Intermediate Results of the Research for Percutaneous and Surgical Treatment for Left Anterior Descending Artery Chronic Total Occlusion

Objective: Is to find out which revascularization methods have less of risk factors and complications after the surgery and long-term period. Method(s): From January 2018 to December 2019 were operated 134 patients with LAD CTO. 48 of them underwent MIDCAB: 36 (75%) males and 12 (25%) females;aged 58.7 +/-8.7;7 (14.6%) with previous diabetes;10 (20.8%) with previous PCI of LAD with drug-eluting stent. In the PCI group there were 86 patients: 52 (60.5%) males and 34 (39.5%) females;aged 64.8 +/-8.3;23 (26.7%) with previous diabetes. Result(s): Hospital mortality was 0 (0%) in MIDCAB unlike 1 (1.2%) in PCI. Myocardial infarction was 0 (0%) in both the groups. In MIDCAB the number of conversions to onpump and sternotomy was 0 (0%), there were 6 (12.5%) pleuritis with pleural puncture and 3 (6.2%) with long wound-aches. The hospitalization period was 10.7+/-2.9 days for MIDCAB and 9.9 +/-3.9 days for PCI. In the PCI group 2.0 +/-1.0 drug-eluting stents were used. In-hospital costs were higher for PCI 3809 unlike 3258 for MIDCAB. After one year in MIDCAB group died 2 (4.2%) patients, from noncardiac causes. In PCI group died 3 (3.5%) patients, all from cardiac causes. Because of pandemic COVID-19 were checked only 48 patients by angiography and general clinical examination: 25 after MIDCAB and 23 after PCI. 5 patients have a graft failure, caused by surgical mistakes. 4 patients have stents restenosis and 1 has LAD's reocclusion. Conclusion(s): Both methods of revascularization for LAD CTO are demonstrated similar results. EuroSCORE II (P = 0.008) and glomerular filtrating rate (P = 0.004) are significant potential risk factors for mortality in both groups, age is potential risk factor for graft failure (P = 0.05). Dyslipidemia is significant risk factor for LAD restenosis in PCI group (P = 0.02). MIDCAB is associated with lower incidence of revascularization repeat and in-hospital mortality in the literature data and it costs lower than PCI for LAD CTO as our study has shown.

A Novel Multi-Parameter Calibrator for Ventilator Tester Based on Reciprocating Plunger

Ventilators are widely needed when the COVID-19 is a global outbreak, and they are used to provide mechanical ventilation for patients who are physically unable to breathe, or breathe insufficiently. A ventilator tester is an instrument used to verify and calibrate ventilation parameters of ventilators like gas flow, tidal volume, frequency. As a measuring device, the ventilator tester also needs to be calibrated periodically. And different parameters are usually calibrated with different devices. In order to improve calibration efficiency and accuracy, a novel multi-parameter calibrator for ventilator tester based on reciprocating plunger is proposed in this work. The system composition is introduced and mathematical models are deduced. According to calibrating regulation, different calibrating modes are simulated and realized. © FLOMEKO 2022.All rights reserved

Internet of Things (IoT) based Health Monitor Device

Health is the centre of human enlightenment. Due to the recent Covid outbreak and several environmental pollutions, checking one's vitals regularly has become a necessity. Ours is an IoT-based device that measures a user's heart rate, blood oxygen level and body temperature. The device is compact and portable, making it easy for users to wear. The readings are measured and shown on an OLED display with the help of sensors. The data is also available on the cloud. A webpage and a mobile application were developed to view the data from the cloud. Individual graphs of the vitals with time are available on the mobile application. This can be used for progress measurement and statistical analyses. Authorized personnel can access the patient's vitals. This creates a scope for Tele-medication in rural and underdeveloped regions. Besides, one can also view his/her vitals for personal health routine. © 2022 IEEE.

