María Begoña Coco-Martín

Summary: This retrospective cohort study analysed a total of 344 patients from the OSTEOMED registry with matched baseline and follow-up DXA data, finding that comorbidities such as nephrolithiasis, hypertension or coronary heart disease may influence the response to prescribed anti-osteoporotic treatment. Purpose: To determine: 1) comorbidities associated with reduced bone mineral density (BMD), T-score and Z-score at the lumbar spine (L1 to L4 vertebrae), femoral neck and total hip; and 2) the role of multimorbidity (≥ 2 comorbidities) in reduced BMD, T-score and Z-score at the lumbar spine, femoral neck and total hip. Methods: Retrospective cohort study analyzing patients [319 females (92.73%), 25 males (7.27%), age 62.13 ± 10.46 years] from the OSTEOMED registry with matched baseline and follow-up dual-energy X-ray absorptiometry (DXA) data. Patients' sex, age, body mass index (BMI), comorbidities and treatments were collected from their medical records after they had given written informed consent. Results: Considering a least significant change (LSC) of 4.2%, neither comorbidity nor multimorbidity was statistically significantly associated with a reduction in BMD in any of the bone regions studied. However, binary logistic regression analyses adjusted for sex, age, BMI and treatments showed that nephrolithiasis ( p = 0.044) and coronary heart disease ( p = 0.026) were statistically significantly associated with a reduction in total hip T-score and that hypertension ( p = 0.049) and coronary heart disease ( p = 0.01) were statistically significantly associated with a reduction in total hip Z-score. Conclusion: Despite comorbidity and multimorbidity, patients with osteoporosis are mostly well protected by anti-osteoporotic treatment in daily clinical practice. However, nephrolithiasis, hypertension, and coronary heart disease can influence the response to prescribed anti-osteoporotic treatment, especially at the total hip level.

Immersive virtual reality (VR) is recently being explored as a therapeutic alternative for the treatment of amblyopia. This pilot study aimed to evaluate the preliminary efficacy, safety, usability and satisfaction obtained with the use of a novel VR system (NEIVATECH) to provide binocular vision training in previously treated older amblyopic children with non-compliance or non-response to patching. A prospective, multicentre, open-label, single-arm, pilot study was conducted in which the intervention under study was 9 h of therapy with the NEIVATECH system, distributed in 18 half-hour sessions spread over 1 month. A comprehensive visual assessment was conducted before and after the intervention, and at the end of the intervention the safety and usability of the system and patient satisfaction were evaluated. After therapy, statistically significant differences were observed in the near best-corrected visual acuity (BCVA) of the dominant (p = 0.022) and non-dominant (p = 0.022) eye, in stereopsis based on the Binocular Function Score (p = 0.045) and in the break (p = 0.012) and recovery (p = 0.009) points of negative fusional vergence for distance vision. The safety and usability of the system and patient satisfaction with the therapy were adequate. These findings support further investigation of this treatment option in future studies incorporating a control group with which to compare the results obtained. Trial registration: NCT04819386.

Background/Objectives: Early identification of complications in chronic and infectious diseases can reduce clinical deterioration, lead to early therapeutic interventions and lower morbidity and mortality rates. Here, we aimed to assess the feasibility of a novel clinical decision support system (CDSS) based on the automatic generation of alerts through remote patient monitoring and to identify the patient profile associated with the likelihood of severe medical alerts. Methods: A prospective, multicenter, open-label, randomized controlled trial was conducted. Patients with COVID-19 in home isolation were randomly assigned in a 1:1 ratio to receive either conventional primary care telephone follow-up plus access to a mobile app for self-reporting of symptoms (control group) or conventional primary care telephone follow-up plus access to the mobile app for self-reporting of symptoms and wearable devices for real-time telemonitoring of vital signs (case group). Results: A total of 342 patients were randomized, of whom 247 were included in the per-protocol analysis (103 cases and 144 controls). The case group received a more exhaustive follow-up, with a higher number of alerts (61,827 vs. 1825; p < 0.05) but without overloading healthcare professionals thanks to automatic alert management through artificial intelligence. Baseline factors independently associated with the likelihood of a severe alert were having asthma (OR: 1.74, 95% CI: 1.22–2.48, p = 0.002) and taking corticosteroids (OR: 2.28, 95% CI: 1.24–4.2, p = 0.008). Conclusions: The CDSS could be successfully implemented and enabled real-time telemonitoring of patients’ clinical status, providing valuable information to physicians and public health agencies.

Posthospital care aims to enhance patient access to providers and reduce avoidable readmissions. This study assessed the feasibility, barriers, and influencing factors associated with implementing remote patient monitoring (RPM) for oncology patients at the Hartford HealthCare Cancer Institute (HHC) in Hartford, CT, and across a statewide health system. A mixedmethods approach was employed, combining quantitative surveys with qualitative interviews and focus groups to gather insights from hospital stakeholders. The focus was on organizational culture, leadership, learning capacity, and available resources for RPM implementation. Surveys were distributed between September 1 and 30, 2022, and responses were analyzed based on frequency and percentage. Items with the highest rates of neutral or negative responses informed subsequent qualitative data collection. Purposeful sampling was employed to recruit stakeholders and patients for interviews and focus groups conducted between January 1 and 30, 2023. Organizational maps were created to visualize current and prospective clinical workflows. Of 63 stakeholders invited to complete the readiness for implementation survey, 53 responded (84% response rate), with 67% supporting RPM to improve patient care. The interviews and focus group discussions revealed stakeholder perspectives on readiness for change, organizational climate, resource availability, and perceived barriers and facilitators to change. In total, 78 participants-including survey respondents, Patient and Family Advisory Council (PFAC) members, and hospital staff-were invited to participate in qualitative data collection, with 52 individuals (67%) agreeing to participate. 8 one-on-one interviews and six focus groups were conducted. Key themes included integrating RPM into existing systems, relevance to care teams, and prioritizing patient-and family-centered care. Additional subthemes were also identified. Stakeholders supported RPM as a means to enhance communication and improve access to care for patients with oncology. Providers emphasized critical success factors, including dedicated intervention teams, effective response protocols for symptom alerts, and system-wide access to clinical data. Patient participants underlined the importance of incorporating patient-centered design into RPM program development.