A Cost-effective, Patient-facing Electronic Stethoscope For Telemedical Cardiac Auscultation

Introduction: The COVID19 pandemic spurred an unprecedented growth in telehealth utilization across medical specialties which challenged providers to adapt their standard history and physical protocols for the virtual realm. Heart failure clinicians could readily translate some aspects of physical examination such as jugular venous distention and lower extremity edema assessment over video incorporating bendopnea to gain additional information. However, objective data for clinicians to rely on and guide therapy was often missing. A myriad of technology is available to bridge this gap ranging from simple wearables to invasive hemodynamic monitors though come with varying price tags and avenues of accessibility. Objective(s): We sought to develop an affordable, patient-facing electronic stethoscope of comparable quality to those existing that could seamlessly integrate with any telemedicine platform for real-time or asynchronous clinician review. Method(s): A rigorous design process guided by clinician and patient input generated nearly 100 concepts stratified through a pugh decision matrix in reference to an existing product, the Eko Core, to decide on the most suitable design - the AusculBand. With the form factor of a wrist-band, the AusculBand encases a custom bell with a high fidelity microphone and unique circuitry to sit comfortably in the palm of a user's hand to facilitate self-auscultation over the chest wall for real-time clinician review via telemedicine. Recognizing cardiac sounds to fall between 20 Hz and 2000 Hz, frequency response testing was conducted to determine the cut-off frequency of the AusculBand. With knowledge of an industry standard signal-to-noise ratio of 10.31 dB, a simple comparative study was devised between our novel AusculBand and the commercial Eko Core. With each device, a single-user in replicative fashion collected cardiac signals from the chest wall and background noise from the bicep to generate signal-to-noise ratio readouts and compare overall sound quality. Result(s): In response to frequency testing, the AusculBand was found to attenuate frequencies higher than 1997 Hz when testing a signal that swept through a range of 0 to 3,000 Hz at a constant amplitude. This result was within 0.2% of the 2000 Hz upper-limit of cardiac sounds and surpassing our design input goal of <= 1%. Signal-to-noise ratio analysis revealed 27.29 dB for the AusculBand and 24.02 dB for the Eko Core each exceeding the industry standard of 10.31 dB. Head-to-head comparison revealed the AusculBand achieved nearly double the loudness of the Eko Core. The projected price of the AusculBand is $80. The Eko Core is currently marketed at $350. Conclusion(s): The AusculBand is a cost-effective, patient-facing electronic stethoscope that surpasses industry standards in signal-to-noise ratio and is readily adaptable to popular telemedicine platforms. Additional modification is underway to add a single-lead electrocardiogram to bolster the device as an all-in-one, affordable and accessible telemedicine tool for cardiac analysis.Copyright © 2022

Research on fatigue identification methods based on low-load wearable ECG monitoring devices

The identification of fatigue in personal workers in particular environments can be achieved through early warning techniques. In order to prevent excessive fatigue of medical workers staying in infected areas in the early phase of the coronavirus disease pandemic, a system of low-load wearable electrocardiogram (ECG) devices was used as intelligent acquisition terminals to perform a continuous measurement ECG collection. While machine learning (ML) algorithms and heart rate variability (HRV) offer the promise of fatigue detection for many, there is a demand for ever-increasing reliability in this area, especially in real-life activities. This study proposes a random forest-based classification ML model to identify the four categories of fatigue levels in frontline medical workers using HRV. Based on the wavelet transform in ECG signal processing, stationary wavelet transform was applied to eliminate the main perturbation of ECG in the motion state. Feature selection was performed using ReliefF weighting analysis in combination with redundancy analysis to optimize modeling accuracy. The experimental results of the overall fatigue identification achieved an accuracy of 97.9% with an AUC value of 0.99. With the four-category identification model, the accuracy is 85.6%. These results proved that fatigue analysis based on low-load wearable ECG monitoring at low exertion can accurately determine the level of fatigue of caregivers and provide further ideas for researchers working on fatigue identification in special environments. © 2023 Author(s).

