Abrar-Ahmad Zulfiqar, Amir El Hassani Hajjam, Samy Talha, Mohammed Hajjam, Jawad Hajjam, Sylvie Ervé, Nadir Kadri, Jean Doucet, Emmanuel Andrès

John Libbey Eurotext 2019, Volume 25, Numéro 2

La télémédecine est aujourd’hui en vogue, portée par le développement des outils informatiques et de communication. Elle est notamment donné la preuve de son intérêt dans des domaines tels que la cardiologie, la dermatologie et la diabétologie. Le vieillissement de la population conduit naturellement à déployer ces technologies à la gériatrie, et les établissements d’hébergement pour personnes âgées dépendantes (Ehpad), notamment, sont de plus en plus concernés. Nous faisons ici un tour d’horizon des projets de télémédecine mis en place dans les Ehpad de France.

Zulfiqar Abrar-Ahmad, Kadri Nadir, Doucet Jean1, Hajjam Amir, Talha Samy, Hajjam Mohamed, Hajjam Jawad, Ervé Sylvie5, Gény Bernard, Letourneau Dominique and Andrès Emmanuel

Introduction

Elderly and very elderly people living in nursing homes are frequently being hospitalized, more often than not in emergency situations, and the number is steadily increasing. To combat this problem, the French government has implemented a policy to increase accommodation by building new nursing homes across most regions of France. Thus, the number of patients admitted to hospital emergency departments from nursing homes continues to grow year after year, particularly for people in nursing homes with little medical attention that have no night care nurses, and that often have very limited medical time (coordinating doctors). Nursing home healthcare staff must be given tools to limit the flow of these poly pathological older patients to Emergency Services – such as assistance in the prevention of decompensation of some geriatric syndromes to create a preventive policy and improve quality of life for the residents. Literature data supports this: transfer to Emergency Units cause increased rates of morbidity and mortality.

Abrar-Ahmad Zulfiqar, Nadir Kadri, Jean Doucet, Amir Hajjam, Samy Talha, Mohamed Hajjam, Jawad Hajjam, Sylvie Erve, Bernard Gény, Dominique Letourneau, et al.

Abstract
The aim of the GER-e-TEC™ project is to study the contribution of telemonitoring residents in nursing homes of Rouen University Hospital, with a structuring and recording of medical care in order to avoid situations of acute decompensation and complication of geriatric risks. E-care platform will provide personalized care for the main geriatric risks, to avoid the occurrence of an acute decompensation factor in the elderly patient. The collection of information by the platform will increase knowledge of the patients and provide a particularly effective tool for transmission between nursing staff and general practitioners in nursing homes. This information collection will allow the extraction of markers to improve the early detection of any decompensation and thus improve patient monitoring and reduce the number of hospitalizations. The platform will also provide any paramedical and medical health professional with the resident’s geriatric data, which will be updated regularly, including the anthropometric, nutritional, cognitive and iatrogenic data, constituting a real illustration integrated into the electronic platform of the standardized gerontological evaluation, thanks to simple and non-time-consuming measures. Geriatric risks will include the risk of falling, constipation, dehydration, confusion, iatrogenicity, undernutrition, heart failure, diabetes, infections and bedsores. This study will start in April 2019

Emmanuel Andrès, Laurent Meyer, Abrar-Ahmad Zulfiqar, Mohamed Hajjam, Samy Talha, Sylvie Ervé, Jawad Hajjam, Nathalie Jeandidier and Amir Hajjam El Hassani

Abstract
Since the beginning of the 1990s, several telemedicine projects and studies focused on type 1 and type 2 diabetes have been developed, including very few elderly diabetic patients. Several of these projects specifically concerned elderly subjects (n = 4). Mainly, these projects and studies show that telemonitoring diabetes results in improved blood glucose control—a significant reduction in HbA1c, improved patient ownership of the disease, greater patient adherence to therapeutic and hygiene-dietary measures, positive impact on comorbidities (hypertension, weight, dyslipidemia), improved quality of life for patients, and at least good patient receptivity and accountability. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g., background, ability for self-management, medical condition), sample selection, and approach for treatment of control groups. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development.

