Artificial intelligence could help NHS physios with exercise compliance

New research published by the think tank Reform, Thinking on its own, suggests that Artificial intelligence (AI) can analyse data collected on wearable technology and help NHS clinicians support changes in patients’ behaviour.

• Chartered Society of Physiotherapy news item
• Thinking on its own: AI in the NHS

NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously

Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group.

Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.

From the NIHR Dissemination Centre

Point-of-care and home faecal calprotectin tests for monitoring treatment response in inflammatory bowel disease [MIB132]

New medtech innovation briefing from NICE:

Elevated faecal calprotectin (FC) is a marker of intestinal inflammation, including that caused by inflammatory bowel disease (IBD). NICE diagnostics guidance recommends FC testing for the diagnosis of IBD; this briefing summarises the available information on the use of FC to monitor treatment response in patients with IBD.

There are 3 types of FC test available: point of care (used by healthcare professionals), home use (used by patients or carers) and laboratory (used by laboratory scientists). This briefing includes only point‑of‑care and home‑use tests because laboratory tests are widely available in the NHS, although their usage varies.

Radiation dose monitoring software for medical imaging with ionising radiation [MIB127]

New:  Medtech Innovation Briefing from NICE:

The technologies described in this briefing are 8 radiation dose monitoring software technologies that automatically gather and analyse information on patients' exposure to ionising radiation from medical imaging and X‑ray-guided procedures.

The innovative aspects are that dose-related data from medical imaging with ionising radiation can be systematically collected, monitored and analysed in a largely automated way. The technologies are designed to improve image quality while minimising radiation exposure to the patient.

Table 1 Summary of included technologies

Innovations

Current guidelines and arrangements

Population, setting and intended user

Costs

Resource consequences

Diabetes UK Consensus Guideline for Flash Glucose Monitoring

Flash glucose monitoring (Flash GM) is a new technology that has recently been made available on the NHS Drugs Tariff. This means in principle it is available to people with diabetes in the UK on
NHS prescription. It is important that healthcare professionals and local health decision makers
are aware of the new technology so that they can make sure that people with diabetes have access
to Flash GM in their local area.

Surveillance Audiometry

This document replaces all previous versions. Its purpose is to describe a standard procedure, and to provide recommendations, for effective pure-tone surveillance audiometry primarily on those exposed to noise at work. It also includes the recommended format for audiogram forms. This document is not intended to provide guidance on specific circumstances or on interpretation of results

Inpatient Monitoring of Decompensated Heart Failure: What Is Needed?

Current Heart Failure Reports pp 1–5 DOI 10.1007/s11897-017-0352-x 

Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients.

UHCW Research: Ali, Danish

Parkinson’s disease in adults (NG71)

This new NICE guideline covers diagnosing and managing Parkinson's disease in people aged 18 and over. It aims to improve care from the time of diagnosis, including monitoring and managing symptoms, providing information and support, and palliative care. It includes recommendations on:

• information and support
• diagnosing Parkinson's disease
• pharmacological management of motor symptoms
• pharmacological management of non-motor symptoms
• non-pharmacological management of symptoms
• impulse control disorders
• palliative care

Measuring and monitoring of safety framework e-guide: better questions, safer care

This guide has been produced in conjunction with Advancing Quality Alliance, UK Improvement Alliance, Health Improvement Scotland and the Improvement Academy.

It contains a range of useful resources to help health and care professionals to take a more holistic approach when looking at the safety of care. It also offers detailed case studies and practical templates spanning roles from board to ward, and across ambulance, acute, mental health and primary care settings.

FreeStyle Libre for glucose monitoring

NICE has developed a medtech innovation briefing (MIB) on FreeStyle Libre for glucose monitoring.

The innovative aspect is that FreeStyle Libre measures glucose levels from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a near-continuous record of measurements which can be accessed on demand. It can also indicate glucose level trends over time.

The intended place in therapy is as an alternative to routine blood glucose monitoring in people with type 1 and 2 diabetes who use insulin injections. Finger-prick blood glucose measurements are sometimes still needed, such as when a person is ill or when they are driving.

Chartered Society of Physiotherapy provides new guidance on fentanyl patches in physiotherapy practice

The CSP has published guidance for members who treat patients who wear transdermal fentanyl patches, which are prescribed to treat severe pain.

