A FEASIBILITY STUDY OF REMOTE MONITORING OF CAPD PATIENT’S BLOOD PRESSURE AND
BLOOD GLUCOSE MEASUREMENTS VIA THE INTERNET. G. Pylypchuk, P. Jacobson, C. McAllister
University of Saskatchewan, St. Paul’s Hospital, Saskatoon, Saskatchewan. Regina, Saskatchewan
The purpose of this study was to determine the feasibility of remotely monitoring blood pressure (BP) and
glucose measurements in a cohort of diabetic patients receiving continuous ambulatory peritoneal
dialysis (CAPD).
BiomedHealthtech is engaged in serving the healthcare industry since 1989 and now introduce Remote Monitoring Technologies (RMT) which is a new concept of Patient Monitoring designed to meet the demands of Modern Healthcare and thus reduce the Mortality Rate.
Enabling Remote Patient Monitoring: Opportunities and Challenges at Bio2Devic...Akhsar Kharebov
Personal medical devices track an ever increasing amount of patient information away from the hospital. Coupled with quantitative self devices such as fitness trackers or calories counters, provide valuable information as the condition of a patient. Digital Health is growing a new realm of opportunities for biospace professionals. Yet challenges exist. Medical information software are archaic and siloed. Medical system is slow to adopt.
Patients recognize the benefits of technology-enhanced care, yet only 1 out of 10 use remote patient monitoring today. Read three keys to adoption. https://accntu.re/3fnEy6r
How is telemedicine transforming healthcare?HT Works
Telemedicine, the provision of health services via electronic communication media, has been around for decades. However, the uptake of telemedicine was previously slow until the start of the COVID-19 pandemic.
Here are ten ways telemedicine is changing healthcare.
Read more: https://htworkslk.com/Medoment/how-is-telemedicine-transforming-healthcare/
BiomedHealthtech is engaged in serving the healthcare industry since 1989 and now introduce Remote Monitoring Technologies (RMT) which is a new concept of Patient Monitoring designed to meet the demands of Modern Healthcare and thus reduce the Mortality Rate.
Enabling Remote Patient Monitoring: Opportunities and Challenges at Bio2Devic...Akhsar Kharebov
Personal medical devices track an ever increasing amount of patient information away from the hospital. Coupled with quantitative self devices such as fitness trackers or calories counters, provide valuable information as the condition of a patient. Digital Health is growing a new realm of opportunities for biospace professionals. Yet challenges exist. Medical information software are archaic and siloed. Medical system is slow to adopt.
Patients recognize the benefits of technology-enhanced care, yet only 1 out of 10 use remote patient monitoring today. Read three keys to adoption. https://accntu.re/3fnEy6r
How is telemedicine transforming healthcare?HT Works
Telemedicine, the provision of health services via electronic communication media, has been around for decades. However, the uptake of telemedicine was previously slow until the start of the COVID-19 pandemic.
Here are ten ways telemedicine is changing healthcare.
Read more: https://htworkslk.com/Medoment/how-is-telemedicine-transforming-healthcare/
A session by Kevin Courville, CEO, Prevail Holdings, Inc. on the topic 'Advanced Cardiology Treatment' at IFAH USA 2019 held at Caesars Palace, 18-20 June, 2019.
Lemon-RSM Presentation On Quality & Safety In HealthcareNirav Jogani
The Burden of Poor Quality & Safety and how to improve the same and thereby improve patient satisfaction & outcomes and thereby the performance of the healthcare organization.
Presentation by Alan Dubovsky, Chief Patient Experience Officer, Cedars Sinai Medical Center, about their Patient Experience Program. Begins with a review of patient satisfaction scores, clinical performance initiatives, medical outcomes, ongoing research, academic programs, and national awards. Next is a timeline of activites, from building the PX Infrastructure, PX Improvement Projects, Launching PX Skill Building Programs and introducing PX Innovation. Includes details about the Primary functions of the office of Patient Experience:
The measurement, reporting, and analysis of all Patient Feedback and the coordination and implementation of all Patient Experience improvement efforts across the health system. The patient voice is captured through Solicited Feedback, Patient & Family Advisor Programs and Verbatim Feedback. Presentation finishes with a discussion about the Future Of Patient Feedback. Some of those areas: Using patient segmentation to group patients into distinct segments, Asking patients unique questions to understand their primary concerns, Asking planned admissions who helped set their expectations?