Assessment of Jordanian physicians' knowledge about venous thromboembolism risk and management among COVID-19 patients

Objectives: The aim of this study was to assess Jordanian physicians' awareness about venous thromboembolism (VTE) risk among COVID-19 patients and its treatment protocol. Method(s): This was a cross-sectional-based survey that was conducted in Jordan in 2020. During the study period, a convenience sample of physicians working in various Jordanian hospitals were invited to participate in this study. Physicians' knowledge was evaluated and physicians gained one point for each correct answer. Then, a knowledge score out of 23 was calculated for each. Key Findings: In this study, 102 physicians were recruited. Results from this study showed that most of the physicians realize that all COVID-19 patients need VTE risk assessment (n = 69, 67.6%). Regarding VTE prophylaxis, the majority of physicians (n = 91, 89.2%) agreed that low molecular weight heparin (LMWH) is the best prophylactic option for mild-moderate COVID-19 patients with high VTE risk. Regarding severe/critically ill COVID-19 patients, 75.5% of physicians (n = 77) recognized that LMWH is the correct prophylactic option in this case, while 80.4% of them (n = 82) knew that mechanical prevention is the preferred prophylactic option for severe/critically ill COVID-19 patients with high bleeding risk. Moreover, 77.5% of physicians (n = 79) knew that LMWH is the treatment of choice for COVID-19 patients diagnosed with VTE. Finally, linear regression analysis showed that consultants had an overall higher knowledge score about VTE prevention and treatment in COVID-19 patients compared with residents (P = 0.009). Conclusion(s): All physicians knew about VTE risk factors for COVID-19 patients. However, consultants showed better awareness of VTE prophylaxis and treatment compared with residents. We recommend educational workshops be conducted to enhance physicians' knowledge and awareness about VTE thromboprophylaxis and management in COVID-19 patients.Copyright © 2022 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved.

Current Healthcare Policy and Environmental Status of Digital Health Medical Devices in South Korea

Objectives: COVID 19 and increasing unmet needs of health technology had accelerated an adoption of digital health globally and the major categories are mobile-health, health information technology, telemedicine. Digital health interventions have various benefit on clinical efficacy, quality of care and reducing healthcare costs. The objective of the study is to identify new reimbursement policy trend of digital health medical devices in South Korea. Method(s): Official announcements published in national bodies and supplementary secondary research were used to capture policies, frameworks and currently approved products since 2019. Result(s): With policy development, several digital health devices and AI software have been introduced as non-reimbursement by utilizing new Health Technology Assessment (nHTA) pathway including grace period of nHTA and innovative medical devices integrated assessment pathway. AI based cardiac arrest risk management software (DeepCARS) and electroceutical device for major depressive disorders (MINDD STIM) have been approved as non-reimbursement use for about 3 years. Two digital therapeutics for insomnia and AI software for diagnosis of cerebral infarction were approved as the first innovative medical devices under new integrated assessment system, and they could be treated in the market. In addition, there is remote patient monitoring (RPM) reimbursement service fee. Continuous glucose monitoring devices have been reimbursed for type 1 diabetes patients by the National Health Insurance Service (NHIS) since January 2019. Homecare RPM service for peritoneal dialysis patients with cloud platform (Sharesource) has been reimbursed since December 2019, and long-term continuous ECG monitoring service fee for wearable ECG monitoring devices (ATpatch, MEMO) became reimbursement since January 2022. Conclusion(s): Although Korean government has been developed guidelines for digital health actively, only few products had been reimbursed. To introduce new technologies for improved patient centric treatment, novel value-based assessment and new pricing guideline of digital health medical devices are quite required.Copyright © 2023

Reassures Me There Are People Around Who Care about Me: Analyzing Meanings of Support for People with Epilepsy