The document aims to increase awareness among physiotherapists about potential risks associated with the patches.

It includes a recommendation that physios should carefully monitor patients who wear transdermal patches while having aquatic hydrotherapy.

Remote health management: reducing bed blocking in the NHS

Institution of Mechanical Engineers (IMechE) - 
This report highlights the potential for remote monitoring technology to ease delayed discharges in the NHS and estimates that the widespread implementation of digital health could have already saved the NHS over £1 billion over the last five years. The report calls for the Department of Health to create a standardised remote health management network by 2020 which would enable acute and social care providers to have access to patient data and remote monitoring.

• Report

Testing times: restrictions accessing test strips and meters for people with diabetes

Diabetes UK - 
This report highlights the difficulties that patients have been experiencing in accessing blood sugar monitoring equipment. The survey of patients found that a quarter of respondents had experienced restrictions and that over half of those who had experienced restrictions have type 1 diabetes.

• Report

Physio wins digital pioneer award for use of modems to help patients at home

A physiotherapist who uses technology to help monitor patients who receive non-invasive ventilation (NIV) at home has received an award for being a digital pioneer.

Can the value of end tidal CO2 prognosticate ROSC in patients coming into ED with an out of hospital cardiac arrest (OOHCA)?

New from BestBETs

A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.

Current literature suggests that: 1) Our current ETCO2 aim of 10-20mmHg may be inadequate and should be modified to 25mmHg. 2) A 3-5 minute ETCO2 level of ≤10mmHg is associated with bad prognosis and as such, it may be beneficial to consider stopping patient resuscitation should this be the clinical case. 3) It is important to see the trend of ETCO2 rather than making a decision solely on one specific value, as sometimes an abrupt increase in ETCO2 could be a sign of impending ROSC. 4) More robust prospective data on the optimal ETCO2 value that is associated with ROSC would be helpful in defining a more accurate future target for intervention.

Hypothermia: prevention and management in adults having surgery

This updated NICE guideline covers preventing and managing inadvertent hypothermia in people aged 18 and over having surgery. It offers advice on assessing patients’ risk of hypothermia, measuring and monitoring temperature, and devices for keeping patients warm before, during and after surgery.

Monitoring Response in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy—A Single Institution Study

The aims of this poster were:

1. To identify pre-treatment MRI and tumour features which are predictive of response to NAC.
2. To evaluate the correlation between residual disease on post-NAC MRI with residual disease on final pathology.

UHCW Research: Dr Muthyala Sreenivas

ER-WCPT Dublin dean talks of tool to help with wearable tech pilots

In a debate, at the ER-WCPT conference in Dublin, about how technologies can enhance healthcare education and clinical practice, Professor Caulfield said that, over the past 10 years, personal sensors had massively increased the capacity to measure human performance.

But he cautioned that, particularly in relation to consumer products, there was a lack of scientific evidence and huge variations in the accuracy of data they produced.

Clinical effectiveness and cost-effectiveness of use of therapeutic monitoring of tumour necrosis factor alpha (TNF-α) inhibitors [LISA-TRACKER® enzyme-linked immunosorbent assay (ELISA) kits, TNF-α-Blocker ELISA kits and Promonitor® ELISA kits] versus standard care in patients with Crohn's disease: systematic reviews and economic modelling

Health Technol Assess. 2016 Nov;20(83):1-288.

Systematic reviews and economic modelling of clinical effectiveness and cost-effectiveness of therapeutic monitoring of tumour necrosis factor alpha (TNF-α) inhibitors [using LISA-TRACKER® enzyme-linked immunosorbent assay (ELISA) kits (Theradiag, Marne La Vallee, France, or Alpha Laboratories, Heriot, UK), TNF-α-Blocker ELISA kits (Immundiagnostik AG, Bensheim, Germany) and Promonitor® ELISA kits (Proteomika, Progenika Biopharma, Bizkaia, Spain)] versus standard care for Crohn's disease (CD).

Our finding that testing is not cost-effective for IFX should be viewed cautiously in view of the limited evidence. Clinicians should be mindful of variation in performance of different assays and of the absence of standardised approaches to patientassessment and treatment algorithms.
UHCW Research: Arasaradnam R

Physio trials remote monitoring tool that could improve patient compliance

A doctor has teamed up with a physiotherapist to develop a free app that allows physios to remotely monitor the progress of musculoskeletal patients.