Intellectual disability (ID) affects approximately 1% of the population. Some patients with severe or profound ID are essentially non-communicating and therefore risk experiencing pain and distress without being able to notify their caregivers, which is a major health issue. This real-world proof of concept study aimed to see if heart rate (HR) monitoring could reveal whether non-communicating persons with ID experience acute pain or distress in their daily lives. We monitored HR in 14 non-communicating participants with ID in their daily environment to see if specific situations were associated with increased HR. We defined increased HR as being > 1 standard deviation above the daily mean and lasting > 5 s. In 11 out of 14 participants, increased HR indicated pain or distress in situations that were not previously suspected to be stressful, e.g. passive stretching of spastic limbs or being transported in patient lifts. Increased HR suggesting joy was detected in three participants (during car rides, movies). In some situations that were previously suspected to be stressful, absence of HR increase suggested absence of pain or distress. We conclude that HR monitoring may identify acute pain and distress in non-communicating persons with ID, allowing for improved health care for this patient group.

Objective Pulse arrival time (PAT) is a potential main feature in cuff-less blood pressure (BP) monitoring. However, the precise relationship between BP parameters and PAT under varying conditions lacks a complete understanding. We hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and both SBP and DBP. Therefore, this study aimed to investigate the correlation between PAT and BP during two exercise modalities with differing BP responses using an unobtrusive wearable device. Methods Seventy-five subjects, of which 43.7% had a prior diagnosis of hypertension, participated in an isometric and dynamic exercise test also including seated periods of rest prior to, in between and after. PAT was measured using a prototype wearable chest belt with a one-channel electrocardiogram and a photo-plethysmography sensor. Reference BP was measured auscultatory. Results Mean individual correlation between PAT and SBP was −0.82 ± 0.14 in the full protocol, −0.79 ± 0.27 during isometric exercise and −0.77 ± 0.19 during dynamic exercise. Corresponding correlation between PAT and DBP was 0.25 ± 0.35, −0.74 ± 0.23 and 0.39 ± 0.41. Conclusion The results confirm PAT as a potential main feature to track changes in SBP. The relationship between DBP and PAT varied between exercise modalities, with the sign of the correlation changing from negative to positive between type of exercise modality. Thus, we hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and BP with emphasis on DBP.

No abstract

No abstract

Background: The target is for at least 30 per cent of dialysis patients to be treated at home. Close monitoring by the specialist health service is vital for boosting the patients' confidence and sense of coping with home dialysis. The study originated in a renal outpatient clinic where the renal nurses were using routines and support tools that provided no scope for increasing the share of patients on home dialysis. A digital monitoring tool needed pilot testing. The objective was to establish the practical value of the tool, and how it would need to be further developed in order to meet the needs of the hospital and the patients.Objective: During the innovation process, the renal nurses at the outpatient clinic played an active part in the pilot project, while it proved more difficult to bring out the patients' perspective due to their poor health. We therefore wanted to investigate how personas might be developed to provide a clearer picture of the patients' needs and the relationship between the patients and the health service. We also wanted to promote a more user-centred focus for the development of monitoring technology for home treatment programmes. Method:The study is an explorative, qualitative and longitudinal case study designed to test the digital monitoring tool. We collected data through interviews, observations and workshops with patients and renal nurses at the renal outpatient clinic as well as with hospital and community nursing staff, and the supplier's employees. Our thematic analysis of case data gave us a base from which to develop personas that were later presented to the specialist renal nurses for validation.Results: Our results show considerable variation in the patients' need for monitoring and their access to methods that allow them to cope with home dialysis in their everyday lives. These varied needs are met by the renal nurses, who spend a considerable amount of time on communication, logistics and facilitation to secure the best possible treatment compliance. The personas were designed to take account of this interaction. Conclusion:The use of personas has attracted criticism because the practice may be perceived to cause reduced involvement in the process by genuine service users. In this study, however, we have used personas precisely because there was limited opportunity to involve severely ill patients with the innovation process. To a large extent, personas can illustrate the interaction between renal nurses and patients, and the choices made by patients. Further work on personas should include descriptions of characters other than patients, e.g. members of the community nursing team and the patient's relatives.