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Circulation Nov 2022Morbidity from undiagnosed atrial fibrillation (AF) may be preventable with early detection. Many consumer wearables contain optical photoplethysmography (PPG) sensors...
BACKGROUND
Morbidity from undiagnosed atrial fibrillation (AF) may be preventable with early detection. Many consumer wearables contain optical photoplethysmography (PPG) sensors to measure pulse rate. PPG-based software algorithms that detect irregular heart rhythms may identify undiagnosed AF in large populations using wearables, but minimizing false-positive detections is essential.
METHODS
We performed a prospective remote clinical trial to examine a novel PPG-based algorithm for detecting undiagnosed AF from a range of wrist-worn devices. Adults aged ≥22 years in the United States without AF, using compatible wearable Fitbit devices and Android or iOS smartphones, were included. PPG data were analyzed using a novel algorithm that examines overlapping 5-minute pulse windows (tachograms). Eligible participants with an irregular heart rhythm detection (IHRD), defined as 11 consecutive irregular tachograms, were invited to schedule a telehealth visit and were mailed a 1-week ambulatory ECG patch monitor. The primary outcome was the positive predictive value of the first IHRD during ECG patch monitoring for concurrent AF.
RESULTS
A total of 455 699 participants enrolled (median age 47 years, 71% female, 73% White) between May 6 and October 1, 2020. IHRDs occurred for 4728 (1%) participants, and 2070 (4%) participants aged ≥65 years during a median of 122 (interquartile range, 110-134) days at risk for an IHRD. Among 1057 participants with an IHRD notification and subsequent analyzable ECG patch monitor, AF was present in 340 (32.2%). Of the 225 participants with another IHRD during ECG patch monitoring, 221 had concurrent AF on the ECG and 4 did not, resulting in an IHRD positive predictive value of 98.2% (95% CI, 95.5%-99.5%). For participants aged ≥65 years, the IHRD positive predictive value was 97.0% (95% CI, 91.4%-99.4%).
CONCLUSIONS
A novel PPG software algorithm for wearable Fitbit devices exhibited a high positive predictive value for concurrent AF and identified participants likely to have AF on subsequent ECG patch monitoring. Wearable devices may facilitate identifying individuals with undiagnosed AF.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04380415.
Topics: Adult; Female; Humans; Middle Aged; Male; Atrial Fibrillation; Prospective Studies; Photoplethysmography; Electrocardiography, Ambulatory; Electrocardiography; Wearable Electronic Devices
PubMed: 36148649
DOI: 10.1161/CIRCULATIONAHA.122.060291 -
Obstetrics and Gynecology Feb 2020To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
OBJECTIVE
To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
DATA SOURCES
We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.
METHODS OF STUDY SELECTION
Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.
TABULATION, INTEGRATION, RESULTS
Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.
CONCLUSION
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
Topics: Female; Gynecology; Humans; Obstetrics; Pregnancy; Prenatal Care; Quality of Health Care; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 31977782
DOI: 10.1097/AOG.0000000000003646 -
Zeitschrift Fur Gerontologie Und... Nov 2022The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly... (Review)
Review
The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly increases with age. Therefore, older adults are an important target group for vaccinations. Several vaccines are currently licensed in Europe for older adults, namely two mRNA vaccines, two adenoviral vector vaccines and a protein-based vaccine. The immunogenicity and clinical efficacy of these vaccines in the first approval trials were equal or only slightly reduced for older adults compared to younger age groups; however, the concentration of neutralizing antibodies and protection against infection greatly declined over time and the latter is substantially reduced for virus variants, particularly for the Omicron variant. Nevertheless, protection against severe disease and hospitalization is maintained at a high level for longer time periods, and after three vaccine doses (2 + 1 schedule) also for the Omicron variant. Additional booster vaccinations are currently recommended for patients with risk factors, especially older adults. With respect to the currently valid recommendations for different age and risk groups, the publications and notifications of the national vaccine advisory bodies should be referred to.All currently available vaccines target the original virus strain. New vaccines, which are adapted to virus variants are currently being developed and tested, and it is highly likely that they will be used in the near future; however, viral evolution is ongoing and a continuous development of adapted vaccines will probably be necessary.
