PubMed | Royal Brompton and Harefield NHS Trust, Fellow in cardiology and Chorleywood Health Center
Type: Journal Article | Journal: Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2016
Familial hypercholesterolaemia is a genetic condition characterised by high cholesterol levels in the blood and an increased risk of premature coronary heart disease. In this article, the authors review the clinical features, pathology, epidemiology and clinical management of this often underdiagnosed condition.
Lamprinakos G.C.,National Technical University of Athens |
Asanin S.,Anticimex |
Broden T.,CNet Svenska AB |
Prestileo A.,Santer Reply |
And 4 more authors.
Information Sciences | Year: 2015
Software platforms focused on the healthcare monitoring sector have recently attained a great penetration in the ICT market and they certainly constitute a key contributor to the improvement of the elderly people's quality of life and the reduction of healthcare costs. It is of great importance that the platform allows for the simultaneous health, mental and psychological status evaluation of an elderly person. However, the integration of vital signs monitoring (Telehealth) with behavioral analysis based on home care sensors (Telecare) has not yet been established at a large scale. We describe the design and implementation of such platform that enables the deployment of services to follow-up the patient's health status based on a set of monitored parameters per disease and to profile user's habits and diagnose deviations from their usual activities. A key aspect of the platform is its Service Oriented Architecture middleware that collects data from heterogeneous Telecare and Telehealth gateways and provides the upper service layers with a unified and standards compliant message. In this way, an integrated view of Telehealth and Telecare data and alerts is made possible into a backend Web Portal where clinicians and operators have access to. © 2015 Elsevier Inc. All rights reserved.
PubMed | Laboratory of Signals and Systems L2S, Telefonica, St Georges Hospital, Public Hospitals of Paris AP HP and 3 more.
Type: Journal Article | Journal: Journal of medical Internet research | Year: 2016
Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patients home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy.The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home.Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I
Clarke M.,Brunel University |
Gokalp H.,Brunel University |
Fursse J.,Chorleywood Health Center |
Jones R.W.,Chorleywood Health Center
IEEE Journal of Biomedical and Health Informatics | Year: 2016
This study presents a novel dynamic threshold algorithm that is applied to daily self-measured SpO2 data for management of chronic obstructive pulmonary disease (COPD) patients in remote patient monitoring to improve accuracy of detection of exacerbation. Conventional approaches based on a fixed threshold applied to a single SpO2 reading to detect deterioration in patient condition are known to have poor accuracy and result in high false alarm rates. This study develops and evaluates use of a dynamic threshold algorithm to reduce false alarm rates. Daily data from four COPD patients with a record of clinical interventions during the period were selected for analysis. We model the SpO2 time-series data as a combination of a trend and a stochastic component (residual). We estimate the long-term trend using a locally weighed least-squares (low-pass) filter over a long-term processing window. Results show that the time evolution of the long-term trend indicated exacerbation with improved accuracy compared to a fixed threshold in our study population. Deterioration in the condition of a patient also resulted in an increase in the standard deviation of the residual (σres ), from 2% or less when the patient is in a healthy condition to 4% or more when condition deteriorates. Statistical analysis of the residuals showed they had a normal distribution when the condition of the patient was stable but had a long tail on the lower side during deterioration. © 2013 IEEE.
Jones A.,University College London |
McMillan M.R.,University College London |
Jones R.W.,Chorleywood Health Center |
Jones R.W.,Brunel University |
And 6 more authors.
PLoS ONE | Year: 2012
Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N = 43) and women (N = 45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2*-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β = -0.50 bpm.unit-1, P = 0.009; SV:β = -0.33 mL.unit-1, P = 0.01; CO:β = -61 mL.min-1.unit-1, P = 0.002; systolic BP:β = -0.41 mmHg.unit-1, P = 0.01; TPR:β = 0.11 WU.unit-1, P = 0.02), cognitive (correct answers: r = -0.28, P = 0.01; time to answer: r = 0.26, P = 0.02) and endocrine responses (cortisol: r = -0.25, P = 0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence. © 2012 Jones et al.
Karatzanis I.,Foundation for Research and Technology Hellas |
Kontogiannis V.,Foundation for Research and Technology Hellas |
Spanakis E.G.,Foundation for Research and Technology Hellas |
Chiarugi F.,Foundation for Research and Technology Hellas |
And 2 more authors.
Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering, LNICST | Year: 2013
Type 2 diabetes is increasing worldwide. When compared with other chronic diseases, deaths due directly to type 2 diabetes are less. The problem though, is the mortality rates caused by the consequences of type 2 diabetes; complications that represent a major health burden which may destabilise health economies. Recognised complications are: cardiovascular disease, peripheral vascular disease, renal failure, retinal eye disease, and neuropathy leading to high levels of morbidity and mortality from heart attack, foot ulceration and leg amputation, stroke, renal failure, and blindness. Better care of type 2 diabetes and early recognition and treatment of its complications reduce levels of morbidity and mortality. There is a need to support the diabetic patient in achieving effective glucose control and life-style changes leading to improved nutrition and healthy levels of physical activity, and to early recognize and treat complications. To make this possible and efficient, a patient portal has been developed, as part of the REACTION platform, which supports interactions between the diabetic patient and both their professional and non-professional carers. Introducing the patient portal and the REACTION platform to real-life healthcare systems will empower patients more by increasing their ability to selfmanage, improve the quality of their life and the overall management of their diabetes, reduce the risk of developing complications and lessen their use of health services. © Institute for Computer Sciences, Social Informatics and Telecommunications Engineering 2013.
