Wearable Health Devices (WHDs) are increasingly helping people to better monitor their health status both at an activity/fitness level for self-health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnostic and guidance of treatment. The technology revolution in the miniaturization of electronic devices is enabling to design more reliable and adaptable wearables, contributing for a world-wide change in the health monitoring approach. In this paper we review important aspects in the WHDs area, listing the state-of-the-art of wearable vital signs sensing technologies plus their system architectures and specifications. A focus on vital signs acquired by WHDs is made: first a discussion about the most important vital signs for health assessment using WHDs is presented and then for each vital sign a description is made concerning its origin and effect on heath, monitoring needs, acquisition methods and WHDs and recent scientific developments on the area (electrocardiogram, heart rate, blood pressure, respiration rate, blood oxygen saturation, blood glucose, skin perspiration, capnography, body temperature, motion evaluation, cardiac implantable devices and ambient parameters). A general WHDs system architecture is presented based on the state-of-the-art. After a global review of WHDs, we zoom in into cardiovascular WHDs, analysing commercial devices and their applicability versus quality, extending this subject to smart t-shirts for medical purposes. Furthermore we present a resumed evolution of these devices based on the prototypes developed along the years. Finally we discuss likely market trends and future challenges for the emerging WHDs area.

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Wearable Health Devices-Vital Sign Monitoring, Systems and Technologies.

https://air.unimi.it/bitstream/2434/702816/2/main.pdf

Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care.

Transcranial direct current stimulation (tDCS) has been proposed as an adjuvant technique to improve functional recovery after ischaemic stroke. This study evaluated the effect of tDCS over the left frontotemporal areas in eight chronic non-fluent post-stroke aphasic patients. The protocol consisted of the assessment of picture naming (accuracy and response time) before and immediately after anodal or cathodal tDCS (2 mA, 10 minutes) and sham stimulation. Whereas anodal tDCS and sham tDCS failed to induce any changes, cathodal tDCS significantly improved the accuracy of the picture naming task by a mean of 33.6% (SEM 13.8%).

Improved naming after transcranial direct current stimulation in aphasia. Commentaries

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with “strong agreement”. The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

https://link.springer.com/content/pdf/10.1007%2Fs00134-017-4920-z.pdf

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

Airway clearance techniques in neuromuscular disorders: A state of the art review.

Objective To compare the impact of a care bundle including medication reconciliation at discharge by a pharmacist versus standard of care, on continuity of therapeutic changes between hospital and primary care and outcome of patients, within 1 month after discharge. Methods Randomised controlled trial in 120 adult patients with at least one chronic disease and three current medications before admission, hospitalised in an infectious disease department of a tertiary hospital and discharged home. Patients were randomly assigned (1:1) to receive a discharge care bundle including medication reconciliation, counselling session and documentation transfer to primary care physician (PCP) (intervention group) or standard of care (control group). Primary outcome was the proportion of in-hospital prescription changes, not maintained by the PCP, 1 month after discharge. Secondary outcome measures included the proportion of patients experiencing early PCP's consultation, hospital readmissions or adverse reactions within 1-month postdischarge and cost of discharge prescriptions. Results Baseline characteristics were comparable between the two groups. One month after discharge, the proportion of in-hospital prescription changes, not maintained by the PCP, was 11% in the intervention group versus 24% in the control group (P = .007). The median delay before PCP's consultation was longer in the intervention group (30.5 vs 19.5 days, P = .013), there were fewer patients readmitted to hospital (3.4% vs 20.7%, P = .009, odds ratio (OR) = 0.13 [0.02-0.53]) and fewer patients who suffered from adverse drug reaction (7.0% vs 22.8%, P = .04, OR = 0.26 [0.07-0.78]). Conclusion This care bundle resulted in the reduction of treatment changes between hospital discharge and primary care.

Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial

Alors que le traitement des ostéomyélites à entérobactéries productrices de BLSE repose sur les carbapénèmes, le schéma thérapeutique optimal de celles causées par OXA-48 est peu étayé par la littérature. Nous avons évalué l'efficacité du ceftazidime-avibactam (CAZ-AVI) dans différentes combinaisons au travers d'un modèle expérimental chez le lapin d'ostéomyélite à E. coli producteur d'OXA-48/BLSE. E. coli pACYC184 est une souche clinique hébergeant les inserts blaOXA-48 et blaCTX-M15, avec une sensibilité accrue à l'imipénème (CMI, 2 mg/L), sensible à la gentamicine (CMI, 0,5 mg/L), à la colistine (CMI, 0,25 mg/L). L), au CAZ-AVI (CMI, 0,094 mg/L), à la fosfomycine (CMI, 1 mg/L) et résistant à la ceftazidime (CMI, 16 mg/L). Les courbes de bactéricidies ont été réalisées à 4 x CMI. Une ostéomyélite a été induite par injection tibiale d'un agent sclérosant suivi de 2 × 108 UFC/ml d'E. coli. Le traitement antibiotique étant différé à J14 de l'ostéomyélite et administré durant 7 jours, parmi 6 groupes de 12 lapins: (1) groupe témoin (2) colistine 150.000 UI/kg SC tid, (3) CAZ-AVI 100/25 mg/kg SC tid seul ou en association avec (4) colistine, (5) fosfomycine 150 mg/kg SC bid ou (6) gentamicine 15 mg/kg IM qd. A 3 jours de la fin du traitement (J24), les lapins ont été euthanasiés et les os broyés ont été mis en culture afin de quantifier le nombre de bactéries et à la recherche de mutants résistants au CAZ-AVI. In vitro, CAZ-AVI seul bien que bactéricide en 3h, était responsable de repousse après 6h. A contrario, les associations CAZ-AVI + gentamicine ou colistine ont été rapidement bactéricides et synergiques en 6h, tandis que CAZ-AVI + fosfomycine était synergique en 24h. Aucun mutant au CAZ-AVI n'est apparu chez les survivants. In vivo, chez les témoins à J24, la médiane avec l'IQR du nombre de bactéries était de 5,4 (4,7-5,7) log10 UFC/g d'os. Par rapport aux témoins, les lapins traités par la colistine seule avaient une densité bactérienne osseuse similaire (P = 0,24), et aucun os n'a été stérilisé. Inversement, CAZ-AVI seul a diminué de manière significative la densité bactérienne osseuse (3,5 (2,0-4,5) log10 UFC/g; P = 0,004) mais n'a pas permis d'obtenir une stérilisation osseuse significative (n = 3/11; 36 %). Cependant, lorsqu'il était utilisé en association, CAZ-AVI + colistine, fosfomycine ou gentamicine a considérablement réduit la densité bactérienne osseuse (P <0,0001) et a également permis d'obtenir une stérilisation osseuse chez 90,1%, 100% et 100% des lapins traités, respectivement. Dans notre modèle expérimental d'ostéomyélite à E. coli OXA-48/BLSE, l'utilisation en association du CAZ-AVI, quel que soit l'antibiotique utilisé (gentamicine ou colistine ou fosfomycine), a été plus efficace que n'importe quelle monothérapie. Aucun lien d'intérêt 

Evaluation de l'efficacité du ceftazidime-avibactam seul or en association dans un modèle d'ostéomyélite à E. coli producteur d'OXA-48/BLSE

Zini, J.1; Gajdos, V.2; Benoist, G.3; Blanc, P.4; Basmaci, R.5; Vaugier, I.6; Essid, A.1; Awa, B.1; Emna, B.1; Maud, G.1; Mbieleu, B.1; Bergounioux, J.1 Author Information 

PP254 [Lung » Modalities of respiratory support]: PREDICTIVE FACTORS OF HIGH FLOW NASAL CANULA (HFNC) SHORT TERM FAILURE IN SEVERE ACUTE BRONCHIOLITIS

Long-Term Effectiveness of a Cognitive Behavioral Therapy (CBT) in the Management of Fatigue in Patients with Relapsing Remitting Multiple Sclerosis (RRMS): A Multi-Centre, Randomised, Open-Label, Controlled Trial Versus Standard Care

Isabelle Vaugier

Papers

Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial

Evaluation de l'efficacité du ceftazidime-avibactam seul or en association dans un modèle d'ostéomyélite à E. coli producteur d'OXA-48/BLSE

PP254 [Lung » Modalities of respiratory support]: PREDICTIVE FACTORS OF HIGH FLOW NASAL CANULA (HFNC) SHORT TERM FAILURE IN SEVERE ACUTE BRONCHIOLITIS

Long-Term Effectiveness of a Cognitive Behavioral Therapy (CBT) in the Management of Fatigue in Patients with Relapsing Remitting Multiple Sclerosis (RRMS): A Multi-Centre, Randomised, Open-Label, Controlled Trial Versus Standard Care