Management of Pediatric Pulmonary Hypertension Using Remote Pulmonary Artery Pressure Sensor Monitoring

Background Management of pediatric pulmonary hypertension (PH) may require manipulation of multiple receptor sites to maximize response to medical therapy. Assessment of response typically occurs through imaging, labs, physical exam and recurrent cardiac catheterization, with anesthetic exposure to assess pulmonary artery pressures (PAP) and vascular resistance (PVR). We aimed to assess feasibility, safety and utility of remote PAP monitoring in pediatric PH patients. Methods We reviewed 4 pediatric patients with significant PH, each of whom underwent cardiac catheterization with pulmonary vasoreactivity testing and placement of a CardioMEMS remote PAP monitoring device. Results Four patients (P1-4: ages 5, 6, 8 and 10 years old) underwent CardioMEMS insertion without procedural complication. P1, P2 and P3 presented with unrepaired VSD;ASD with partial anomalous pulmonary venous return;and ASD and PDA, respectively, while P4 had prior repair of atrioventricular canal. Three patients had Down syndrome. All had elevated PAP and PVR. Mean left lower PA branch size was 7 mm. Mean PAP prior to therapy was 70 mm Hg for P1, 82 for P2, 93 for P3 and 30 for P4. All 4 patients required initiation of triple therapy for treatment of PH, with improvement or normalization of PAP by CardioMEMS, which also included surgical or catheter based intervention for 3 patients. Post-repair of P2, he was unable to be separated from cardiopulmonary bypass and was placed on ECMO. Right ventricular cardiac output improved over 2 weeks, with improvement of PAP determined through serial CardioMEMS. He was successfully decannulated, utilizing CardioMEMS in the OR. Two patients also developed COVID respiratory infections at home with CardioMEMS assessments allowing for oxygen and medication titration. Conclusion Remote PAP monitoring is feasible and appears safe in pediatric patients with adequate PA size. It allows for manipulation of medical therapy with real time knowledge of impact on PAP and can augment management during weaning of mechanical cardiac support. It may also augment decision-making in management of PH patients with developmental disabilities in whom traditional assessments may be more challenging.Copyright © 2023 American College of Cardiology Foundation

FREQUENCY CHARACTERISTICS OF ACOUSTIC FEATURES OF SOUND SIGNALS IN THE LUNGS OF CHILDREN WITH PNEUMONIA USING A NEW ACOUSTIC DIAGNOSTIC DEVICE "TREMBITA-CORONA"

Relevance. Community-acquired pneumonia (CAP) is an urgent problem in practical medicine and the main cause of morbidity and mortality in the world. Diagnosing pneumonia is complex and requires a comprehensive study, taking into account many factors. The development of passive diagnostic methods, such as acoustic ones, is especially promising for children, as this approach reduces significantly the level of radiation exposure to an unformed child's body. The aim. To determine the peculiarities of the frequency characteristics of acoustic signals in the lungs of children with pneumonia using the new acoustic diagnostic device «Trembita-Corona». Materials and methods. We studied 120 children aged 1 month to 18 years, who were treated in the pediatric departments of the Children's Clinical Hospital №. 5 and Children's Clinical Hospital № 7. The children were divided into two groups: Group I – 60 patients with community-acquired pneumonia, Group II – 60 healthy children. Children from І group underwent a comprehensive examination. All children underwent research using the "Trembita-Corona" acoustic monitoring device for the diagnosis of respiratory noise and localization of lung lesions. The computerized analysis of breathing sounds was carried out using mathematical methods without involving human factors. The study was conducted in accordance with the international principles of conducting clinical studies GCP, GLP, the protocol was approved at the meeting of the Commission on Bioethical Expertise at the National Medical University named after O.O. Bogomolets (protocol No. 138 of November 10, 2020). Informed consent of parents/guardians was obtained for conducting the study, which was approved at the same meeting of the Commission on Bioethical Expertise at Bogomolets National Medical University (protocol № 138 of November 10, 2020). Statistical processing of the obtained results was carried out using the licensed programs "MedStat", "Matlab" and with the original calculation programs included in the "Trembita-Corona" system. This work is a part of the complex research work (CRW) of the Department of Pediatrics of Postgraduate Education of Bogomolets National Medical University "Characteristics of the state of health of children who have suffered from COVID-19 and the justification of medical and rehabilitation measures" (2022-2024). State registration number 0122U000486. The authors are performers of the CRW fragment. Results. In children, the clinical picture of CAP consisted of pulmonary (respiratory) complaints, symptoms of intoxication, RF, and local physical changes. Respiratory lung sounds in the frequency range from 0.1 Hz to 30 kHz were studied in all patients using the "Trembita-Corona" device and the corresponding original software. The most promising is the selection of the pathological process of lung damage in pneumonia in the ranges of 0, 1, 2, 3, 4, 5, 6 octaves based on the differences between the average signal power (p<0.05) in children with САP and healthy children. Conclusion. We, in cooperation with leading specialists of the National Aviation University, have developed an experimental sample of the "Trembita-Corona" acoustic monitoring device for the diagnosis of respiratory lung sounds. The "Trembita-Corona" acoustic monitoring device is a new and promising acoustic method for determining the location of a pathological process in the lungs. It was found that the most promising is the selection of the pathological process of lung damage in pneumonia in the ranges of 0, 1, 2, 3, 4, 5, 6 octaves based on the differences between the average signal power (p<0.05) in children with САP and healthy children. © 2022 Authors. All rights reserved.