Aims The study aimed to examine the nature and outcomes of social support for the well-being and quality of life (QoL) of adults with epilepsy. Methods The Australian Epilepsy Longitudinal Survey's 5 th Wave included the Medical Outcomes Study Modified Social Support Survey on four dimensions of social support and the QOLIE-31. Both numerical data and open-ended responses were analyzed quantitatively and qualitatively. A mixed method was used where quantitative analysis used t -tests, analysis of variance and block recursive regression, and qualitative analysis identified themes. Results Three-hundred thirty-two people with epilepsy (PWE) participated. The quantitative component showed that for emotional/informational support being older and living alone were key factors. These as well as household income were important in tangible support. For affectionate support living alone and household income were factors, but only income was a factor for positive social interaction. In addition, only positive social interaction predicted increased QoL. In the qualitative component of the study both positive and negative supports were identified for the emotional/informational supports. Many reported the benefits of having information, although some reported failure to have their needs taken seriously by health professionals or epilepsy associations. Inability to drive was an important feature of negative tangible support as was finding some assistive services unaffordable. Reports of positive social interaction identified being accepted as a person with epilepsy that is the primary concern. Peer support plays a role here. Discussion The findings of factors affecting the four dimensions of support in this study have supported a number of studies. This includes the effects of positive social interaction on QoL. The qualitative analysis supports these results, but it also contributes to deeper understanding of support in the lives of PWE. Conclusion Social support is a particularly important issue for PWE. The results of this study demonstrate the complexities and benefits of obtaining the appropriate forms of support. This survey took place before the coronavirus disease 2019 pandemic and it may well be that this phenomenon affects PWE's support needs. Copyright © 2023. Indian Epilepsy Society. All rights reserved.

Rapid exchange of a percutaneous gastrostomy tube during an early episode of COVID-19

We retrospectively report a case of rapid exchange of a percutaneous radiologic gastrostomy tube (balloon-occluded type catheter) via off-label use of a pigtail catheter for nutrition supply during a very early episode of coronavirus disease 2019 (COVID-19) in an outpatient clinic. This case demonstrates that minimally invasive percutaneous procedures might be provided safely and effectively under appropriate precautions for preventing COVID-19 transmission during the pandemic.Copyright © 2023, Society of Gastrointestinal Intervention.

A 3D printed microfluidic PCR device towards detecting SARS-CoV-2

A 3D printed (3DP) microfluidic polymerase chain reaction (PCR) device was demonstrated by detecting synthetic SARSCoV-2 at 106 copies/μL. The microfluidic device was fabricated using stereolithography 3DP and had a reaction volume of ~22 nL. The microdevice showed PCR amplification with 85 base synthetic ssDNA targets and primers designed for a SARS-CoV-2-specific region. The device was 2.5 times faster compared to a qPCR instrument with >60,000 times smaller reagent volume. The 3DP microdevice is a promising technology to significantly reduce the manufacturing costs of microfluidic devices that could be used towards point-of-care applications. © 2023 SPIE.

Face Mask Detector for Raspberry Pi Based on Computer Vision and Edge Computing

The pandemic of the coronavirus disease 2019 has shown weakness and threats in various fields of human activity. In turn, the World Health Organization has recommended different preventive measures to decrease the spreading of coronavirus. Nonetheless, the world community ought to be ready for worldwide pandemics in the closest future. One of the most productive approaches to prevent spreading the virus is still using a face mask. This case has required staff who would verify visitors in public areas to wear masks. The aim of this paper was to identify persons remotely who wore masks or not, and also inform the personnel about the status through the message queuing telemetry transport as soon as possible using the edge computing paradigm. To solve this problem, we proposed to use the Raspberry Pi with a camera as an edge device, as well as the TensorFlow framework for pre-processing data at the edge. The offered system is developed as a system that could be introduced into the entrance of public areas. Experimental results have shown that the proposed approach was able to optimize network traffic and detect persons without masks. This study can be applied to various closed and public areas for monitoring situations. © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).

MFS Design in Appstore-enabled Smart Featurephones for Low-literate, Marginalized Communities

Mobile Financial Services (MFS) has gained significant popularity during the COVID-19 pandemic, especially among marginalized and low-income, low-literate communities around the world. Such communities have not been traditionally considered while designing MFS services via smartphone apps or USSD services in featurephones. Financial constraints limit such end-users towards basic featurephones, where recent appstore support has made it possible to deploy app-based MFS solutions beyond USSD. This new featurephone platform is a relatively underexplored area in terms of addressing design issues related to aforementioned end-users while developing MFS solutions. Our work addresses this gap by presenting qualitative findings on barriers to technology access focused on MFS solutions in marginal communities. We present a prototype non-USSD, app-based solution on an appstore-supported featurephone platform designed via a human-centered approach. This work has the potential to increase the financial inclusivity of marginalized communities in cashless MFS transactions via low-cost, appstore-enabled featurephones. © 2023 ACM.