Asking new patients what was their prior perception compared to reality?
ClickMedix Introduction and Case Studies 2014ClickMedix
ClickMedix enables health organizations to provide continuous and coordinated care to patients through mobile technologies while improving patient outcomes at lower costs.
How to Increase Telehealth in Diabetes Care (June 2019 - DData Exchange)Aaron Neinstein
Dr. Aaron Neinstein, Endocrinology Professor at UCSF, describes the use of diabetes technology and telehealth for diabetes care, barriers that are being overcome, and barriers yet to be. Presented at the June 2019 DiabetesMine DData Exchange.
A session by Kevin Courville, CEO, Prevail Holdings, Inc. on the topic 'Advanced Cardiology Treatment' at IFAH USA 2019 held at Caesars Palace, 18-20 June, 2019.
Lemon-RSM Presentation On Quality & Safety In HealthcareNirav Jogani
The Burden of Poor Quality & Safety and how to improve the same and thereby improve patient satisfaction & outcomes and thereby the performance of the healthcare organization.
Presentation by Alan Dubovsky, Chief Patient Experience Officer, Cedars Sinai Medical Center, about their Patient Experience Program. Begins with a review of patient satisfaction scores, clinical performance initiatives, medical outcomes, ongoing research, academic programs, and national awards. Next is a timeline of activites, from building the PX Infrastructure, PX Improvement Projects, Launching PX Skill Building Programs and introducing PX Innovation. Includes details about the Primary functions of the office of Patient Experience:
The measurement, reporting, and analysis of all Patient Feedback and the coordination and implementation of all Patient Experience improvement efforts across the health system. The patient voice is captured through Solicited Feedback, Patient & Family Advisor Programs and Verbatim Feedback. Presentation finishes with a discussion about the Future Of Patient Feedback. Some of those areas: Using patient segmentation to group patients into distinct segments, Asking patients unique questions to understand their primary concerns, Asking planned admissions who helped set their expectations?
Asking new patients what was their prior perception compared to reality?
ClickMedix Introduction and Case Studies 2014ClickMedix
ClickMedix enables health organizations to provide continuous and coordinated care to patients through mobile technologies while improving patient outcomes at lower costs.
How to Increase Telehealth in Diabetes Care (June 2019 - DData Exchange)Aaron Neinstein
Dr. Aaron Neinstein, Endocrinology Professor at UCSF, describes the use of diabetes technology and telehealth for diabetes care, barriers that are being overcome, and barriers yet to be. Presented at the June 2019 DiabetesMine DData Exchange.
Digital Health - Hypertension Case StudySatnam Bains
For Digital Health to be effective, we need more than technology. We need the right service re-design from a clinical perspective, and support for patients to improve their health literacy, and achievable goals to facilitate long term behaviour change. Only then can we enter into the realm and much sought after nirvana of preventative health. This presentation was created by the CEO of Health Fabric and a set of clinicians to share their knowledge around a case study around hypertension management.
CHOLELITHIASIS, NEPHROLITHIASIS SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPH...Jack Frost
CHOLELITHIASIS, NEPHROLITHIASIS
SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPHROSIS
This presentation contains real names of persons involve of this particular study. This names should not be copied or rewritten. Used the data of this study as basis only. All rights reserved 2009.
Continuous Glucose Monitoring for Diabetes, Obesity and Metabolism Research i...InsideScientific
Historically, diabetes, obesity and metabolism research has focused on acute metabolic testing characterized by infrequent sampling methods. This research contributes critical information regarding glucose metabolism and homeostasis; however, the acute approach and low sampling frequency leaves critical gaps in glucose metabolism research findings.
