Attitudes Toward the Adoption of Remote Patient Monitoring and Artificial Intelligence in Parkinson's Disease Management: Perspectives of Patients and Neurologists

OBJECTIVE

Early detection of Parkinson's Disease (PD) progression remains a challenge. As remote patient monitoring solutions (RMS) and artificial intelligence (AI) technologies emerge as potential aids for PD management, there's a gap in understanding how end users view these technologies. This research explores patient and neurologist perspectives on AI-assisted RMS.

METHODS

Qualitative interviews and focus-groups were conducted with 27 persons with PD (PwPD) and six neurologists from Finland and Italy. The discussions covered traditional disease progression detection and the prospects of integrating AI and RMS. Sessions were recorded, transcribed, and underwent thematic analysis.

RESULTS

The study involved five individual interviews (four Italian participants and one Finnish) and six focus-groups (four Finnish and two Italian) with PwPD. Additionally, six neurologists (three from each country) were interviewed. Both cohorts voiced frustration with current monitoring methods due to their limited real-time detection capabilities. However, there was enthusiasm for AI-assisted RMS, contingent upon its value addition, user-friendliness, and preservation of the doctor-patient bond. While some PwPD had privacy and trust concerns, the anticipated advantages in symptom regulation seemed to outweigh these apprehensions.

DISCUSSION

The study reveals a willingness among PwPD and neurologists to integrate RMS and AI into PD management. Widespread adoption requires these technologies to provide tangible clinical benefits, remain user-friendly, and uphold trust within the physician-patient relationship.

CONCLUSION

This study offers insights into the potential drivers and barriers for adopting AI-assisted RMS in PD care. Recognizing these factors is pivotal for the successful integration of these digital health tools in PD management.

Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification

Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries.

Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy.

Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51–4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53–2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36–13.56, P = 0.0018).

Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations.

eConsultation between health care professionals in primary health care and specialized medical care

The synchronous eConsultation is provided by a specialist in a hospital to a GP appointment either by pre-set request or without scheduling. The patient participates in the session. The eConsultation employs video or chat and the program integrated into Health Village service platform enables also sharing x-rays, still photos and other EHR material. Health Village delivers public health services for general public, digital care pathways for patients with specific diagnoses and digital tools for professionals.

The eConsultation project started in 2018, after interviewing the member municipalities (n = 24, 1 600 000 inhabitants) of the Hospital District of Helsinki and Uusimaa (HUS) in Finland. The municipalities gave a high priority to eConsultation as a way of further integration of service chains and dissemination of common practices between and within the specialized and primary health care services.

Funded by the HUS and supported by the HUS IT Department eHealth Services, eConsultation pilots started in 2018 in close collaboration between the public specialized and primary health care organizations in neurology, orthopedics and wound treatment. The pilots indicated that eConsultation are more efficient than traditional consultation methods (e.g., the time used by a neurologist in eConsultation dropped by 87% vs. a face-to-face consultation visit). Almost all of patients and 84% of primary care professionals reported high level of satisfaction. The consultants found that the presence of a patient fostered, if needed, additional clinical interview and diagnostic procedures by proxy, as well as assessment of individual needs of a GP. The primary care professionals appreciated queue-free response (45 seconds in eConsultation with no pre-set appointment time) and augmented educational validity.

Scaling of eConsultation across the whole hospital district and more specialties is going on. eConsultation will be explored in depth in two starting scientific studies.

Key messages

Synchronous eConsultation. more efficient than traditional consultation methods.

From Tertiary to Primary Care - Understanding Context in the Transfer of Digital Headache Service Pathway

A digital service pathway for managing chronic headache has been designed in tertiary care in Finland. The digital tool facilitates self-management by providing exercises, information and messaging opportunities for patients. However, the largest potential benefits are in primaryand occupational care. Thus, the purpose of this study was to explore the needs and requirements of primary and occupational care actors for better understanding of the context in the transfer of the service. The study was performed as a single embedded case study. The qualitative data was collected through semi-structured interviews with 16 informants from different organizations and analyzed with Gioia-methodology. This study gathers important empirical knowledge about the meaning of context and transferring digital health interventions from one context to another from clinician and management perspective. Nine key contextual differences were identified and six main expectations emerged.

