Biomedical subjects

Stanley M Finkelstein

Publications and source records attributed to Stanley M Finkelstein.

9 recordsLinked to original sources

PubMed2006

Home telehealth improves clinical outcomes at lower cost for home healthcare.

Patient outcomes and cost were compared when home healthcare was delivered by telemedicine or by traditional means for patients receiving skilled nursing care at home. A randomized controlled trial was established using three groups. The first group, control group C, received traditional skilled nursing care at home. The second group, video intervention group V, received traditional skilled nursing care at home and virtual visits using videoconferencing technology. The third group, monitoring intervention group M, received traditional skilled nursing care at home, virtual visits using videoconferencing technology, and physiologic monitoring for their underlying chronic condition. Discharge to a higher level of care (hospital, nursing home) within 6 months of study participation was 42% for C subjects, 21% for V subjects, and 15% for M subjects. There was no difference in mortality between the groups. Morbidity, as evaluated by changes in the knowledge, behavior and status scales of the Omaha Assessment Tool, showed no differences between groups except for increased scores for activities of daily living at study discharge in the V and M groups. The average visit costs were $48.27 for face-to-face home visits, $22.11 for average virtual visits (video group), and $32.06 and $38.62 for average monitoring group visits for congestive heart failure and chronic obstructive pulmonary disease subjects, respectively. This study has demonstrated that virtual visits between a skilled home healthcare nurse and chronically ill patients at home can improve patient outcome at lower cost than traditional skilled face-to-face home healthcare visits.

Community Health Nursing↗

PubMed2006

The design of an Internet-based system to maintain home monitoring adherence by lung transplant recipients.

Regimen adherence is a key factor in the success of home monitoring of lung transplant recipients. Patients generally adhere satisfactorily with home spirometry in the short-term, but adherence tends to decline over time. Telehealth and Internet technology provide new methods to address this issue. The unique contribution of the Adherence Enhancement Internet Program (AEIP) is the integration of multiple adherence enhancement strategies operating in a unified approach to the adherence problem, while meshing all user groups to facilitate interactions. This Internet-based program focused on promoting subject specific strategies was developed to maintain the initial high levels of adherence beyond the first year post transplant. The program provides more immediate subject feedback related to home monitoring data, reminders from the patient's health care providers, educational material, and guidance in dealing with subject specific barriers to maintaining adherence. It also simplifies communication between patients and health care providers, and supports providers in certain patient care tasks. A feasibility trial involving 12 lung transplant recipients demonstrated that subjects were able to use the AEIP with little training, found it acceptable, and were generally enthusiastic regarding it as a tool to maintain or enhance adherence.

Diagnosis, Computer-Assisted↗

PubMed2006

Managing chronic disease through home telehealth.

This article describes the use of telehealth to monitor chronic illness in a home setting. It discusses the state of the art in commercial telehealth systems as well as 3 research projects undertaken by the University of Minnesota's program in health informatics that explore the potential of home telehealth to aid in care of patients with chronic conditions.

Aged↗

PubMed2005

Incomplete event documentation in medical records of lung transplant recipients.

CONTEXT: The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete. OBJECTIVE: To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data. DESIGN, SETTING, AND SUBJECTS: Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years. OUTCOME MEASURE: Proportion of acute bronchopulmonary illness events documented in clinic medical record. RESULTS: By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions. CONCLUSIONS: Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.

Academic Medical Centers↗

PubMed2004

Telehomecare: quality, perception, satisfaction.

The aim of this study was to demonstrate that telehomecare linking homebound patients with their home health-care nurses over the plain old telephone system (POTS) provides high-quality, clinically useful, and patient satisfactory interactions. Congestive heart failure, chronic obstructive pulmonary disease, and chronic wound-care patients receiving skilled home nursing care were randomized into control (standard home health care, HHC) and two intervention (standard care plus video conferencing/Internet access; the above plus physiological monitoring) groups. Virtual visits (VVs), consisting of two-way audio and video interactions between the central site HHC nurse and the subject at home, were compared for technical quality and clinical usefulness by the HHC nurses who performed the VVs. Subject perception of telehomecare and satisfaction with their HHC were assessed over the course of the project. There were a total of 567 virtual and 1,057 actual visits conducted for the 53 subjects completing the study. The technical quality of VVs were rated at 94.7%. They were considered to be as useful as actual visits in 90.7% of cases. Subject telehomecare perception increased after experiencing the process. All subjects were satisfied with their HHC; satisfaction increased with an increasing level of telehomecare intervention. Subjects receiving physiological monitoring and video conferencing/Internet access in addition to standard care were most satisfied with their care. VVs can be conducted over POTS. Patients can use telehomecare with moderate levels of training. These programs can provide timely and quality home health nursing care with VVs augmenting traditional home visits.