Sociodemographic Differences in the Utilization of Remote Pulmonary Artery Pressure Measurements for Heart Failure Patients in the USA

Background The COVID-19 pandemic prompted a major surge in telehealth practices, including the increased utilization of remote Pulmonary Artery Pressure (PAP) among cardiologists worldwide. This study aimed to assess the sociodemographic differences in the utilization of the CardioMEMS HF system for remote PAP monitoring in patients with Heart Failure in the USA. Methods The National inpatient sample database of the USA was queried for all patients with HF who received the CardioMEMS HF system between 2016 and 2019. Multiple logistic regression models were subsequently performed to investigate the socio-demographic factors influencing remote pulmonary artery pressure measurements. Results A total of 1540 patients had a CardioMEMS device for remote PAP monitoring between 2016 and 2019. Following a multivariate analysis accounting for potential confounders, we noted that the use of remote PAP was lower in women vs. men (Adjusted odds ratio (AOR): 0.65, CI 0.52 - 0.82, p < 0.001). Patients who lived in low (AOR: 0.38, CI 0.25 - 0.57, p < 0.001), medium (AOR: 0.57, CI 0.40 - 0.82, p = 0.003), and high-income neighborhoods (AOR: 0.60, CI 0.44 - 0.82, p < 0.001), were also less likely to have remote PAP compared to patients who lived in very high-income neighborhoods. There was no racial difference or association between device use and primary insurance payer. Conclusion There are inequities in the utilization of remote PAP monitoring amongst the Heart Failure population within the USA.Copyright © 2023 American College of Cardiology Foundation

The evolving landscape of pulmonary arterial hypertension clinical trials

Although it is a rare disease, the number of available therapeutic options for treating pulmonary arterial hypertension has increased since the late 1990s, with multiple drugs developed that are shown to be effective in phase 3 randomised controlled trials. Despite considerable advancements in pulmonary arterial hypertension treatment, prognosis remains poor. Existing therapies target pulmonary endothelial dysfunction with vasodilation and anti-proliferative effects. Novel therapies that target proliferative vascular remodelling and affect important outcomes are urgently needed. There is need for additional innovations in clinical trial design so that all emerging candidate therapies can be rigorously studied. Pulmonary arterial hypertension trial design has shifted from short-term submaximal exercise capacity as a primary endpoint, to larger clinical event-driven trial outcomes. Event-driven pulmonary arterial hypertension trials could face feasibility and efficiency issues in the future because increasing sample sizes and longer follow-up durations are needed, which would be problematic in such a rare disease. Enrichment strategies, innovative and alternative trial designs, and novel trial endpoints are potential solutions that could improve the efficiency of future pulmonary arterial hypertension trials while maintaining robustness and clinically meaningful evidence.Copyright © 2022 Elsevier Ltd

