Tec4Home Stroke : a Pilot Study Assessing Feasibility of Home Telemonitoring Technology in Managing Hypertension After Stroke/Tia
Bibliographic record
Abstract
BACKGROUND Blood pressure (BP) control is associated with reduced risk of first-ever and recurrent stroke. However, strategies to optimize BP management in the u201creal worldu201d or outside clinical trials are not known. METHODS We explored the feasibility of a home telemonitoring program in managing hypertension by assessing the proportion of participants or caregivers completing a six-month monitoring period. Participants with minor stroke/TIA (NIHSS <5) within one year and BP >140/90 mmHg were enrolled.Participant's measured BP three times per week for 6 months with data entered into a secure web form. The average BP was assessed weekly by a nurse for one month, then monthly to direct medication titration (target below 135/85 mmHg) using an algorithm based on Canadian best practice recommendations.RESULTS 53 participants were enrolled from March 2018-March 2019 from Vancouver General Hospitalu2019s Stroke Prevention Clinic. 47 participants managed their own BP measurements; six were managed by a caregiver. Mean BP decreased to 132/77 (+12/8) mmHg, 130/75 (+12/8) mmHg and 124/76 (+9/8) mmHg at 1, 3 and 6 months respectively (Figure 1). At 3 months, 71% of participants reached their designated BP target. This increased to 75% at 6 months.To date, 12 participants have been lost to follow-up (LTFU). One participant died before study completion, six lost contact with the study team, and five withdrew consent due to lack of time for monitoring (2), normal home BP (1), presence of medication side effects (1, symptomatic hypotension) and preference for BP management by their family physician (1). Attrition was greatest among the first 25 participants who were enrolled under a more intensive monitoring protocol. Study procedures were simplified for the second 25 participants with the aim of improving participant retention.CONCLUSION In our cohort, more than 70% of participants achieved BP control at 3 months after enrollment and titration of BP medications was well tolerated without physician intervention.Home telemonitoring following a stroke can be a suitable model to deliver vascular risk factor control for high risk patients adherent to its use. Further research is warranted to elucidate the best patient characteristics suitable for home telemonitoring program.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".