Emmanuel Andrès, Samy Talha, Mohamed Hajjam and Amir Hajjam El Hassani

Results

Numerous non-invasive telemonitoring projects based on connected objects and information and communication technology (ICT) have emerged in the CHF field over the last 10 years. Others are under development, such as the main international randomized telemonitoring studies TELE-HF, TIM-HF, and BEAT-HF, or the French telemonitoring projects SCAD, OSICAT, PIMS, MEDICA, and E-care. The E-care project is a new-generation project supporting patients’ returning home after hospital discharge. It perfectly fits within the framework of telemedicine 2.0 projects, including for the first time artificial intelligence (AI). This project has been specifically designed to automatically detect situations at risk for CHF. The potential contribution of these French projects (OSICAT, E-care), in terms of mortality, morbidity, number of hospitalizations prevented, as well as economic benefits, is currently studied or documented.

Emmanuel Andrès, Nathalie Jeandidier, Laurent Meyer, Thibault Bahougne,  Abrar-Ahmad Zulfiqar, Samy Talha, Noel Lorenzo Villalba, Mohamed Hajjam and Amir Hajjam El Hassani

Abstract

In recent years, several technological innovations such as non-invasive glucose sensors, intelligent insulin pumps, artificial pancreas, telemedicine, and artificial intelligence have become part of the daily lives of diabetic patients. A review of the literature dedicated to these technologies supports the efficacy of them in diabetic patients. Mainly, these technologies have shown a beneficial effect on diabetes management with an improvement of blood glucose control, with a significant reduction in HbA1c, patient ownership of the disease, patient adherence to therapeutic and hygiene-dietary measures, the management of co-morbidities (hypertension, weight, dyslipidemia), and at least, good patient receptivity and accountability. Especially, the emergence of these technologies in the daily lives of diabetic patients has led to an improvement in the quality of life for patients. To date, the magnitude of their effects remains debatable, especially with the variation in patients’ characteristics, sample selection and approach for treatment of control groups.

Emmanuel Andrès, Nathalie Jeandidier, Laurent Meyer, Thibault Bahougne, Abrar-Ahmad Zulfiqar, Samy Talha, Mohamed Hajjam and Amir Hajjam El Hassani

Abstract

In recent years, several technological innovations have become part of the daily lives of diabetic patients as non-invasive glucose sensors, intelligent insulin pumps, artificial pancreas, telemedicine, and artificial intelligence. A review of the literature dedicated to these technologies supports the efficacy of these latter in diabetic patients. Mainly, these technologies have shown a beneficial effect on diabetes management with an improvement of blood glucose control, with a significant reduction in HbA1c; patient ownership of the disease; patient adherence to therapeutic and hygiene–dietary measures; the management of co-morbidities (hypertension, weight, dyslipidemia); and at least, good patient receptivity and accountability. Especially, the emergence of these technologies in the daily lives of diabetic patients has led to an improvement of the quality of life for patients. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics, samples selection and approach for treatment of control groups.

Emmanuel Andrès; Laurent Meyer; Abrar–Ahmad Zulfiqar; Mohamed Hajjam; Samy Talha; Sylvie Ervé; Jawad Hajjam; Jean Doucet; Nathalie Jeandidier; Amir Hajjam El Hassani

Abstract 

Since the beginning of the 1990’s, several telemedicine projects and studies focused on diabetes type 1 and type 2 mellitus have been developed. Mainly, these projects and studies show that telemonitoring diabetic result in: improved blood glucose control; a significant reduction in HbA1c; improved patient ownership of the disease; greater patient adherence to therapeutic and hygiene–dietary measures; positive impact on co-morbidities (hypertension, weight, dyslipidemia); improved quality of life for patients; and at least good patient receptivity and accountability. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g. background, ability for self–management, medical condition), samples selection and approach for treatment of control groups. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development. Two examples are the DIABETe and Telesage telemonitoring project which perfectly fits within the telemedicine 2.0 framework, being the firsts to include artificial intelligence with MyPrediTM and DiabeoTM (AI).

Abrar A. Zulfiqar, Amir Hajjam and Emmanuel Andrès

Abstract

Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000’s, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.