Distance and Temperature Self-Monitoring Device using Radio Frequency (RF) for COVID-19 Safety Protocol

People all around the country have taken precautions to be safe since the COVID-19 outbreak began. It's critical to maintain such precautions until the virus is under control and vaccine is available to protect everyone from contracting it. Taking safety precautions is not always simple and consistent. They are, however, critically vital. This study aims to design and construct a device that will monitor the safe distance and body temperature of the user. The device does not require wi-fi and simply requires a small amount of infrastructure to charge (USB 5v). It utilizes basic technology and may be assembled with commonly available, low-cost components. The device mainly uses the NRF24L01 RF module, ultrasonic sensor and MLX90614 thermometer sensor for the monitoring system. It is also composed of other electronic components like switch, LCD display and power source. The device will prevent the virus from infecting you, your family, and your friends. Results have shown that this device is applicable for distance and temperature monitoring of a person as an aid to prevent the spread of the virus. © 2022 IEEE.

Challenges of implementing nonpharmaceutical- interventions to prevent COVID- 19 in an urban-slum in Lagos-Nigeria

Introduction/ Background: Non-pharmaceutical interventions are important public health measures targeted at behavioral changes to interrupt the transmission of coronavirus in humans. This study evaluated the challenges of implementing non-pharmaceuticalinterventions, assessed adherence, and identified requirements to the successful control of the spread of COVID-19 among individuals living in an urban-slum setting in Lagos-Nigeria. Methods: A cross-sectional study conducted among resident of an urban-slum in Makoko, Lagos-Nigeria. Adult members of households aged 18 years and above were selected via convenient sampling. An interviewer administered semi-structured questionnaire was used to obtain information on sociodemographic characteristics, living conditions and adherence to non-pharmaceutical interventions over a period of five-months from May to September 2020. Adherence to nonpharmaceutical intervention was determined by calculating an adherence index from 10 evidence based protective behaviors and a self-report of adhering to the measures. Descriptive-statistics and multiple-logistics regression model were used to determine challenges and factors associated with adherence to COVID-19 preventive measures. Results: A total of 357 participants with a mean-age of 45.8 ± 12.9 years were included in the analysis. Majority were males (62.2%) and married (83.8%). Most participants (93.8%) had no space for selfisolation as majority lived in a one-roomapartment (72.8%), shared toilets/kitchen-space (63.6%) with other families and had no constant source of water-supply (61.9%). About 98.8% are aware of the pandemic but only 33.9% adhered to the preventive-measures. The ability to afford facemasks/hand-sanitizers (aOR:6.7;95% CI:3.8-11.6), living-alone (aOR:3.7;95%CI:1.3-10.6), and ability to buy-water (aOR:0.3;95% CI:0.1-0.5) were found to be associated with adherence to the preventivemeasures after adjusting for covariates in a multilogistic- regression-model. Impact: This study gives insight on the realities/challenges of implementing non-pharmaceutical-intervention against COVID-19 disease in a setting of economically disadvantaged individuals who are at a great risk of being a hub for circulating the virus. This will aid the government in addressing cogent factors that might fuel re-occurrence of the pandemic waves. Conclusion: Implementation of non-pharmaceutical interventions for COVID-19 prevention was a challenge as only a quarter of residents adhered to national guidelines. Government should prioritize vaccinating these cohort of individuals and address factors like poor housing, overcrowding and lack of public water supply that affects adherence to public health measures in this setting.

