sensors into an E, H & R (HER) and send the patient file to a H, I & S (HIS).
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