Topics: Humans; Aged; COVID-19; SARS-CoV-2; Vaccination; Antibodies, Neutralizing
PubMed: 36112215
DOI: 10.1007/s00391-022-02102-x -
Clinical Epidemiology 2016The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the... (Review)
Review
AIM OF THE DATABASE
The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research.
STUDY POPULATION
The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits.
MAIN VARIABLES
Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses.
DESCRIPTIVE DATA
Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start, and thereafter every 6 months. The longitudinally collected information about the disease activity and side effects made it possible to investigate the clinical efficacy and adverse events of different disease-modifying therapies.
CONCLUSION
The database contributed to a certain harmonization of treatment procedures in Denmark and will continue to be a major factor in terms of quality in clinical praxis, research and monitoring of adverse events, and plays an important role in research.
PubMed: 27822098
DOI: 10.2147/CLEP.S99500 -
Communicable Diseases Intelligence... Mar 2015Since the introduction of measles vaccine to the vaccination schedule, the burden of measles has substantially fallen in Australia. Despite this, a number of recent... (Review)
Review
BACKGROUND
Since the introduction of measles vaccine to the vaccination schedule, the burden of measles has substantially fallen in Australia. Despite this, a number of recent measles outbreaks have occurred. The aim of this study was to examine the burden of measles in Australia using notification, hospitalisation and mortality data with the objectives of setting a baseline for comparison prior to the introduction of the combined measles-mumps-rubella-varicella vaccine.
METHODS
Data were obtained from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database and the National Mortality Database to obtain notification, hospitalisation and death data, respectively from 2000 to 2011. Rates were calculated and compared over time by age group and jurisdiction.
RESULTS
Since 1993, measles notifications have fallen considerably in Australia. However, between 2000 and 2011, measles notification rates and hospitalisation rates fluctuated. Between 2000 and 2011, there were 990 measles notifications in Australia. The average annual notification rate was 0.4 per 100,000 population. Children aged 0-4 years were the most susceptible group, particularly infants less than 1 year of age (average annual rate, 1.6 per 100,000 population). High incidence was also observed in adolescents (average annual rate, 0.7 per 100,000 population) and young adults (average annual rate, 0.8 per 100,000 population). Jurisdictional variation occurred with differing patterns of notifications and hospitalisations.
CONCLUSIONS
Although a marked reduction in measles notifications and hospitalisations has occurred in the past decade, susceptible individuals should be vaccinated to prevent outbreaks and to maintain a low incidence of measles and Australia's elimination status.
Topics: Adolescent; Adult; Australia; Chickenpox Vaccine; Child; Child, Preschool; Disease Notification; Disease Outbreaks; Epidemiological Monitoring; Female; Hospitalization; Humans; Immunization Schedule; Incidence; Infant; Male; Measles; Measles-Mumps-Rubella Vaccine; Morbillivirus; Survival Analysis; Vaccination; Vaccines, Combined
PubMed: 26063085
DOI: No ID Found -
Frontiers in Pharmacology 2021Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such... (Review)
Review
Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such control is warranted. An evaluation via the 8 factors of the CSA provides the comprehensive assessment required for permanent listing of new chemical entities and previously uncontrolled substances. Such an assessment was published for two kratom alkaloids in 2018 that the Food and Drug Administration (FDA) have identified as candidates for CSA listing: mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG) (Henningfield et al., 2018a). That assessment concluded the abuse potential of MG was within the range of many other uncontrolled substances, that there was not evidence of an imminent risk to public health, and that a Schedule I listing (the only option for substances that are not FDA approved for therapeutic use such as kratom) carried public health risks including drug overdoses by people using kratom to abstain from opioids. The purpose of this review is to provide an updated abuse potential assessment reviewing greater than 100 studies published since January 1, 2018. These include studies of abuse potential and physical dependence/withdrawal in animals; receptor binding; assessments of potential efficacy treating pain and substance use disorders; pharmacokinetic/pharmacodynamic studies with safety-related findings; clinical studies of long-term users with various physiological endpoints; and surveys of patterns and reasons for use and associated effects including dependence and withdrawal. Findings from these studies suggest that public health is better served by assuring continued access to kratom products by consumers and researchers. Currently, Kratom alkaloids and derivatives are in development as safer and/or more effective medicines for treating pain, substances use disorders, and mood disorders. Placing kratom in the CSA via scheduling would criminalize consumers and possession, seriously impede research, and can be predicted to have serious adverse public health consequences, including potentially thousands of drug overdose deaths. Therefore, CSA listing is not recommended. Regulation to minimize risks of contaminated, adulterated, and inappropriately marketed products is recommended.