CardioMEMS monitoring system improves prognosis of patients with advanced heart failure in the real-world

Background: Despite several pharmacological advances, the morbidity and mortality in heart failure (HF) remain high, posing a problem for both patients and the National Health System. The natural history of this disease alternates phases of stability and phases of exacerbation, with a progressive decline in the patient's functional capacity and quality of life;this has led to the development of remote monitoring systems. These devices are emerging as an important tool for the effective HF management, even during the COVID-19 pandemic. Methods: We enrolled 6 patients with end-stage HF, who received the combined CardioMEMS / Levosimendan strategy to reduce the number of hospitalizations and optimize both tailored adjustment of home therapy and infusions of Levosimendan. Specifically, CardioMEMS is a wireless sensor that can be implanted in the pulmonary artery, where it detects cardiac filling pressures, an objective measure of the patient's hemodynamic congestion;these pressures increase two weeks before the onset of symptomatic congestion. Results: The 6 patients (72.25±4.60 years;33.33% female) who received the device did not have any complications related to the procedure. Patients were monitored daily by CardioMEMS;if the cardiologist detected a tendency for pulmonary artery diastolic pressure (PAPd) to rise, patients were contacted for home therapeutic changes. If no further changes were possible, the patient was hospitalized for the infusion of Levosimendan. In particular, following the implantation of CardioMEMS, a significant reduction in HF unscheduled hospital admissions was recorded (hospitalizations / month: pre-CardioMEMS 0.657±0.303 vs post-CardioMEMS 0.029±0.021, p 0.0313) (Figure 1). In addition, lower pulmonary arterial pressures were recorded at 6-months FU on CardioMEMS monitoring (pre vs post: PAPs: 51.25±2.56 vs 42.75±2.46 mmHg, p 0.0168;PAPd: 26.25±0.85 vs 20.25±0.85 mmHg, p 0.0034), a reduction in the echocardiographic E/e' ratio (20.86±1.77 vs 14.13±2.02, p 0.0057), an improvement in the quality of life (EQ5D 75.17±2.06 vs 108.60±8.70, p 0.0078) and a reduction in IL-6 levels (p 0.0211). Conclusions: In this study we present the first experience of serial infusions of Levosimendan guided by CardioMEMS. Our results support the usefulness of this device in remote management of the HF patient, especially during this pandemic.

Resource Aware Fog Based Remote Health Monitoring System

In today's world of medical science, remote patient monitoring devices are becoming more important and a future need particularly in the present COVID-19 situation as individuals are preferred to be kept isolated. Patients would be benefited from a suitable monitoring system that measures their important medical parameters such as pulse rate, oxygen saturation or SpO2, body temperature, blood pressure, and Galvanized Skin Response (GSR). This system can increase the medical staff efficiency by drastically decreasing their duties in hospitals and the need to attend to them individually. Patients in their home isolation may utilize the device as well, and their vital indicators may be checked by doctors remotely. In this work, we are prototyping a powerefficient, wearable medical kit and a resource-aware fog network set up to handle the Internet of Things (IoT) data traffic. The idea behind the design is to process the critical medical sensors' data in the fog nodes which are deployed at the edge of the network. The data thus received, is used for a machine learning-based solution for personal health anomalies and COVID-19 infection risk analysis. © 2022 IEEE.

TELEFIT - An IoT enabled health care Device

Amidst this uncertain situation of the Covid pandemic happening worldwide, It is necessary to protect the health workers too. Since they are more prone to the dangerous virus than any other. To reduce the risk of virus infection spreading to Health care workers, this paper proposes the concept of wearing a smart Healthwear band, an IoT monitoring device integrated with a mobile application for monitoring the patients with a contact-less mechanism. Healthware is placed on the Covid infected patients which sense the temperature, pulse, and oxygen level of the patient. This was monitored manually before with the equipment present in the hospitals. This Health wear device automatically collects the data of patients and alerts the Nurses and doctors in case of emergencies. This reduces the contact of Healthcare workers with infected patients. This paper briefly describes the working of the IoT enabled healthcare device and the methodology used in detail. The cost of the proposed device is very less compared to other existing systems. © 2022 IEEE.