In this exclusive webinar sponsored by Data Sciences International, we present a new method of continuously monitoring blood glucose via implantable telemetry. Using case studies, we explore how a complete glucose profile can be observed while also reducing animal stress and associated labor for the scientist. Dr. Ralf Dechend (Max Delbruck Center for Molecular Medicine) presents a method of glucose monitoring in a novel pregnant rat model of type 2 diabetes and shares realized advantages pertaining to this new continuous approach. In addition, Christian Schnell (Novartis) discusses the value of continuous glucose data in the application of pharmacokinetics and pharmacodynamics while testing an oncology compound.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
My memorable case! AN UNANTICIPATED CARDIAC ARREST & UNUSUAL POST-RESUSCITATI...Prof. Mridul Panditrao
ABSTRACT
A case report of a primigravida, who was admitted with severe pregnancy induced hypertension
(BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was
initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies,
intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered
cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was
successfully resuscitated. The patient initially showed peculiar psychological changes and with
passage of time, certain psycho-behavioural patterns emerged which could be attributed to near
death experiences, as described in this case report.
A soape note on uncontrolled hypertensionRomit Subba
This was our SOAPE note on Uncontrolled HTN. SOAPE S Stands for Subjective O stands for Objective A for Assessment P for Plan and E for Education . Patient have Uncontrolled HTN for which we being a pharmacist giving our rationale depending upon his/her SOAPE. Suggestions and comments are appreciated.
A Mobile-Phone Tele-Medicine System That Promotes Self-Management of Blood Pr...IJERA Editor
The current practice adopted by hypertensive patients in managing hypertension is making frequent visits to a health center as recommended by medical specialists. However, very few patients adhere to this practice as it is time consuming and tiresome especially if they have to travel for long distances to have their BP checked. This practice is also not practical for critically-ill patients. Consequently, most patients neglect BP check-ups and therefore focus on medication alone. This puts the patients’ at risk as uncontrolled BP can lead to fatal complications. The overall objective of this research was to design, develop and pilot-test a mobile telemedicine system that helps patients’ to self-manage their BP condition from the comfort of their homes. Participatory action research design was used in this study. Testing for performance, usability and utilityof the tele-medicine system was conducted.
Population Health Approach for Diabetic Patients with Poor A1c ControlPhytel
New clinical research from The American Journal of Managed Care is available on the benefits of a population health approach for diabetes care. The peer-reviewed findings underline the importance of proactive health management for all patients, not just those with already high A1c levels.
Prospective Study of Acute Appendicitis with its Clinical, Radiological Profi...semualkaira
Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado and Modified Alvarado Scores (MASS) are the commonly used scoring
systems for its diagnosis, but its performance has been found to
be poor in certain populations. Hence, we compared the RIPASA
score with MASS, to find out which is a better diagnostic tool for
acute appendicitis in the Indian population.
Disparity of Interstitial Glucose for Capillary Glucose in Dialysis Diabetic ...semualkaira
The prevalence of chronic kidney disease (CKD) has steadily increased and diabetes is now considered the leading cause of endstage kidney disease (ESRD). Glycemic control in chronic renal
patients on dialysis presents additional difficulties because both
uremia and dialysis can affect insulin secretion and tissue insulin
sensitivity
A pilot study to investigate the feasibility and acceptability of Telehealth ...3GDR
Dr Kenneth Law, MBChB MRCGP MSc Health Informatics, GP and Clinical Lead of Innovation Local Care Direct, University of Leeds.
https://mhealthinsight.com/2016/06/27/join-us-at-the-kings-funds-digital-health-care-congress/
Remote Patient Monitoring (RPM) is becoming an essential part of future healthcare. Read this guide, to learn more about remote patient monitoring. Click here :https://bluestartelehealth.com/
Chamberlain College of NursingNR439 Evidence-Based PracticeWe.docxsleeperharwell
Chamberlain College of Nursing NR439: Evidence-Based Practice
Week 6: Reading Research Literature Worksheet
Directions: Complete the following required worksheet using the required article for the current session.
