We conducted a systematic review of the literature for assessing the value of home monitoring for heart failure (HF) patients. The abstracts of 383 articles were read. We excluded those in which either no home monitoring was done or only the technical aspects of the telemedicine application were described. Forty-two studies met the selection criteria. We classified the results into feasibility (technical and institutional) and impact (on the clinical process, on patient health, on accessibility and acceptability of the health system, and on the economy). Evaluating the articles showed that home monitoring in HF patients is viable, given that: (1) it appears to be technically effective for following the patient remotely; (2) it appears to be easy to use, and it is widely accepted by patients and health professionals; and (3) it appears to be economically viable. Furthermore, home monitoring of HF patients has been shown to have a positive impact on: (1) the clinical process, supported by a significant improvement of patient follow-up by adjustment of treatment, diet or behaviour, as well as hospital readmissions and emergency visits reduction; (2) the patient's health, supported by a relevant improvement in quality of life, a reduction of days in hospital, and a decrease in mortality; and (3) costs resulting from the use of health resources.
Noise and artifacts are inherent contaminating components and are particularly present in Holter electrocardiogram (ECG) monitoring. The presence of noise is even more significant in long-term monitoring (LTM) recordings, as these are collected for several days in patients following their daily activities; hence, strong artifact components can temporarily impair the clinical measurements from the LTM recordings. Traditionally, the noise presence has been dealt with as a problem of non-desirable component removal by means of several quantitative signal metrics such as the signal-to-noise ratio (SNR), but current systems do not provide any information about the true impact of noise on the ECG clinical evaluation. As a first step towards an alternative to classical approaches, this work assesses the ECG quality under the assumption that an ECG has good quality when it is clinically interpretable. Therefore, our hypotheses are that it is possible (a) to create a clinical severity score for the effect of the noise on the ECG, (b) to characterize its consistency in terms of its temporal and statistical distribution, and (c) to use it for signal quality evaluation in LTM scenarios. For this purpose, a database of external event recorder (EER) signals is assembled and labeled from a clinical point of view for its use as the gold standard of noise severity categorization. These devices are assumed to capture those signal segments more prone to be corrupted with noise during long-term periods. Then, the ECG noise is characterized through the comparison of these clinical severity criteria with conventional quantitative metrics taken from traditional noise-removal approaches, and noise maps are proposed as a novel representation tool to achieve this comparison. Our results showed that neither of the benchmarked quantitative noise measurement criteria represent an accurate enough estimation of the clinical severity of the noise. A case study of long-term ECG is reported, showing the statistical and temporal correspondences and properties with respect to EER signals used to create the gold standard for clinical noise. The proposed noise maps, together with the statistical consistency of the characterization of the noise clinical severity, paves the way towards forthcoming systems providing us with noise maps of the noise clinical severity, allowing the user to process different ECG segments with different techniques and in terms of different measured clinical parameters.
ICD Electrograms and Origin of Impulses. Introduction:The implantable cardioverterdefibrillator (ICD) electrogram (EG) is a documentation of ventricular tachycardia. We prospectively analyzed EGs from ICD electrodes located at the right ventricle apex to establish (1) ability to regionalize origin of left ventricle (LV) impulses, and (2) spatial resolution to distinguish between paced sites. Methods and Results: LV electro-anatomic maps were generated in 15 patients. ICD-EGs were recorded during pacing from 22 ± 10 LV sites. Voltage of far-field EG deflections (initial, peak, final) and time intervals between far-field and bipolar EGs were measured. Blinded visual analysis was used for spatial resolution. Initial deflections were more negative and initial/peak ratios were larger for lateral versus septal and superior versus inferior sites. Time intervals were shorter for apical versus basal and septal versus lateral sites. Best predictive cutoff values were voltage of initial deflection <-1.24 mV, and initial/peak ratio >0.45 for a lateral site, voltage of final deflection <-0.30 for an inferior site, and time interval <80 milliseconds for an apical site. In a subsequent group of 9 patients, these values predicted correctly paced site location in 54-75% and tachycardia exit site in 60-100%. Recognition of paced sites as different by EG inspection was 91% accurate. Sensitivity increased with distance (0.96 if ≥ 2 cm vs 0.84 if < 2 cm, P < 0.001) and with presence of low-voltage tissue between sites (0.94 vs 0.88, P < 0.001). Conclusions: Standard ICD-EG analysis can help regionalize LV sites of impulse formation. It can accurately distinguish between 2 sites of impulse formation if they are ≥2 cm apart. (J Cardiovasc Electrophysiol, catheter ablation, electroanatomical mapping, electrogram, implantable defibrillator, pace-mapping, ventricular tachycardia
A systematic review of telemedicine projects in Colombia was conducted. We searched electronic databases, and also searched for relevant Internet websites. Each project manager was contacted by telephone to identify projects which had not actually been carried out. They were interviewed to request information about the projects they were managing, and whether they knew of other projects in Colombia. The search process identified 43 different projects, which were classified into two groups: telemedicine research initiatives and projects for providing health-care services via telemedicine. There were 32 projects which provided telemedicine services, of which 14 had been finished, 11 remained active, 4 were being implemented and no data were available about the state of the other 3. Health-care services had been provided using telemedicine to at least 550,000 patients. The projects had connected more than 650 health-care institutions, mainly in deprived areas of the country. Unfortunately, although many projects seem to have had a positive effect, none of them had been rigorously evaluated, and therefore in the absence of scientific evidence no general recommendations can be made. However, the methodology of the present study appears suitable for similar reviews of telemedicine in other developing countries.
Indoor Location (IL) using Received Signal Strength (RSS) is receiving much attention, mainly due to its ease of use in deployed IEEE 802.11b (WiFi) wireless networks. Fingerprinting is the most widely used technique. It consists of estimating position by comparison of a set of RSS measurements, made by the mobile device, with a database of RSS measurements whose locations are known. However, the most convenient data structure to be used, and the actual performance of the proposed fingerprinting algorithms, are still controversial. In addition the statistical distribution of indoor RSS is not easy to characterize. Therefore, we propose here the use of nonparametric statistical procedures for diagnosis of the fingerprinting model, specifically: (1) A non parametric statistical test, based on paired bootstrap resampling, for comparison of different fingerprinting models; (2) New accuracy measurements (the uncertainty area and its bias) which take into account the complex nature of the fingerprinting output. The bootstrap comparison test and the accuracy measurements are used for RSS-IL in our WiFi network, showing relevant information relating to the different fingerprinting schemes that can be used.
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