Publications by authors named "Velardo C"

Biocompatible materials fabricated from natural protein polymers are an attractive alternative to conventional petroleum-based plastics. They offer a green, sustainable fabrication method while also opening new applications in biomedical sciences. Available from several sources in the wild and on domestic farms, silk is a widely used biopolymer and one of the strongest natural materials.

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Background: Blood pressure (BP) control following stroke is important but currently sub-optimal. This trial aimed to determine whether self-monitoring of hypertension with telemonitoring and a treatment escalation protocol, results in lower BP than usual care in people with previous stroke or transient ischaemic attack (TIA).

Methods: Unblinded randomised controlled trial, comparing a BP telemonitoring-based intervention with control (usual care) for hypertension management in 12 primary care practices in England.

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  • The study aimed to test the effectiveness of sending text messages to promote medication adherence in adults with type 2 diabetes, informing a future large-scale trial in the UK.
  • Conducted across multiple primary care centers, 209 participants were randomly assigned to receive text messages or usual care, with a goal to retain over 80% of participants for follow-up at 6 months.
  • A total of 12,734 messages were sent, with a high recruitment rate of 60-80 participants monthly, and baseline health data was available for most participants, setting the stage for the measurement of outcomes after 6 months.
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  • Inadequate management of elevated blood pressure during pregnancy is linked to increased maternal deaths, highlighting the need for better hypertension management.
  • A clinical trial involving 2,441 pregnant individuals at higher risk for preeclampsia assessed whether self-monitoring of blood pressure (BP) with telemonitoring improved early detection of hypertension.
  • Results showed no significant difference in the time to first recorded hypertension between those using self-monitoring and those receiving usual care, indicating that self-monitoring did not provide additional benefits in this context.
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Importance: Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear.

Objective: To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension.

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Background: Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly.

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  • * From May 2019 to March 2020, out of 281 identified patients, only 26 were successfully recruited to use a tablet, pulse oximeter, and activity monitor to aid their COPD self-management post-discharge.
  • * High dropout rates were noted, with over half of the participants withdrawing within four weeks of discharge, indicating difficulties in retaining patients for digital interventions aimed at improving COPD management after hospitalization.
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Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control.

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Background: Successful management of gestational diabetes mellitus (GDM) reduces the risk of morbidity in women and newborns. A woman's blood glucose readings and risk factors are used by clinical staff to make decisions regarding the initiation of pharmacological treatment in women with GDM. Mobile health (mHealth) solutions allow the real-time follow-up of women with GDM and allow timely treatment and management.

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Introduction: This technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM).

Methods: The development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires.

Results: The tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks.

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Background: Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home-based BP management can be effective at maintaining optimal BP.

Objective: To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person-based approach (PBA) and integral patient and public involvement (PPI).

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Background: Hip fracture is common, affecting 20% of women and 10% of men during their lifetime. The trajectory of patients' recovery as they transition from the acute hospital setting to their usual residence is poorly understood. Recently, the use of activity trackers to monitor physical activity during recovery has been investigated as a way to explore this trajectory.

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Objective: The impact of heart failure (HF) on perceived and objectively measured levels of physical activity (PA) can inform risk stratification and treatment recommendation. We aimed to compare self-reported and objectively measured PA levels in a large sample of participants with and without HF.

Methods: A validated PA questionnaire was used to estimate self-reported weekly PA among 1600 participants with HF and 387 580 participants without HF.

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Introduction: Self-monitoring of blood pressure (BP) in pregnancy could improve the detection and management of pregnancy hypertension, while also empowering and engaging women in their own care. Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies (BUMP 1) and whether self-monitoring reduces systolic BP during hypertensive pregnancy (BUMP 2).

Methods And Analyses: Both are multicentre, non-masked, parallel group, randomised controlled trials.

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Background: Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring.

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Introduction: Type 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly.

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Background: Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment.

Objective: We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring.

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There is an increasing need for fast and accurate transfer of readings from blood glucose metres and blood pressure monitors to a smartphone mHealth application, without a dependency on Bluetooth technology. Most of the medical devices recommended for home monitoring use a seven-segment display to show the recorded measurement to the patient. We aimed to achieve accurate detection and reading of the seven-segment digits displayed on these medical devices using an image taken in a realistic scenario by a smartphone camera.

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Objectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM).

Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20).

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Background: Blood pressure (BP) is a key modifiable risk factor for patients with CKD, with current guidelines recommending strict control to reduce the risk of both progression of CKD and cardiovascular disease. Trials of BP lowering require multiple visits to achieve target BP which increases the costs of such trials, and in routine care BP measured in clinic may not accurately reflect usual BP.

Objective: We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enable BP machine which could transmit BP measurements to a tablet device which had a bespoke app to guide measurement of BP and collect questionnaire data) was acceptable to patients with CKD, and whether patients would provide sufficient BP readings to assess variability and guide treatment.

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Traditional heart failure markers fail to reliably predict heart-failure related hospitalisations and deaths. Multi- sensor patch data can provide an objective insight into activity and sleep patterns of patients and may therefore improve the performance of current risk-quantification algorithms. This work aimed to establish the feasibility of collecting multi-sensor patch data from heart failure patients and to perform an initial analysis of activity and sleep patterns of heart failure patients in relation to disease severity.

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Step counting from smart-phones allows a wide range of applications related to fitness and health. Estimating steps from phones' accelerometers is challenging because of the multitude of ways a smart-phone can be carried. We focus our work on the windowed peak detection algorithm, which has previously been shown to be accurate and efficient and thus suitable for mobile devices.

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Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015.

Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based.

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Background: Though many overweight and obese adults attempt to lose weight without formal support, little is known about the strategies used in self-directed weight loss attempts. We set out to assess cognitive and behavioural strategies for weight loss and their associations with weight change.

Methods: Prospective, web-based cohort study of overweight UK adults (BMI≥25kg/m2) trying to lose weight through behaviour change.

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