Name:
Date:
Purpose of the Study:
Research & Design:
Sample:
Data Collection:
Data Analysis:
Limitations:
Findings/Discussion:
Reading Research Literature:
3/2020 ST 1
ARTICLE
Investigating the recording and accuracy of fluid balance
monitoring in critically ill patients
A Diacon, MCur; J Bell,' 3 MCur, BCur, PGDN
1 Division o f Nursing, Faculty o f Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
3 TASK Applied Science, Karl Bremer Hospital, Bellville, Cape Town, South Africa
3 Department o f Nursing Science, School o f Clinical Care Sciences, Faculty o f Health Sciences, Nelson Mandela Metropolitan University,
Port Elizabeth, South Africa
Corresponding author: A Diacon ([email protected])
Background. The accurate assessment o f flu id balance data collected during physical assessment as well as during monitoring and
record-keeping forms an essential part of the baseline patient information tha t guides medical and nursing interventions aimed at
achieving physiological stability in patients. An informal audit o f 24-hour fluid balance records in a local intensive care unit (ICU) showed
that seven out of ten flu id balance calculations were incorrect.
Objective. To identify and describe current clinical nursing practice in fluid balance monitoring and measurement accuracy in ICUs,
conducted as part of a broader study in partial fu lfilm ent of a Master o f Nursing degree.
Methods. A quantitative approach utilis ing a descriptive, exploratory study design was applied. An audit of 103 ICU records was
conducted to establish the current practices and accuracy in recording o f flu id balance monitoring. Data were collected using a
purpose-designed tool based on relevant literature and practice experience.
Results. Of the original recorded fluid balance calculations, 79% deviated by more than 50 mL from the audited calculations. Further-
more, a significant relationship was shown between inaccurate fluid balance calculation and administration of diuretics (p=0.01).
Conclusion. The majority o f flu id balance records were incorrectly calculated.
S AfrJCrit Care 2014;30(2):55-57. DOI:10.7196/SAJCC.193
M ain ta in ing a balance between flu id intake and
output plays an im portant role in the management
o f a crit ica lly ill patient. The accurate assessment
o f the flu id balance data collected during physical
assessment as well as during m onitoring activities
and record-keeping forms an essential part o f the baseline patient
in fo rm ation tha t guides medical and.
Optimizing Protocol Design and Enhancing Patient Enrollment Case Study Covance
An emerging biopharmaceutical company was considering development of a pharmacologic agent for treatment of patients with diabetic kidney disease (DKD).
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
1. A Feasibility Study of Remote
Monitoring of CAPD Patient’s
Blood Pressure and Blood
Glucose Measurements Via the
Internet
G. Pylypchuck, P. Jacobson, C. McAllister
University of Saskatchewan, St Paul’s Hospital, Department of Nephrology,
ChroniCare
2. Abstract
A FEASIBILITY STUDY OF REMOTE MONITORING OF CAPD PATIENT’S BLOOD PRESSURE AND
BLOOD GLUCOSE MEASUREMENTS VIA THE INTERNET. G. Pylypchuk, P. Jacobson, C. McAllister
University of Saskatchewan, St. Paul’s Hospital, Saskatoon, Saskatchewan. ChroniCare, Regina, Saskatchewan
The purpose of this study was to determine the feasibility of remotely monitoring blood pressure (BP) and
glucose measurements in a cohort of diabetic patients receiving continuous ambulatory peritoneal
dialysis (CAPD). This can be achieved using BP monitors, glucometers and a ChroniCare appliance
(HealthGate) to transmit the data to a secure internet server over a home telephone access. Tight
control of BP and blood sugar has been proven to improve both mortality and renal function in diabetic
patients with end stage renal disease. Physician access to real time BP and glucose measurements
via the internet may allow for better control of these clinical parameters over time. Seventeen diabetic
patients currently monitored by St. Paul’s Hospital dialysis unit were selected to trial this equipment.