Aged↗

PubMed2003

Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events.

BACKGROUND: Atherosclerosis begins in the arterial wall, with endothelial dysfunction accompanied by functional and structural changes that influence arterial stiffness. Pulse contour analysis provides an assessment of compliance or elasticity of the large conduit arteries (C(1)) and small microcirculatory arteries (C(2)). In this study, the predictive value of reduced elasticity of these arteries was evaluated by follow-up of subjects who underwent pulse contour analysis at the University of Minnesota. METHODS: Questionnaires were sent to 870 subjects who had radial artery pulse wave analysis performed between 1993 and 1999 using a noninvasive sensor, parameter estimating algorithm and modified Windkessel model of the circulation. Responses from 419 subjects >19 years of age reported on any cardiovascular events including death, myocardial infarction, stroke, transient ischemic attacks, angina, or coronary or peripheral vascular interventional procedures. RESULTS: Of the subjects, 168 (41%) reported one or more cardiovascular events. Events were more common in those with elevated blood pressure, elevated cholesterol, diabetes, and family history of events. Age, reduced C(1), and reduced C(2) were univariate predictors of events. After adjusting for age, a 2-unit decrease in C(2) remained a significant predictor (odds ratio 1.50, P <.001), whereas C(1) was no longer predictive. CONCLUSION: Reduced small artery elasticity, which is a measure of endothelial dysfunction, is significantly associated with cardiovascular events independent of age.

Arteries↗

PubMed2003

Home monitoring for lung transplant candidates.

Home monitoring by lung transplant recipients has been effective for early detection of clinical problems. This study used an electronic diary for home monitoring by lung transplant candidates to improve communication between candidates and the transplant team. Candidates were randomized into control (52 subjects following standard telephone reporting procedures) and intervention (67 subjects using an electronic diary to record and transmit a range of health-related measures) groups. Outcome measures were monitoring adherence and level of communication (for monitor acceptability and utilization), hospital length of stay after transplantation and survival at 4 months (for clinical effectiveness). Subjects used the diary without difficulty and with good adherence. Subjects and coordinator contacts were similar between groups; intervention group subjects were positive regarding contact based on diary use. There were no significant differences in clinical outcomes between groups. Changing diary questions might improve the effectiveness of electronic monitoring for lung transplant candidates.

Adult↗

PubMed2002

Health locus of control and adherence with home spirometry use in lung transplant recipients.

Home monitoring is an effective tool that can be used to promote the health of lung transplant recipients, but only if the recipients transmit data to the healthcare team. This study examines the relationship of the Multidimensional Health Locus of Control scale to adherence with home spirometry use. Form C of this scale was mailed to 139 eligible lung and heart-lung transplant recipients. Eighty-three respondents returned the questionnaire. The respondents were on average 4 years older and had greater adherence than nonrespondents. Men tended to score higher than women on all the subscales. These scales were not related to type of transplant or underlying disease. Adherence was also unrelated to the Multidimensional Health Locus of Control scale, with little difference in adherence across persons with various levels of the health locus of control subscales.

Female↗

PubMedDate not supplied

Decision support for the triage of lung transplant recipients on the basis of home-monitoring spirometry and symptom reporting.

Purpose The objective of this study was to develop and evaluate a computerized rule-based decision support algorithm for nursing triage of potential acute bronchopulmonary events in lung transplant recipients on the basis of home monitoring of spirometry and symptoms. Methods The algorithm automatically separates recipients into 2 groups: those who are stable or improving and those who should be "watched" further because of their potential for developing bronchopulmonary events according to their weekly home-monitoring measurements. A total of 155 recipients (82 females and 73 males) contributed 1944 weekly records for the training (420), testing (786), and prospective evaluation (738) data sets. Weekly records contained daily values of forced expiratory volume at 1 second and respiratory symptoms, which were the inputs for the triage rules. Results Sensitivity and specificity were greater than 90% for the prospective evaluation comparing the computer decision support system with the manual nurse review of the same home-monitoring reports. Conclusions Algorithm performance in identifying lung recipients who should be placed on a "watch" list for the potential to develop acute bronchopulmonary events is comparable to the standard human clinical review of the same weekly home-monitoring data.

Algorithms↗