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A pilot study was conducted to determine if a smartphone-based adjunct to standard care could increase the completion rate of a cardiac rehabilitation program (CRP). Based on historical completion rates, 66 participants who were about to commence a hospital-based CRP were randomized so that half received three devices embedded with near-field communication, namely, a smartphone [pre-installed with an application (app) designed specifically for cardiac rehabilitation], portable blood pressure monitor, and weight scale while completing the CRP. The completion rate among participants who were randomized to the intervention group was 88%, compared to 67% in the control group ( = 0.038). This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( 5/week) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP. No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP. A statistically significant correlation ( = 0.472; = 0.013) was found between the average time participants walked each day (as estimated via the smartphone app) and participants' six minute walking distance (6MWD) before they were discharged from the CRP (a clinically validated measurement).

Background Patients hospitalized with acute coronary syndrome (ACS) or heart failure (HF) are frequently readmitted. This is the first randomized controlled trial of a mobile health intervention that combines telemonitoring and education for inpatients with ACS or HF to prevent readmission. Objective This study aims to investigate the feasibility, efficacy, and cost-effectiveness of a smartphone app–based model of care (TeleClinical Care [TCC]) in patients discharged after ACS or HF admission. Methods In this pilot, 2-center randomized controlled trial, TCC was applied at discharge along with usual care to intervention arm participants. Control arm participants received usual care alone. Inclusion criteria were current admission with ACS or HF, ownership of a compatible smartphone, age ≥18 years, and provision of informed consent. The primary end point was the incidence of unplanned 30-day readmissions. Secondary end points included all-cause readmissions, cardiac readmissions, cardiac rehabilitation completion, medication adherence, cost-effectiveness, and user satisfaction. Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients’ smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients’ usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months. Results Overall, 164 inpatients were randomized (TCC: 81/164, 49.4%; control: 83/164, 50.6%; mean age 61.5, SD 12.3 years; 130/164, 79.3% men; 128/164, 78% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39% vs 9/49, 18%; P=.03) and medication adherence (57/76, 75% vs 37/74, 50%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus $6028 (US $4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus $100,000 (approximately US $70,000) annually. Conclusions TCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945

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The binding of acidic dyes and other negatively charged ions is a well-known property of the proteins of blood plasma and is a specific property of the albumin fractions, the globulin fractions being almost inactive in this respect. This is easily observed when an acidic dye such as bromophenol blue is added to plasma and the plasma then subjected to electrophoresis on filter paper. The blue dye travels solely with the plasma albumin, leaving the globulin fractions unstained. A similar result is observed with the naturally occurring bile pigments in jaundiced plasma. Much further evidence is available for this specific property of plasma albumin and has been reviewed by Goldstein (1949), by Klotz (1949), and by Edsall (1947). Smith and Smith (1938) showed that for a number of plasmas from pathological as well as normal states the retention of phenol red by an ultrafiltration membrane was closely related to the albumin content of the plasma. Rosenfeld and Surgenor (1952) have proposed a method of estimation of human plasma albumin in whole plasma by using the interaction with haematin, the extent of the interaction being measured spectrophotometrically.In the present paper, the substance 1-anilinonaphthalene-8-sulphonic acid is used to estimate the dye-binding capacity of human plasma from a number of pathological conditions. The substance is non-fluorescent in aqueous solution, but brightly fluorescent when absorbed by plasma albumin and is one of a class of compounds with this unusual property described elsewhere (Weber and Laurence, 1954). The method to be described depends on the use of a limited amount of plasma, so that the fluorescent substance is always present in excess of the dye-binding capacity. The amount of dye bound is then a measure of the dye-binding capacity of the plasma and it is evaluated from the fluorescent intensity as only the bound dye is fluorescent. By using standard solutions of a purified albumin to relate albumin concentration with dye-binding capacity, the fluorescent intensities may be converted to equivalent albumin concentrations. Comparisons between these estimates and results of independent determinations by standard techniques are given. As no generally accepted absolute method of albumin determination in plasma is available, the best criterion of the validity is statistical agreement between any two independent methods. This criterion is used to assess the fluorimetric methods and also the standard methods of albumin determination. Fluorimetric MethodsReagents.-The following reagents were used in the fluorimetry:Fluorescent Standard Solution.-l-Naphthylamine-6(7)-sulphonic acid (B.D.H.), 40 mg., was dissolved in 100 ml. of 0.1 M-borate buffer (pH 9.2) and diluted to 1 litre with water.Stock Dye Solution.-l-Anilinonaphthalene-8-sulphonic acid was prepared by the method of Hodgson and Marsden (1939) and 4 mg. was dissolved in an equivalent amount of 0.lN-NaOH and diluted to 500 ml. with water.The l-anilinonaphthalene-8-sulphonic acid was prepared by heating together for 15 ho...

This study demonstrates that music therapy (BMGIM) may be used to access and understand the internal recovery process of postcardiothoracic surgical patients, providing an additional clinical tool to augment the external rehabilitation process.

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