Temperature Monitoring and Application of Machine Learning in Radiology for COVID-19 Pandemic

Entire world got hit by a pandemic due to COVID-19 virus. This virus had a huge toll on the human race which is the reason there is a need to detect such a threat on anearly stage. To detect the virus, some of its symptoms like high fever, cough, cold, and congestion in lungs. Spreading of this virus occurs due to a physical touch between two living or non-living surfaces. Therefore, constant sanitization is required in the contaminated zones. An advanced machine that can take a human X-ray and analyze for infection, check the temperature of the body as well as sanitize while a person is leaving can be a boon to detect cases early. In the entry stage, an X-ray machinewill take a chest X-ray of the person and use machine learning classifiers in order to detect any infection in lungs. On the second stage a temperature monitoring device using infrared sensor will check for high or low temperatures. Alongside, a sterilizing unit having UVC rays will disinfect the person in front of it. In this way, an instant checkup for COVID-19symptoms can help to eradicate the virus. This system can be used for offices, public places as well as medical facilities for detection of the virus. © 2021 IEEE.

Pediatric Multi-System Inflammatory Syndrome With Fatal Cerebral Edema in a Patient With COVID-19

INTRODUCTION: There are increasing reports of a pediatric multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) that presents with varying clinical features, but includes features of Kawasaki disease or toxic shock syndrome. Symptoms include fever, rash, abdominal pain, vomiting, and diarrhea. Many patients present without any respiratory symptoms and testing for SARS-CoV-2 is often negative. METHODS: A retrospective chart review was performed. RESULTS: A 7-year-old previously healthy male presented with 3 days of fevers up to 102.4F, headaches, abdominal pain, and intractable vomiting. Both parents had tested positive for SARS-CoV-2 four weeks prior. Nasopharyngeal swab tested positive for SARS-CoV-2 RNA. Echocardiogram was normal. CT venogram of his head was negative for any pathology. He developed severe neck pain and persistent headache during his hospitalization. Soon after receiving hydroxychloroquine, he developed a facial rash and altered mental status with episodes of aphasia, agitation, and pinpoint pupils. He then became unresponsive with left gaze deviation. A non-contrast head CT and CT angiography were negative. He was given levetiracetam and cefazolin and transferred to the pediatric intensive care unit. An electroencephalogram (EEG) showed no epileptiform activity. Over the following 7 hours, the EEG demonstrated left frontotemporal slowing, which progressed into a loss of fast activity over the right hemisphere with increased delta activity in the left hemisphere, then abruptly changed to generalized voltage attenuation.He rapidly lost brainstem reflexes, developing fixed and dilated pupils. Repeat CT scan revealed diffuse cerebral edema with loss of gray-white differentiation. Lab results then were consistent with severe inflammation. An intracranial pressure monitor revealed pressures greater than 76 mmHg. His exam soon became consistent with brain death. Pathologic evaluation showed diffuse cerebral edema with perivascular mononuclear infiltrates. CONCLUSION: The cause of this pediatric multi-system inflammatory syndrome is unclear and the mechanism by which SARS-CoV-2 affects the nervous system is unknown. Pediatric patients with COVID-19 and neurologic symptoms should be closely monitored as they can rapidly decline due to fulminant cerebral edema.

Personal Safety Monitoring Devices in Wake of COVID19: Application of IoT and Sensor Technology

There are constraints to provide the effective treatment for COVID19 patients in hospitals due to infectious nature of the disease. Quality treatment and continuity in the healthcare of patient is difficult in case of patients of diseases of infectious nature. In the process of treatment, many patients are not been properly monitored to their clinical events for better diagnosis. Patients are uncomfortable for the delay in medical attention as cost of such treatments is too high as various devices are to be included in the care. Therefore, it is required to provide the unrestricted medical advice and support to avoid further spread of the disease and better cure of the patient. In this manuscript, we proposed two ICT enabled centralized patient monitoring devices along with usage of other IoT-based systems which are to be used for COVID19 hospitals to help the Paramedic’s staff to monitor the body temperature of the COVID19 patients in emergency medical situations for serious patients with the aim of stabilizing them without moving to their place. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Design of an IoT Safety Distance Monitoring Device for COVID-19

