Remote patient monitoring (RPM) leverages advanced technology to monitor and manage patients' health remotely and continuously. In 2022 European Alliance of Associations for Rheumatology (EULAR)... Show moreRemote patient monitoring (RPM) leverages advanced technology to monitor and manage patients' health remotely and continuously. In 2022 European Alliance of Associations for Rheumatology (EULAR) points-to-consider for remote care were published to foster adoption of RPM, providing guidelines on where to position RPM in our practices. Sample papers and studies describe the value of RPM. But for many rheumatologists, the unanswered question remains the 'how to?' implement RPM.Using the successful, though not frictionless example of the Southmead rheumatology department, we address three types of barriers for the implementation of RPM: service, clinician and patients, with subsequent learning points that could be helpful for new teams planning to implement RPM. These address, but are not limited to, data governance, selecting high quality cost-effective solutions and ensuring compliance with data protection regulations. In addition, we describe five lacunas that could further improve RPM when addressed: establishing quality standards, creating a comprehensive database of available RPM tools, integrating data with electronic patient records, addressing reimbursement uncertainties and improving digital literacy among patients and healthcare professionals. Show less
Frailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate... Show moreFrailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate the association between frailty and MRI features of cerebral small vessel disease in a group of non-demented older individuals. We included 170 participants who were classified as frail (n = 30), pre-frail (n = 85) or non-frail (n = 55). The association of frailty and white matter hyperintensity volume and shape features, lacunar infarcts and cerebral perfusion was investigated by regression analyses adjusted for age and sex. Frail and pre-frail participants were older, more often female and showed higher white matter hyperintensity volume (0.69 [95%-CI 0.08 to 1.31], p = 0.03 respectively 0.43 [95%-CI: 0.04 to 0.82], p = 0.03) compared to non-frail participants. Frail participants showed a non-significant trend, and pre-frail participants showed a more complex shape of white matter hyperintensities (concavity index: 0.04 [95%-CI: 0.03 to 0.08], p = 0.03; fractal dimensions: 0.07 [95%-CI: 0.00 to 0.15], p = 0.05) compared to non-frail participants. No between group differences were found in gray matter perfusion or in the presence of lacunar infarcts. In conclusion, increased white matter hyperintensity volume and a more complex white matter hyperintensity shape may be structural brain correlates of the frailty phenotype. Show less
According to ideomotor theory, goal-directed action involves the active perceptual anticipation of actions and their associated effects. We used multivariate analysis of fMRI data to test if... Show moreAccording to ideomotor theory, goal-directed action involves the active perceptual anticipation of actions and their associated effects. We used multivariate analysis of fMRI data to test if preparation of an action promotes precision in the perceptual representation of the action. In addition, we tested how reward magnitude modulates this effect. Finally, we examined how expectation and uncertainty impact neural precision in the motor cortex. In line with our predictions, preparation of a hand or face action increased the precision of neural activation patterns in the extrastriate body area (EBA) and fusiform face area (FFA), respectively. The size of this effect of anticipation predicted individuals' efficiency at performing the prepared action. In addition, increasing reward magnitude increased the precision of perceptual representations in both EBA and FFA although this effect was limited to the group of participants that learned to associate face actions with high reward. Surprisingly, examination of representations in the hand motor cortex and face motor cortex yielded effects in the opposite direction. Our findings demonstrate that the precision of representations in visual and motor areas provides an important neural signature of the sensorimotor representations involved in goal-directed action. Show less
The present fMRI study tested the assumption that a single pairing of a stimulus and a logically unrelated response is sufficient for binding the corresponding stimulus and response codes into an... Show moreThe present fMRI study tested the assumption that a single pairing of a stimulus and a logically unrelated response is sufficient for binding the corresponding stimulus and response codes into an event representation (event file) that is automatically retrieved upon processing of at least one of its components. In particular, we investigated whether repeating a face or a house stimulus and/or a left or a right manual response induces the automatic retrieval of the response or stimulus that it previously accompanied. ROI analyses of fusiform face area, parahippocampal place area, and right and left motor cortex revealed that repeating one component of a previously encountered stimulus-response episode leads to the suppression of cortical areas processing the other components, suggesting that these components were indeed automatically retrieved and conflicted with ongoing processing. The particular pattern obtained is consistent with predictions from diffusion models of decision making, which suggest a crucial role of local competition in response selection. Show less
Kuhn, S.; Keizer, A.W.; Rombouts, S.A.R.B.; Hommel, B. 2011
Ideomotor theory claims that actions are cognitively represented and accessed via representations of the sensory effects they evoke. Previous studies provide support for this claim by showing that... Show moreIdeomotor theory claims that actions are cognitively represented and accessed via representations of the sensory effects they evoke. Previous studies provide support for this claim by showing that the presentation of action effects primes activation in corresponding motor structures. However, whether people actually use action-effect representations to control their motor behavior is not yet clear. In our fMRI study, we had participants prepare for manual or facial actions on a trial-by-trial basis, and hypothesized that preparation would be mediated by the cortical areas that code for the perceptual effects of these actions. Preparing for manual action induced higher activation of hand-related areas of motor cortex (demonstrating actual preparation) and of the extrastriate body area, which is known to mediate the perception of body parts. In contrast, preparing for facial action induced higher activation of face-related motor areas and of the fusiform face area, known to mediate face perception. These observations provide further support for the ideomotor theory and suggest that visual imagery might play a role in voluntary action control. Show less