Enhanced Role of EMA in EU Crisis Response

The regulation also sets out obligations on marketing authorization holders (MAHs) and medical devices manufacturers, authorized representatives, importers, distributors, and notified bodies duties to: * Provide information that will assist with the monitoring by the MSSG/MDSSG of shortages of medicinal products and devices contained in the critical medicines list and updating this when necessary * Provide a justification for any failure to provide the requested information by the established deadlines * Immediately provide any evidence of an actual or potential shortage of medicinal products or devices * Provide information to EMA by 2 Sep. 2022 that will enable the establishment of a Single Point of Contact (SPOC) network, and the industry Single Point of Contact (iSPOC) network, with mandates to updating this when necessary (7). Enhanced advisory role In addition to the measures designed to address medicinal and medical device shortages, an Emergency Task Force (ETF) will also be established within EMA to provide scientific advice and review evidence on medicines that have the potential to address public health emergencies, offer scientific support to facilitate clinical trials, and support existing EMA committees with their authorization and safety monitoring of medicines (8). According to the document published by EMA on Crisis Preparedness and Management, the key benefits for EMA of having these responsibilities include: * Accelerated evaluation and access to safe and effective medicines which could treat or prevent a disease causing, or likely to cause, a public health emergency * Improved quality of data and the effective use of resources through increased support at EU level towards the conducting of clinical trials in preparation for, and during a public health emergency * Improved coordination and harmonization at EU level in preparation for and during a public health emergency (7).

Paper-Based Devices for Virus Detection in Water

Viral infections are global health concerns that can cause high infection and mortality rates, as of the example from SARS-CoV-2 pandemic. Although conventional methods, e.g., polymerize chain reaction (PCR), can provide reliable and robust detection results, they are often time- and cost-consuming, limiting their application in resource-poor settings. Recently, paper-based devices, as a new biosensing technique, have emerged as a promising tool to conventional methods for pathogen detection including bacteria and virus. In this chapter, we provide a comprehensive introduction and insights on the development of paper-based devices for the pathogen detection in water. Firstly, the substrate materials and fabrication methods for paper-based devices are introduced. Engineering assay onto paper-based devices for virus detection is subsequently discussed for the rapid and on-site monitoring. We also compare the strengths and drawbacks between paper-based devices and the conventional analytical methods for virus detection, including culture method, biochemical test, immune assay, and molecular method. This chapter also discusses the feasibility of paper-based devices for point-of-use detection in water matrix, and the challenges and prospects of paper-based devices in water and environmental monitoring. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Infrared Temperature Detection Using MLX90614 Sensor for Wearable Applications

Body temperature is a significant vital sign that can provide great insight as to the state of health of a person. Nowadays, body temperatures are monitored as often as a precaution for the COVID-19 virus. This can be achieved with the use of wearables, which can be non-invasive and convenient for anybody to use. This study aims to design and construct a wearable that can accurately detect the body temperature of a person using the MLX90614 sensor as well as an I2C enabled LCD to allow the user to monitor their temperature at a moment's notice. © 2023 IEEE.