After three initial hospital visits for baseline measurement of BP, glucose, hemoglobin A1c and
equipment education, subjects were instructed to continue monitoring their BP and glucose levels at
the same intervals conducted at home. Subjects were instructed to download their data via telephone
line access on a weekly basis. Patients were provided with satisfaction questionnaires to be
completed at the end of the trial. The BP and glucose data could then be monitored in real time via
internet access from any location. Subjects began the study with a mean BP of 147/72 +/- 24/18
mmHg, and a mean Hemoglobin A1c level of 7.6 ± 1.2%. Baseline BP, glucose and Hemoglobin A1c
levels were compared to values at the end of the study. The mean number of values downloaded per
week was 11.9 ± 11.2 with a range between 2 and 48. Of 17 subjects who began the trial, 15 have
been successfully transmitting data on a regular basis. One subject refused to use the equipment after
completing the initial visits and education and two have been experiencing technical difficulties. It was
possible to view the continuous trend of these vital signs in real time. Data was immediately available
using internet access and can be viewed in both tabular and graphical formats. Limits may be set for
each parameter to notify the physicians when dangerous values are recorded. This data may be used
in the future studies to make meaningful changes to the patients’ medication regimens. CAPD
patients only come to the hospital for follow-up every 2-3 months and it is hypothesized that this tool
will allow more rapid changes in treatment effects and patient compliance. Future studies are planned
to determine the long term effectiveness of this tool on BP and glucose control in this patient
population.
3. Introduction
Many patients treated with continuous ambulatory peritoneal dialysis (CAPD) live in
locations remote from their active dialysis center. These patients are seen by
their nephrologist on average once every three months at the dialysis center.
Apart from these visits, routine management of both dialysis and their co morbid
conditions depends upon decisions of the patient and their family physician.
Many patients live long distances from the dialysis center making more frequent
follow up both difficult and expensive.
Two of the most common co morbidities affecting peritoneal dialysis patients are
diabetes and hypertension. Many studies have proven that tight control of blood
glucose and blood pressure improve both mortality and renal function in diabetic
patients with end stage renal disease. Current practice leaves routine monitoring
of these critical parameters up to the patient. Records of self assessment are
kept by each patient and are evaluated at each follow up visit with the family
physician or nephrologist. Subsequent diagnostic decisions are based upon the
patients self reporting of blood sugar and blood pressure measurements take at
home.
4. New technology may make monitoring of both blood pressure and blood glucose
easier and more effective for this patient population. ChroniCare has developed
a telephone based appliance (HealthGate) which incorporates both patient
used blood pressure machines and glucometers. Blood pressure and glucose
are each measured in their routine fashion with a blood pressure cuff and
glucometer. After measurement, the data is transmitted to a secure server via
telephone access using the HealthGate appliance. Both the patient and their
physician once supplied with the appropriate authentication rights can then
access the data over the internet to assist with medical management. The data
can be accessed in real time. All data is conveniently displayed on a web site
www.chronicare.ca in both graphical at numeric formats. The web site is
designed with algorithms to provide mean and standard deviation data of three
different time frames, the most recent 2 weeks, 4 weeks, as well as all
accumulated data. Acceptable limits are set for each parameter measured.
The number of data points that fall outside of the selected range are also
identified. Use of this technology has not been validated in CAPD patients
living in remote locations from their dialysis center.
The purpose of this study was to determine the feasibility of using this technology in
a cohort of diabetic CAPD patients.
5. Methods
Seventeen subjects were recruited from the population of diabetic CAPD patients in
Saskatoon, Saskatchewan. All patients were recruited in the fall of 2004. Two
of the patients subsequently dropped out of the study. Patients were provided
with a blood pressure monitor and a glucometer together with an telephone
compatible hookup (HealthGate appliance) for downloading their
measurements. Each patient was scheduled for an initial training visit at the
Saskatoon peritoneal dialysis clinic. On the initial visit, baseline demographic
data, blood pressure, glucose and hemoglobin A1c measurements were taken.
They were also provided with their HealthGate appliance and instructed in its
use. Regular telephone technical support was provided to each subject on an
as needed basis to assist with equipment difficulty.
Subjects were instructed to download their data on a weekly basis. They were not
instructed how often to measure their vital signs, this was to be done as per
their normal practice at home. Blood pressure, glucose and heart rate data
were monitored on a regular basis by the CAPD clinic staff via the ChroniCare
website. There were however no clinical decisions made based on the
observed data. After a minimum of four weeks of equipment use, a telephone
questionnaire was conducted to assess the quality of the equipment and the
ease of use by the subjects.
