Supporting patients with heart failure with digital therapeutics-A pilot study in Germany.

Objective: Continuous monitoring and targeted behavioral interventions have been shown to improve health status and quality of life for heart failure patients. Digital therapeutics offer the possibility to make more frequent monitoring and targeted behavioral interventions available for more people. Methods: We conduct a pilot study with 71 patients who were given a smartphone app and wearables for a 3-month period. Clinical indicators as well as patient-reported outcomes were collected at entry and exit examinations. Results: The New York Heart Association class remained stable or improved. Most quantitative outcome measures improved (6-minute walk test distance + 21 m, Kansas City Cardiomyopathy Questionnaire summary score + 6.0 points, European Heard Failure Self-care Behavior Scale summary score + 6.6 points, correct answers in the Atlanta Heart Failure Knowledge Test + 2.1), although the changes were mainly not significantly different from zero. There was no change in EQ-5D weight and 9-item Shared Decision-Making Questionnaire summary score. Conclusions: This before-after comparison shows that an app-based intervention can work as a digital therapeutic for heart failure patients.

Characterization of phage receptors in Streptococcus thermophilus using purified cell walls obtained by a simple protocol.

A simple protocol was designed and applied to obtain Streptococcus thermophilus purified cell walls. To identify the structures involved in phage adsorption, the cell walls of two Strep. thermophilus strains were treated with sodium dodecyl sulphate and proteinase K. These treatments did not reduce the adsorption of phages CYM and 0BJ to the cell walls of Strep. thermophilus YSD10 and Strep. thermophilus BJ15, respectively. However, phage binding was reduced when the cell envelopes were treated with mutanolysin or trichloroacetic acid 5%, suggesting that the phage receptor component is part of the peptidoglycan or a polymer closely linked to it. The ability of several saccharides to inactivate both phages was also assayed. These phage inhibition experiments suggested that the phage CYM adsorbed to a component involving glucosamine and rhamnose, while glucosamine and ribose interfered with the adsorption of phage 0BJ.

Subcapitation arrangements for specialists.

As group practices begin to change from fee-for-service to managed care/capitated contracts, one of the major issues they will face is how to divide up the revenue from capitated contracts. Single specialty primary care groups traditionally have utilized a method that takes into account the panel size of covered lives for revenue distribution. Multispecialty group practices have different and more complicated issues that need to be dealt with. It is important that medical groups understand the implications of capitated contracting. Not only will compensation formulas need to be revised, but utilization management, management information and referrals systems will all need to be reviewed in light of changing payment methodologies. This article will review some of the decisions that need to be carefully considered before a multi-specialty medical group should sign a capitated contract.