Manufacturing Innovation

(ProQuest: ... denotes non-USASCII text omitted.) The annual Global Innovation Index released in September 2021 ranked China twelfth, surpassing developed economies such as Japan, Israel, and Canada and raising fears in the United States amidst sluggish growth in North America and strong growth in the Asia Pacific region.1 Interestingly, the United States government responded by boycotting the Beijing Olympic Games, citing human rights abuses as the main reason.2 A tech war between China and the United States brewed beneath the diplomatic rancor over the attendance at the Olympic Games. Part I documents how the United States has assisted China's tech and intellectual property domination through President Nixon's historic visit to China, giving China Most Favorite Nation (MFN) status and ascending China to the World Trade Organization (WTO). [...]under Deng Xiaoping's leadership during the reform period, China rapidly developed its special economic zones (SEZs), laying the foundation for subsequent tech innovation and production. [...]broadcasting, telecommunications, office machines, computers, integrated circuits, and cell phones are among China's notable exports to the world.9 China dominates in commodities and raw materials, exporting refined petroleum, cotton, plywood, and tea.10 For agricultural products, China occupies the perch as the world's largest producer. Shenzhen rose as the largest among the four.18 Shenzhen, a small fishing locale in the southern part of China's southern province, Guangdong, served as the pioneer of Deng Xiaoping's embrace of economic reforms.19 A market-oriented economy took root in Shenzhen, allowing foreign companies and entities from Hong Kong and Macau to operate and allowing Chinese talents the freedom to leave their hometowns and move into the SEZs.20 Cheap labor proved to be another significant factor facilitating China's rise as a global manufacturer.21 In the 1980s, multinational corporations from Taiwan, Japan, and South Korea, as well as domestic Chinese companies, opened their factories in the SEZs and other cities in China to take advantage of the cheap and plentiful labor force.22 Indeed, when Deng Xiaoping began his pilot SEZs, China's young workers who wished to lift themselves out of poverty descended into the economic zones in search of better opportunities.23 Shenzhen grew from a population of 59,000 in 1980 to a population of 12,357,000 in 2020.24 The new migrants became the workers, participants, and stakeholders in the global manufacturing frontier.25 Because of the abundance of cheap labor, manufacturers in China have no difficulty keeping production prices low and pleasing consumers and businesses worldwide.26 China's currency manipulation is another factor propelling China to its domination in global manufacturing.27 The United States Congress attempted numerous times to introduce legislation to combat China's currency manipulation.28 China artificially devalued its currency through government control of the exchange rate and refused to let the Chinese Renminbi (RMB) float.29 Despite strong criticisms from the United States, China refuses to allow its currency to freely float.30 China's currency manipulations, according to critics, caused the widening of trade deficits between the United States and China.31 China's currency manipulation allows products to be manufactured at lower prices, hampering competitors and thereafter replacing them.32 In order to cope with China's currency practices, United States manufacturers facing their own existential crises must decide to either outsource jobs overseas or face large risks, including financial ruin.33 The United States lost millions of manufacturing jobs due to massive job outsourcing as the trade deficits between the United States and China continued to persist.34 Geopolitically, in shaping post-Cold-War powers, the United States decided to assist China in its transformation from a poverty-stricken country to a global manufacturer.

ID: 213412 Comparison of Remote Programming and On-Site Programming in Patients With SCS and DRG Stimulation