6. Results
Data was collected and transmitted to the internet using the HealthGate appliance
(Figure 1). The downloaded vital sings can be viewed via the internet in both
tabular and graphical formats (Figure 2, Table 2). All subjects included in the
data set have been transmitting data for a minimum of four weeks. Subject
demographic information is presented in Table 1. All subjects were diabetic
patients with end stage renal disease on CAPD.
Over four weeks, the mean blood glucose was 10.4 ± 3.4 mmol/L and the mean
blood pressure was 135.8/73.7 ± 21.2/11.7 mmHg. The mean number of
downloads per subject over four weeks was 35.5 ± 26.4 times for glucose and 32
± 37.4 times for blood pressure.
Results from the patient satisfaction questionnaire are presented in table 3. Overall
ease of use was found to be between good and excellent. The quality of all
three parts of the workstation were also rated between good and excellent. The
patients found the data very easy to transmit using their telephone access. The
quality of both the glucometer and the blood pressure cuff were scored between
good and excellent. The overall satisfaction of the workstation features and
performance were rated between good and excellent.
7. Discussion
The results of this study have demonstrated that it is possible to monitor and
track vital signs in CAPD patients remotely. Patients with access to a
telephone can easily transmit data to the internet for immediate monitoring.
Data can be viewed in real time on the internet. The data can be organized
so that trends can be viewed over time. Negative trends and dangerous
readings can be easily identified and acted upon if necessary.
In this population there was a large variance in the number of data points
transmitted by each patient. It would be ideal for diabetic patients on CAPD
to monitor both their blood glucose and blood pressure levels on frequent
intervals as prescribed by their physicians. Patients and their physicians
could use this data to make meaningful changes in their medication
regimens. A future study is planned to determine the effect of using this
technology together with physician based suggestions for medical
intervention to determine the overall effect on long term control of blood
sugar and blood pressure.
8. As previously stated, glucose and blood pressure control are very important in
diabetic patients on CAPD. This technology allows patients who would
normally have infrequent direct physician contact to be closely monitored at
much more regular intervals. Though not proven by this study, it is likely
that the data transmitted to the internet is much more accurate than the
current system of patient self reporting. Hand written records of glucose
and blood pressure are prone to multiple errors which should be eliminated
by this new technology. Introduction of this technology may introduce new
technological errors into medical data collection, but we feel that these
technological errors will be much less significant than those of hand written
records. This however, has not been clinically proven with this technology.
Further study is again required to determine this effect.
As noted from the patient satisfaction questionnaire, this system of collecting
blood pressure and blood glucose has been very easy to use in this study
cohort. Vital sign measurement was not different than the patients were
previously used to and the added step of downloading the data via
telephone access was easy to use. Patients overall were very pleased with
the quality and ease of use of the equipment. The data presented on the
ChroniCare web site is very easy to monitor and is presented in a
meaningful format to base clinical decisions upon. This technology should
add very useful data to the medical management of diabetic CAPD patients.
With effective use this device should add significantly to gain better control
of both blood pressure and blood glucose in these patients.
9. Table 1. Baseline demographic data.
Age (years) 60.9 ± 11.0
Blood Pressure 147/72 ± 24/18
(mmHg)
Hgb A1c (%) 7.6 ± 1.2
Sex Male (10) Female (5)
11. Table 3. Patient Feedback Questionnaire results
• Device Mean Score
– Easy to use 4.8 ± 0.4
– Construction 4.5 ± 0.7
– Easy to read Display 4.5 ± 0.7
– Reliability 4.2 ± 1.0
• Function
– Installation 4.4 ± 0.7
– Sending data 4.4 ± 0.5
– Reading the Display 4.3 ± 0.7
– Glucometer use 4.6 ± 0.5
– BP cuff use 4.7 ± 0.5
– Confirmation of
Successful transmission 4.3 ± 0.6
• Overall
– Device Features 4.7 ± 0.5
– Performance 4.2 ± 0.6
12. Figure 1. The ChroniCare system. Pictured are: glucometer, blood pressure cuff, and
Healthgate appliance for data transmission. (telephone optional)