PubMed: 35197848
DOI: 10.3389/fphar.2021.775073 -
Nature Sep 2021Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective... (Randomized Controlled Trial)
Randomized Controlled Trial
Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective communication strategies. Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) (n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) (n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies (n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions, and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.
Topics: Adult; Aged; Appointments and Schedules; COVID-19 Vaccines; California; Female; Health Behavior; Humans; Immunization Programs; Intention; Kaplan-Meier Estimate; Male; Ownership; Public Health; Reminder Systems; Vaccination
PubMed: 34340242
DOI: 10.1038/s41586-021-03843-2 -
Journal of Applied Clinical Medical... May 2024Radiotherapy (RT) treatment and treatment planning is a complex process prepared and delivered by a multidisciplinary team of specialists. Efficient communication and...
PURPOSE
Radiotherapy (RT) treatment and treatment planning is a complex process prepared and delivered by a multidisciplinary team of specialists. Efficient communication and notification systems among different team members are therefore essential to ensure the safe, timely delivery of treatments to patients.
METHOD
To address this issue, we developed and implemented automated notification systems and an electronic whiteboard to track every CT simulation, contouring task, the new-start schedule, and physician's appointments and tasks, and notify team members of overdue and missing tasks and appointments. The electronic whiteboard was developed to have a straightforward view of current patients' planning workflow and to help different team members coordinate with each other. The systems were implemented and have been used at our center to monitor the progress of treatment-planning tasks for over 2 years.
RESULTS
The last-minute plans were relatively reduced by about 40% in 2023 compared to 2021 and 2022 with a p-value < 0.05. The overdue contouring tasks of more than 1 day decreased from 46.8% in 2019 and 33.6% in 2020 to 20%-26.4% in 2021-2023 with a p-value < 0.05 after the implementation of the notification system. The rate of plans with 1-3 day planning time decreased by 20.31%, 39.32%, and 24.08% with a p-value < 0.05 and the rate of plans with 1-3 day planning time due to the contouring task overdue more than 1 day decreased by 49.49%, 56.89%, and 46.52% with a p-value < 0.05 after the implementation. The rate of outstanding appointments that are overdue by more than 7 days decreased by more than 5% with a p-value < 0.05 following the implementation of the system.
CONCLUSIONS
Our experience shows that this system requires minimal human intervention, improves the treatment planning workflow and process by reducing errors and delays in the treatment planning process, positively impacts on-time treatment plan completion, and reduces the need for compressed or rushed treatment planning timelines.