Introduction: Spinal cord and dorsal root ganglion stimulation (SCS and DRG) are standard of care in chronic neuropathic pain. During the COVID-19 pandemic, it was critical to arrange postoperative care. Furthermore, the disparity between travel times and transportation options could influence the decision on seeking healthcare. Lacking financial resources could enhance this issue. Telehealth is usually restricted to video conferences, without interfering with implanted medical devices. Now, there exists a platform for remote programming of those devices. It is accessible via smartphones and allows direct contact between a patient and their doctor. Method(s): We initiated a pilot study for evaluating the performance of remote care in patients with SCS or DRG stimulation. We plan the enrollment of 20 patients, 10 each in the retrospective and the prospective group. Retrospective data has been collected from on-site programmed patients in our outpatient clinic in a large registry study. Prospective data is being collected under the new standard of care in the remotely programmed patients. We assess ten scores and categories to evaluate the status preoperatively, at implantation, and the postoperative course. The postoperative data are assessed in the context of video conferences for remote programming. 12 months after implantation, a final video conference is scheduled. In both groups, the same stimulation systems are used. Result(s): The study is ongoing. In the retrospective group (n=8), the mean duration of the programming appointment including waiting time was 43 minutes and the mean travel time 71 minutes (mean travel distance 106km with corresponding costs). So far, 5 patients have been enrolled for remote programming. Measured with the Telehealth Usability Questionnaire, their overall satisfaction with the system is high. In the Patient Global Impression of Change Scale 6 months after implantation, the retrospective group has a mean of 5 and the prospective group of 6 points. Considering the Visual Analog Scale, there was an improvement in both groups between the baseline and follow-up (in the retrospective group from mean 8 to 5 and in the prospective group from mean 8 to 2). Conclusion(s): The general convenience with the remote programming is high. Compared to the retrospective group, the patients do not experience a lack of efficacy of their stimulation. The use of remote programming offers various advantages, e.g., no travel times nor costs that allow simplified and more frequent programming. Especially in a pandemic or in case of travel limitations it is a very helpful tool. Disclosure: Mareike Mueller, MD: None, Andrea Dreyer: None, Phyllis McPhillips, RN: None, Guilherme Santos Piedade, MD: None, Sebastian Gillner, MD: ABBOTT: Consulting Fee:, Boston Scientific: Consulting Fee:, Philipp Slotty, MD: None, Jan Vesper, MD,PhD: Abbott: Consulting Fee:, Abbott: Fees for Non-CME/CE Services (e.g. advisor):, Medtronic: Fees for Non-CME/CE Services (e.g. advisor):, Boston Scientific: Consulting Fee:, Medtronic: Consulting Fee:, UniQure: Fees for Non-CME/CE Services (e.g. advisor):, ABBOTT: Consulting Fee:, Abbott: Speakers Bureau:, ABBOTT: Consulting Fee: Self, ABBOTT: Speakers Bureau: Self, ABBOTT: Contracted Research: Self, Boston Scientific: Consulting Fee: Self, Boston Scientific: Contracted Research: SelfCopyright © 2023

Analysis: FDA's COVID-19 Accelerated Pathways

Current FDA programs to accelerate access In order to accelerate the product approval process, four regulatory programs currently exist to reduce development and review times for products that address unmet medical needs for the treatment of serious or life-threatening conditions. In May 2014, FDA issued a Final Guidance for Industry entitled, "Expedited Programs for Serious Conditions-Drugs and Biologics" which addresses fast track designation, breakthrough therapy designation, priority review designation and accelerated approval.3 In addition to this guidance document, under section 564 of the FD&C Act, 21 U.S.C. 360bbb3, in a situation where the Secretary of Health and Human Services (HHS) issues a declaration of emergency or threat justifying authorization of emergency use for a product caused by chemical, biological, radiological or nuclear (CBRN) agents, as well as an infectious disease, the Commissioner of the FDA may authorize an EUA of an unapproved product or an unapproved use of an approved product. In January 2017, the "Emergency Use Authorization of Medical Products and Related Authorities" guidance was finalized.4 Fast Track designation Section 112 of the Food and Drug Administration Modernization Act of 1997 (FDAMA), entitled "Expediting Study and Approval of Fast Track Drugs," mandates the facilitation of the development and processes to expedite review of therapeutics intended to treat serious or life-threatening conditions presenting with unmet medical needs. [...]a two-tiered system of review times, Standard Review and Priority Review was created.

Strategizing for Strength in EU PharmaN

"Though Europe's response has demonstrated strengths," the strategy document reports, "existing vulnerabilities have been thrown into sharp focus, including those related to data availability, the supply of medicines, or the availability of manufacturing capacities to adapt and support the production of medicines" (2). [...]a lot of the strategy's proposals stem from the European Green Deal, published in late 2019 (4), from which has emanated last year's EU industrial strategy (5). [...]setting up critical medicines production capacity in the EU would have to be compliant with the Union's competition rules and those of the World Trade Organization, the commission warned (2).