Morphology and histology of silent and symptom-causing atherosclerotic carotid plaques - Rationale and design of the Helsinki Carotid Endarterectomy Study 2 (the HeCES2)

INTRODUCTION

Every fifth ischemic stroke is caused by thromboembolism originating from an atherosclerotic carotid artery plaque. While prevention is the most cost-effective stroke therapy, antiplatelet and cholesterol-lowering drugs have a ceiling effect in their efficacy. Therefore, discovery of novel pathophysiologic targets are needed to improve the primary and secondary prevention of stroke. This article provides a detailed study design and protocol of HeCES2, an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis.

MATERIALS AND METHODS

Recruitment and carotid endarterectomies of the study patients with carotid atherosclerosis were performed from October 2012 to September 2015. After brain and carotid artery imaging, endarterectomised carotid plaques (CPs) and blood samples were collected from 500 patients for detailed biochemical and molecular analyses. Findings to date: We developed a morphological grading for macroscopic characteristics within CPs. The dominant macroscopic CP characteristics were: smoothness 62%, ulceration 61%, intraplaque hemorrhage 60%, atheromatous gruel 59%, luminal coral-type calcification 34%, abundant (44%) and moderate (39%) intramural calcification, and symptom-causing "hot spot" area 53%. Future plans: By combining clinically oriented and basic biomedical research, this large-scale study attempts to untangle the pathophysiological perplexities of human carotid atherosclerosis. Key Messages This article is a rationale and design of the HeCES2 study that is an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis. The HeCES2 study strives to develop diagnostic algorithms including radiologic imaging to identify carotid atherosclerosis patients who warrant surgical treatment. In addition, the study aims at finding out new tools for clinical risk stratification as well as novel molecular targets for drug development.

Abstract WMP62: Remote Home Monitoring of Risk Factors After Stroke or TIA to Improve Secondary Prevention - A Pilot Study

Background: Up to 90% of strokes could be prevented by effective treatment of the risk factors. However, there are major problems with the implementation of prevention. For example, only 40% of patients taking medication have blood pressure (BP) at treatment goals and 60% of patients with atrial fibrillation (AF) use anti-coagulant medication.

Hypothesis: Remote home monitoring of risk factors after minor stroke or TIA may lead to better control of risk factors by increasing measurements and patient awareness and uncovering undetected risk factors. This pilot study investigates the feasibility of home monitoring of risk factors after minor stroke or TIA.

Methods and Patients: Patients (n=30, mean age 57 yrs, range 34-79, 37% females) with recent minor stroke or TIA were supplied with a remote home monitoring system at discharge. The system comprised of a cloud backend for data storage and processing, patient user interface (UI), and wireless BP meter and light-weight EKG device with secured connection to clinician UI, through which BP and EKG could be followed real-time and individualized alarm limits could be set. EKG was automatically analyzed in the cloud backend to detect AF. The patients were contacted by phone at two weeks by stroke nurse and they returned the remote home monitoring system at final visit at three months. Additionally they were contacted if AF was detected or their BP required medication adjustment.

Results: Twenty-nine (97%) patients completed the study. One patient discontinued due to unrelated serious illness. One patient did not follow the monitoring program. Of the remaining 28 patients (93%) with complete monitoring data, BP medication needed adjustment in 11 patients (39%) and new AF was detected in 3 patients (11%). Patients appraised that the home monitoring system was easy to use (score 8.6/10) and most would recommend it to peers (score 8.9/10).

Conclusions: Remote home monitoring of risk factors after minor stroke or TIA is feasible and may be an efficient way to improve secondary prevention.

Headache as symptom of intracranial hemorrhage

The most important signs of danger of a headache patient include exceptionally intense or acute headache, transient loss or progressive impairment of consciousness, and neurological deficit symptoms. These patients are referred to an urgent assessment by a physician. Computed tomography scanning of the head is carried out in the case of suspected hemorrhage of a headache patient. Routine diagnosis employing cerebrospinal fluid analysis can be abandoned when excluding subarachnoid hemorrhage in a patient with headache symptoms, if blood is with certainty not observed in the CT scan of the head and no more than six hours have passed after the onset of the symptom. If subarachnoid hemorrhage is detected, cerebral CT angiography will be performed at the same time and a neurosurgeon consulted about the need of operative treatment.