ABSTRACT
An automated personalised intervention algorithm was developed to determine when and if patients with chronic disease in a remote monitoring programme required intervention for management of their condition. The effectiveness of the algorithm has so far been evaluated on 29 patients. It was found to be particularly effective in monitoring newly diagnosed patients, patients requiring a change in medication as well as highlighting those that were not conforming to their medication. Our approach indicates that RPM used with the intervention algorithm and a clinical protocol can be effective in a primary care setting for targeting those patients that would most benefit from monitoring.
Subject(s)
Algorithms , Chronic Disease/therapy , Decision Support Systems, Clinical , Medical Records Systems, Computerized , Monitoring, Physiologic/methods , Remote Consultation/methods , Aged , Cohort Studies , Computer Graphics , Data Collection/methods , Diabetes Mellitus, Type 2/therapy , Family Practice , Female , Heart Failure/therapy , Humans , Hypertension/therapy , London , MaleABSTRACT
We have investigated the use of telemonitoring in three long-term conditions: chronic heart failure (CHF), type 2 diabetes and essential hypertension. Participants were provided with a home telemonitoring unit for a 12-week period and entered physiological data each day. The data were sent automatically via the participant's telephone line to a server and could be viewed via a web browser. An intervention algorithm was developed to improve the accuracy with which patients requiring intervention were recognized compared to existing systems based on a simple threshold. Thirty patients completed the 12-week trial. One patient dropped out, giving data on 29 patients (mean age 70 years, 17 women). The algorithm prompted a clinical intervention in 11 patients (38%). The average time that elapsed before the first intervention was 47 days (SD 21). Primarily the interventions (72%) resulted in changes to medication and health advice. The results suggest that four weeks is sufficient time in which to recognize the need to intervene clinically and that in 12 weeks it is possible to effect a change towards a target.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Heart Diseases/therapy , Hypertension/therapy , Monitoring, Ambulatory/methods , Self Care/methods , Telemedicine/methods , Telemetry/methods , Aged , Algorithms , Continuity of Patient Care/standards , Female , Humans , Male , Patient Satisfaction , Physician-Patient RelationsABSTRACT
Acute retinal necrosis in children is a devastating disease that requires early diagnosis and treatment. The authors describe a rarely reported case of bilateral acute retinal necrosis in a child caused by neonatal herpes simplex virus type 2, where the presence of previous chorioretinal scarring made diagnosis challenging.
Subject(s)
Choroid Diseases/pathology , Eye Infections, Viral/virology , Herpes Simplex/virology , Herpesvirus 2, Human/isolation & purification , Retinal Diseases/pathology , Retinal Necrosis Syndrome, Acute/virology , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Aqueous Humor/virology , Child , Drug Therapy, Combination , Eye Infections, Viral/diagnosis , Eye Infections, Viral/drug therapy , Fluorescein Angiography , Glucocorticoids/therapeutic use , Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Humans , Male , Polymerase Chain Reaction , Prednisolone/therapeutic use , RNA, Viral/analysis , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapyABSTRACT
BACKGROUND: Pterygium is a common condition that has many and varied surgical management techniques. Our aim was to describe and evaluate the safety and efficacy of a modified tissue-sparing surgical procedure for management of pterygium. METHODS: This was a retrospective, clinical outcome study of 67 consecutive pterygium head excisions and mini inferior conjunctival autografts (PHEMICA), performed by a single senior surgeon over 7 years. The technique evaluated was a modified pterygium head removal and inferior conjunctival autograft, maximising host tissue preservation. RESULTS: Group A (primary pterygia): 5.25% recurrence rate (3 of 57 eyes). Group B (recurrent pterygia): 30% recurrence rate (3 of 10 eyes). No major complications occurred. One partial autograft necrosis was noted (1.5%, 1 of 67 eyes), with full resolution. INTERPRETATION: The described technique is fast, safe, and effective with a 5.25% recurrence rate in those with primary pterygia. It is not, however, recommended in the treatment of recurrent pterygia; this group of patients requires a more radical excision with a larger autograft and the use of adjuncts such as mitomycin C.