Acceptable nudge strategies to incentivize the use of wearables and physiolytics at work: A Q-methodology examination

The Covid-19 pandemic has increased the pressure on organizations to ensure health and safety in the workplace. An increasing number of organizations are considering wearables and physiolytics devices as part of their safe return to work programs so as to comply with governments' accountability rules. As with other technologies with ambivalent use (i.e., simultaneously beneficial and harmful), the introduction of these devices in work settings is met with skepticism. In this context, nudging strategies as a way of using design, information, and other ways to manipulate behaviors (system 1 nudge) and choices (system 2 nudge) has gained traction and is often applied alongside the introduction of ambivalent technologies with the aim to "nudge” their use. While the feasibility of different nudge strategies is often studied from only a managerial perspective, where employees' volitional autonomy and dignity is often treated as secondary, we explore which nudges are acceptable from the perspectives of ordinary workers. Using Q-methodology as a more evolutionary and participatory way to design nudges, we describe five basic strategies that are (to varying degrees) acceptable to them: (a) positive reinforcement and fun, (b) controlling the organizational environment, (c) self-responsibility, (d) collective responsibility, and (e) adapting the individual environment. Our findings show that there is a wide range of viewpoints on what is being considered an acceptable nudge and stress the importance of a transparent, equal dialogue between those who design nudges and potential nudgees. © Association for Information Technology Trust 2023.

The influence of the Covid-19 pandemic on the shunt revision rate

Introduction: During the first year of the Covid-19 pandemic we observed a decrease of our shunt revision rate. In order to investigate a possible correlation with an assumingly lower general infection rate in children in times of lock down and homeschooling, we performed a detailed analysis of our shunt and general pediatric patient population. Method(s): Electronic patient charts retrieval for children admitted for shunt revision or infectious diseases was performed for four time periods (study period April 2020 - March 2021, control periods from three previous years). A detailed analysis of all shunt revision and infectious cases including age and season specific evaluation followed. Possible correlations were investigated. Result(s): A total of 318 shunt revision and 13,919 pediatric cases have been evaluated. The shunt revision rate during the study period was 29% less compared to the average rate of three previous years (p 0.061), the number of pediatric cases with main diagnosis infection dropped significantly (p < 0.05), whereas other pediatric admissions remained stable. Significant age or seasonal influences did not exist. The number of shunt revisions in association with a documented systemic infection or a primary shunt infection dropped significantly during the study period (p<0.05 each). This was not the case for underdrainage, overdrainage (p>0.05 each) or other indications. In general, infections of upper and lower airways, the gastrointestinal and nervous system decreased during the pandemic, urinary infection rates remained stable. Conclusion(s): The decreased shunt revision rate during the first year of the pandemic seems correlate with a decrease of the general infection rate in children and adolescents at the same time. Infectionassociated shunt failures showed a significant decrease during this period compared to previous years.

Evidence Trends in Remote Patient Monitoring and Remote Therapeutic Monitoring

Objectives: To provide an overview of trends in the current evidence landscape of products and services in development that support remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), given the release of new billing codes for RPM and RTM by Centers for Medicare and Medicaid Services (CMS) in 2019. Method(s): A focused literature review was conducted in PubMed. Articles published between January 1, 2013 and January 1, 2023 were eligible for inclusion if reported technologies were classified as RPM (defined as the collection and interpretation of physiologic data digitally stored and/or transmitted by patients and/or caregivers to qualified health care professionals) or RTM (defined as the use of medical devices to monitor a patient's health or response to treatment using non-physiological data), following CMS definitions. RPM and RTM technologies included hardware, software, telehealth, and blockchain applications. Articles were then categorized using a semi-automated software platform (AutoLit, Nested Knowledge, St. Paul, MN) based on disease area, study design, intervention, and outcomes studied. Result(s): Of the 673 records screened, 245 articles were included. Observational studies (19.6%) were the most common study design, followed by systematic or focused literature reviews (11.0%) and narrative reviews (10.6%). The most common disease areas included cardiology (25.7%), coronavirus disease of 2019 (COVID-19;13.9%), and diabetes (9.4%). The most frequent clinical, non-clinical, and patient-reported outcomes were symptom monitoring (20.8%), all cause readmission and hospitalization rates (both 7.3%), and patient experience (7.8%), respectively. Conclusion(s): CMS policy and coding practices for RPM and RTM are evolving, and this trend is likely to continue into the future. This review provides details on the current evidence trends associated with RPM/RTM technologies. Evidence development of RPM and RTM should be assessed as evidence needs for coverage and reimbursement may receive increased payer management.Copyright © 2023