Mobile phone-based surveillance of cardiac patients at home

We tested the reliability, acceptability and feasibility of a home-monitoring system for cardiac patients. Each participant was equipped with a mobile phone, an automatic blood pressure device and a digital weight scale. In total, 20 patients (14 patients with chronic heart failure, six patients with hypertension; mean age 50 years, standard deviation [SD] 14) were monitored for 90 days each. They were asked to measure their blood pressure, pulse and body weight every day, and to transfer the data together with the dosage of medication to the telemonitoring server using wireless Internet technology in the mobile phone. The physician in charge received email alerts when reported data fell outside pre-defined limits. The patients' compliance with the system was high. During a cumulative monitoring period of 1,735 days, there were 2,040 data transfer sessions, a mean of 102 per patient (SD 43). The mean percentage of successful data transfers was 83% (SD 22). The stability of the telemonitoring system was 98%, meaning that patient data transfer was almost always possible. The accessibility of the secure web server for physicians was above 99%. The web-based home-monitoring system was reliable and easy to handle for both patients and health care professionals. It may be a useful tool for patients with heart failure as well as hypertensive patients.     

Impact of Extracellular Protein Binding on Passive and Active Drug Transport Across Caco-2 Cells

Aim The objective of the study is to evaluate the mechanism behind alterations in passive and active transport of drugs in the presence of basolaterally applied extracellular protein using the Caco-2 cell model. Methods The permeation across Caco-2 monolayers of two groups of compounds, transported either solely by passive diffusion or partly also by active transport in the secretory direction, was studied at two donor concentrations in the absence or presence of bovine serum albumin (BSA, 0–4%). Each group contained compounds with high or low protein binding (PB) capabilities and high or low absorption in humans (fraction absorbed, f_a). The unbound fraction (f_u) of each compound was determined by ultrafiltration. Results The transport rate of the passively permeating compounds was the same in both apical-to-basolateral (absorptive) and basolateral-to-apical (secretory) directions in the absence of BSA. Basolaterally applied BSA increased the transport rate in the absorptive direction and decreased it in the secretory direction for all compounds, in direct proportion to the extent of PB. The efflux ratios for the actively transported compounds were reduced in the presence of BSA. Conclusions Basolaterally applied BSA, which mimics in vivo PB, alters both passive and active drug transport in the Caco-2 cell model. Using C_u in the calculations of transport rate allowed elucidation of the different mechanisms behind these alterations. Our data also suggest that active secretory transport for highly protein-bound compounds might have less effect in vivo than predicted from traditional Caco-2 cell models (without BSA).     

Adolescents' views of oral health education. A qualitative study

The objective of this study was to investigate adolescents' perceptions and desires with respect to oral health education. A series of focus group sessions was conducted with adolescents in schools. The groups comprised an average of 6 individuals, with a total of 34 participants. The main themes of the discussions were the informants' perceptions of the oral health education in different settings and under varying circumstances. The discussions were transcribed verbatim and analyzed according to the basic principles of Grounded Theory. One of the most important issues appeared to be the dental personnel considering the individual as a subject and not as an object. The adolescents in the study were uncertain about their knowledge of oral health. Often, the participants expressed a wish to be taught more at the dental visit. Information in schools was sparse. The support of parents was acknowledged but little discussed. The methods used in advertisements to describe dental products were met with skepticism. These should not be imitated in oral health education as this might undermine the credibility of the dental services. Girls were perceived to be more interested in health than boys were. Two core categories labeled "credibility" and "confidence", which interacted continually, emerged from the data in the analysis. The results indicate that the credibility of the intermediary of the health messages is essential, as is their ability to create confidence. Thus, oral health education among adolescents is more likely to be successful when credibility and confidence are perceived.     

Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?

ObjectivesTo evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU).MethodsData on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts.ResultsSymptom classification was S1 in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with S1 and S2 symptoms (P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms (P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively (P < 0.001 for both).ConclusionsLocal symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens.     

Near Field Communication-based telemonitoring with integrated ECG recordings

Objectives

Telemonitoring of vital signs is an established option in treatment of patients with chronic heart failure (CHF). In order to allow for early detection of atrial fibrillation (AF) which is highly prevalent in the CHF population telemonitoring programs should include electrocardiogram (ECG) signals. It was therefore the aim to extend our current home monitoring system based on mobile phones and Near Field Communication technology (NFC) to enable patients acquiring their ECG signals autonomously in an easy-to-use way.

Methods

We prototypically developed a sensing device for the concurrent acquisition of blood pressure and ECG signals. The design of the device equipped with NFC technology and Bluetooth allowed for intuitive interaction with a mobile phone based patient terminal. This ECG monitoring system was evaluated in the course of a clinical pilot trial to assess the system’s technical feasibility, usability and patient’s adherence to twice daily usage.

Results

21 patients (4f, 54 ± 14 years) suffering from CHF were included in the study and were asked to transmit two ECG recordings per day via the telemonitoring system autonomously over a monitoring period of seven days. One patient dropped out from the study. 211 data sets were transmitted over a cumulative monitoring period of 140 days (overall adherence rate 82.2%). 55% and 8% of the transmitted ECG signals were sufficient for ventricular and atrial rhythm assessment, respectively.

Conclusions

Although ECG signal quality has to be improved for better AF detection the developed communication design of joining Bluetooth and NFC technology in our telemonitoring system allows for ambulatory ECG acquisition with high adherence rates and system usability in heart failure patients.     

Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy

Purpose

Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status.

Materials and methods

We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50?years, n?=?66; 50?C59.9?years, n?=?185; 60?C69.9?years, n?=?367; 70?C79.9?years, n?=?419; ??80?years, n?=?132). Median follow-up was 37?months.

Results

Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5?years after RNU were 69, 73, and 61%, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values????0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P?=?0.021), cancer-specific (P?=?0.002), and all-cause survival (P?P?>?0.001).

Conclusions

We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.     

Two weeks of overfeeding with candy,but not peanuts,increases insulin levels and body weight

Objective: To study the effects of snacking based on fast acting carbohydrates (candy) or fat and protein (peanuts) in a prospective randomized, parallel intervention study. Methods: Basal metabolic rate (BMR) and cardiovascular risk factors were measured before and after hyper-alimentation by addition of 20kcal/kg (84kJ/kg) body weight of either candy or roasted peanuts, to the regular caloric intake, for two weeks in healthy subjects. Eleven men and 14 women completed the randomized study. Results: Energy-intake increased similarly in the groups (candy: +46.1±35%, peanuts: +46.8±28% p=0.96). Body-weight (candy: from 67.3±7.6kg to 68.1±7.3kg, p=0.01, nuts: from 68.7±6.1kg to 69.0±5.7kg p=0.3) and waist circumference increased significantly only in the candy group. At the end of the study LDL cholesterol (candy: 2.6±0.4mmol/l peanuts: 2.1±0.4mmol/l, p=0.005) and ApoB/ApoA-1-ratio (candy: 0.68±0.16 peanuts 0.53±0.11, p=0.01) were higher in the candy group than in the peanut group. On the other hand, BMR increased only in the peanut group (candy: from 6.657±1.1MJ/24h to 6.762±1.1MJ/24h, p=0.3 nuts: from 6.896±0.98MJ/24h to 7.256±1.1MJ/24h, p=0.02). Conclusion: Two weeks of snacking based on peanuts does not cause the same negative metabolic effects as an isocaloric diet in which the snacking is based on short acting carbohydrates in the form of candy in non-obese healthy subjects.