Lagani V.,Foundation for Research and Technology Hellas |
Koumakis L.,Foundation for Research and Technology Hellas |
Chiarugi F.,Foundation for Research and Technology Hellas |
Lakasing E.,Chorleywood Health Center |
And 2 more authors.
Journal of Diabetes and its Complications | Year: 2013
This work presents a systematic review of long-term risk assessment models for evaluating the probability of developing complications in diabetes patients. Diabetes mellitus can cause many complications if not adequately controlled; risk assessment models can help physicians and patients in identifying the complications most likely to arise and in taking the necessary countermeasures. We identified six large medical studies related to diabetes mellitus upon which current available risk assessment models are built on; all these studies had duration over 5 years and most of them included some common demographic and clinical data strongly related to diabetic complications. The most common predictions for long term diabetes complications are related to cardiovascular diseases and diabetic retinopathy. Our analysis of the literature led us to the conclusion that researchers and medical practitioners should take in account that some limitations undermine the applicability of risk assessment models; for example, it is hard to judge whether results obtained on a specific cohort can be effectively translated to other populations. Nevertheless, all these studies have significantly contributed to identify significant risk factors associated with the major diabetes complications. © 2013 Elsevier Inc.
Agency: Cordis | Branch: FP7 | Program: CP | Phase: ICT-2009.5.1 | Award Amount: 16.32M | Year: 2010
The REACTION project will develop an integrated approach to improved long term management of diabetes; continuous blood glucose monitoring, clinical monitoring and intervention strategies, monitoring and predicting related disease indicators, complemented by education on life style factors such as obesity and exercise and, ultimately, automated closed-loop delivery of insulin.\nThe REACTION platform will feature an interoperable peer-to-peer communication platform based on a (SoA) service oriented architecture all functionalities, including devices, are represented as services and applications consisting of a series of services orchestrated to perform a desired workflow. The REACTION platform also features a Model Drive Application Development environment based on extensive use of dynamic ontologies and advanced Data Management capabilities with algorithms for clinical assessment and rule-based data processing.\nThe intelligent, interoperable platform developed by REACTION will provide integrated, professional, management and therapy services to diabetes patients in different healthcare regimes across Europe, including 1) professional decision support for in-hospital environments, 2) safety monitoring for dosage and compliance, 3) long term management of outpatients in clinical schemes, 4) care of acute diabetic conditions and 5) support for self management and life-style changes for diabetic patients.\nA range of REACTION services will be developed targeted to insulin-dependent type 1 diabetic patients. The services aim to improve continuous blood glucose monitoring (CGM) and insulin therapy, by both basal dose adjustment and contextualised glycaemic control based on patient activity, nutrition, stress level, etc. Decision support will assist healthcare professionals, patients and informal carers to better manage diabetes therapy and make correct choices about e.g. good blood glucose control, nutrition and exercise.
PubMed | Foundation for Research and Technology Hellas, Herts Valley Clinical Commission Group and Chorleywood Health Center
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2015
To derive and validate a set of computational models able to assess the risk of developing complications and experiencing adverse events for patients with diabetes. The models are developed on data from the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) studies, and are validated on an external, retrospectively collected cohort.We selected fifty-one clinical parameters measured at baseline during the DCCT as potential risk factors for the following adverse outcomes: Cardiovascular Diseases (CVD), Hypoglycemia, Ketoacidosis, Microalbuminuria, Proteinuria, Neuropathy and Retinopathy. For each outcome we applied a data-mining analysis protocol in order to identify the best-performing signature, i.e., the smallest set of clinical parameters that, considered jointly, are maximally predictive for the selected outcome. The predictive models built on the selected signatures underwent both an interval validation on the DCCT/EDIC data and an external validation on a retrospective cohort of 393 diabetes patients (49 Type I and 344 Type II) from the Chorleywood Medical Center, UK.The selected predictive signatures contain five to fifteen risk factors, depending on the specific outcome. Internal validation performances, as measured by the Concordance Index (CI), range from 0.62 to 0.83, indicating good predictive power. The models achieved comparable performances for the Type I and, quite surprisingly, Type II external cohort.Data-mining analyses of the DCCT/EDIC data allow the identification of accurate predictive models for diabetes-related complications. We also present initial evidences that these models can be applied on a more recent, European population.
PubMed | Middlesex University and Chorleywood Health Center
Type: Journal Article | Journal: London journal of primary care | Year: 2015
Football is a high profile sport with a close relationship with alcohol, and many elite players have had problems with addiction. This can help raise public awareness of problem drinking.We encounter alcohol problems daily in our different perspectives as a GP and an Accident and Emergency Consultant. Both of us are avid football fans.