The COVID-19 pandemic arises in the year 2020 that leads to almost more than 100,000,000 confirmed cases happened in worldwide and yet, the cases are continuing to rise now. One of the common methods that used to prevent the COVID-19 is through keeping the social distancing between each other. However, people do not aware of the importance of applying social distancing rules. A low-cost solution is urgently needed for contact tracing and remind the users to keep the social distancing with the others. An IoT-based safety distance monitoring (ISDM) device is proposed to monitor safety distance, remind people to always stay alert and keep the data of the users that violated the social distancing rules for contact tracing. ISDM is a lightweight wearable wristwatch. Bluetooth Low Energy technique is used to send and receive information such as body temperature and contact tracing information. Fever is the most common symptom of COVID-19 patients. ISDM can operate either online or offline. The health and contact tracing information are stored in a local Micro-SD card storage when offline and data will be uploaded to the cloud server for further analysis once ISDM is connected. The detailed contact tracing information can be used to trace the potential COVID-19 patients with close contact with the COVID-19 patient. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Remote Monitoring System for Covid-19 Patients in Home Isolation and Pilot Study Results in A High Altitude Population

A remote monitoring device for measuring oxygen saturation by finger pulse oximetry, axillary temperature and respiratory rate has been constructed. This device has been tested in a pilot study on patients with confirmed Covid-19, determined by antigen tests, who were undergoing home quarantine. The system uses a Raspberry pi CPU with a PiCamera attached to perform optical character recognition from the displays of low-cost finger pulse oximeters and digital axillary thermometers. The temperature of the finger being measured using pulse oximetry was also recorded, as an additional variable, using a thermistor in contact with the finger. In a pilot prototype validation study, undertaken in Peru with eleven patients, the average oxygen saturation of patients living at 3350 meters above sea level was 92.88%, with a standard deviation of 1.65%. A patient with moderate symptoms and a patient with a deteriorating condition had temporary saturation levels below 88%. Axillary temperature and respiratory rate did not vary considerably over the study period. Finger temperature data was used to determine correct human-computer interaction with respect to measurement errors, failed attempts and to control sampling efficiency, which can be affected by cold fingers. © 2021 IEEE.

AMBULATORY HEMODYNAMIC-GUIDED CARE FOR PATIENTS WITH CHRONIC HEART FAILURE: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: Outpatient hemodynamic-guided heart failure (HF) management is suggested to decrease HF morbidity. With the recent publication of results from the GUIDE-HF trial, we performed an updated meta-analysis of related randomized controlled trials (RCTs). Methods: A PubMed literature search was conducted to identify RCTs exploring the benefit of remote hemodynamic monitoring. The studied demographic included adults diagnosed with HF that were implanted with continuous hemodynamic monitoring devices, regardless of ejection fraction, and with NYHA severity ranging from II-IV. The primary outcome examined was the rate of HF hospitalizations before the COVID-19 pandemic. Random Effects Hartung-Knapp method was used to estimate the pooled odds ratio (OR). Additional sensitivity analysis, using data from the GUIDE-HF trial, was conducted to evaluate the impact of the pandemic on the overall results. Results: A significant decrease in hospitalizations was noted with an estimated pooled OR 0.62 [95% CI 0.41 - 0.94] after including the pre-COVID-19 GUIDE-HF results in the meta-analysis. The I2 statistic was estimated at 38% (p = 0.18). Further sensitivity analysis revealed that this benefit lost statistical significance with the overall results of the GUIDE-HF trial, OR 0.66 [95% CI 0.42 - 1.02]. Conclusion: Our results show that remote hemodynamic monitoring significantly decreases HF-related hospitalizations. Limitations to our findings include;1) GUIDE-HF trial contributed to 35% of the overall results 2) Follow-up time was variable amongst the RCTs 3) Results including data since COVID-19 affected the frequency of HF patient follow-up, possibly affecting the overall results from the GUIDE-HF trial. Given the evolving circumstances relating to the COVID-19 pandemic, further investigations on the pragmatic utility of hemodynamic-guided HF management are warranted.