Topics: Humans; Radiotherapy Planning, Computer-Assisted; Radiotherapy Dosage; Neoplasms; Radiotherapy, Intensity-Modulated; Workflow; Tomography, X-Ray Computed
PubMed: 38615273
DOI: 10.1002/acm2.14344 -
Communicable Diseases Intelligence... Mar 2015In 2007, Australia recorded the highest notification rate (2.8 per 100,000) for mumps since it became notifiable, with outbreaks in Western Australia and the Northern... (Review)
Review
In 2007, Australia recorded the highest notification rate (2.8 per 100,000) for mumps since it became notifiable, with outbreaks in Western Australia and the Northern Territory. Of particular concern was the number of cases seen in vaccinated individuals. The aim of this study was to review subsequent epidemiological data. Notification, hospitalisation and mortality data from the National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database and Australian Bureau of Statistics (ABS) respectively, from 2008 to 2012 for notifications and 2008 to 2011 for hospitalisations and deaths, were analysed by age, year and jurisdiction. ABS population data were used to calculate rates. National mumps notification rates decreased from 1.3 per 100,000 in 2008 to 0.4 per 100,000 in 2010, but then increased to 0.9 per 100,000 in 2012, predominantly due to increased notifications in New South Wales (1.4 per 100,000). Hospitalisation rates remained stable at 0.4 per 100,000 over the 2008-2011 period. The median age of notified cases was 30 years and for hospitalisations, 27 years. The highest rate of notifications and hospitalisations was in the 25-34 years age group. Completeness of vaccination status ranged from 16% to 39%. The increasing trend in mumps notifications needs to be closely monitored. Improved data quality, in particular on vaccination status, is needed to inform the monitoring of vaccine effectiveness. In March 2014 the World Health Organization certified that Australia had achieved measles elimination. Greater availability of case history (vaccination status and place of acquisition) and genotyping data would facilitate an assessment of Australia's progress in relation to mumps elimination.
Topics: Adolescent; Adult; Australia; Child; Child, Preschool; Disease Notification; Epidemiological Monitoring; Female; Hospitalization; Humans; Immunization Schedule; Incidence; Infant; Male; Measles-Mumps-Rubella Vaccine; Mumps; Mumps virus; Survival Analysis; Vaccination
PubMed: 26063086
DOI: No ID Found -
Communicable Diseases Intelligence... Mar 2015Since the introduction of universal rubella vaccination in 1989, the incidence of rubella and congenital rubella syndrome (CRS) in Australia has declined significantly.... (Review)
Review
INTRODUCTION
Since the introduction of universal rubella vaccination in 1989, the incidence of rubella and congenital rubella syndrome (CRS) in Australia has declined significantly. Worldwide, there has been a focus on elimination, with the region of the Americas declaring rubella elimination in 2011. This study aims to review Australian rubella epidemiology for the 2008-2012 period, in the context of historical and international trends.
METHODS
Notification, hospitalisation and mortality data were sourced from the National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database and the Australian Bureau of Statistics (ABS). Data analysis focused on 2008-2012 for notifications and 2008-2011 for hospitalisations and deaths. ABS population data were used to calculate rates.
RESULTS
The average annual rubella notification rate in Australia from 2008-2012 was 0.18 per 100,000 and the average annual hospitalisation rate was 0.03 per 100,000 from 2008-2011. One case of CRS was notified in 2012 and 1 hospitalisation with a principal diagnosis of CRS was recorded in 2008. The median age of rubella notifications was 29 years and 37% of notifications were for infections acquired overseas.
DISCUSSION
Rubella continues to be well controlled in Australia and CRS is rare. The low incidence and increasing proportion of imported cases and other evidence suggest that elimination has been achieved; however, for formal verification of rubella elimination the expansion of genotypic surveillance will be required. Ongoing rubella control needs to focus on improved surveillance, maintenance of high levels of vaccine coverage, vaccination of at-risk populations in Australia, and regional and global efforts towards rubella elimination.
Topics: Adolescent; Adult; Australia; Child; Child, Preschool; Disease Eradication; Disease Notification; Epidemiological Monitoring; Female; Hospitalization; Humans; Immunization Schedule; Incidence; Infant; Male; Measles-Mumps-Rubella Vaccine; Middle Aged; Rubella; Rubella virus; Vaccination
PubMed: 26063094
DOI: No ID Found