Clinical Research Directory

Study of a Patient Cohort Following Digestive Surgical Care After the Implementation of a Telemonitoring and Tele-coordination Platform for Medical, Paramedical, and Social Management

Postoperative hospital stays and complications vary widely after digestive surgery. Enhanced Recovery After Surgery (ERAS) protocols have shortened stays and accelerated recovery after elective procedures, but they remain challenging in emergency surgery and among frail or elderly patients. While theoretical discharge after colorectal surgery is possible between postoperative days 2 and 7, average stays in practice are 12-14 days. Bariatric surgery similarly targets discharge on days 2-3, yet typical stays are 8-10 days. Patients successfully managed under ERAS may face higher readmission risk, often due to worsening comorbidities or serious complications. Prolonged hospitalization and readmissions impact patient safety, comfort, and healthcare costs. Daily hospital costs in surgical units range from €350 to €400. Post-acute care facilities can reduce readmissions but often have long waiting periods. To minimize readmission risk, many surgeons prefer in-hospital postoperative monitoring, limiting early discharge. Recent studies show that connected devices and teleconsultation can provide safe and effective postoperative follow-up. Teleconsultation follow-up is feasible for most patients, with satisfaction rates comparable to in-person visits. Remote monitoring of stoma care has been associated with reduced readmissions. Home-based monitoring using connected vital sign devices in high-risk patients reduces readmissions and emergency visits. In colorectal and bariatric surgery, daily remote monitoring after early discharge (24-48 hours) did not increase morbidity or readmission, suggesting that telemonitoring can safely enable earlier discharge while maintaining patient safety. Continuous monitoring is particularly important for high-risk patients due to rapid deterioration from potential complications. EPOCA is a telemonitoring and telecoordination platform providing medical, paramedical, and social follow-up at home. It combines connected devices, a digital platform for data analysis, and a dedicated medical and paramedical team. Services include teleconsultations, home paramedical care, support for families or care facilities, and 24/7 emergency management. EPOCA reassures patients and caregivers, supports primary care and home care teams, and integrates hospital and emergency services. It addresses challenges posed by aging populations, chronic disease prevalence, and increasingly complex patients. By enabling earlier discharge without increasing readmissions, EPOCA offers a holistic solution bridging hospital and home care. It has already demonstrated success in preventing hospitalizations in high-risk elderly patients and is authorized for telemonitoring of chronic conditions including diabetes, respiratory, renal, and cardiac insufficiency. This study aims to evaluate the feasibility of implementing EPOCA over two years in the CHU Nantes digestive surgery unit. It will target patients undergoing elective or urgent colorectal or bariatric surgery who are at risk of prolonged hospitalization or readmission. High-risk scenarios include anticipated early discharge within 24 hours and patients identified as having elevated readmission risk according to predefined criteria

TOD-IBD: Empowering Patients On-Demand

Crohn's disease and Ulcerative Colitis, collectively known as Inflammatory Bowel Disease (IBD), impose a significant burden on patients and healthcare systems due to their chronic nature and complex treatment. This study aims to assess the effectiveness and safety of on-demand telemonitoring, as opposed to standard fixed-schedule telemonitoring, in managing IBD. The primary objective is to evaluate the impact of on-demand telemonitoring on the number of persistent flares over 12 months. The study involves a multicenter randomized controlled trial comparing standard telemonitoring, which includes regular completion of the Monitor IBD At Home questionnaire and fecal calprotectin home tests, with on-demand telemonitoring where patients use the app based on their symptoms. The study population includes adult patients with stable remission on maintenance therapy. Disease activity, measured by unplanned healthcare contacts, is the primary outcome, while secondary outcomes encompass clinical and patient-reported disease activity, quality of life, self-efficacy, patient activation, total healthcare contacts, safety, and costs. Baseline characteristics include patient, disease, and socio-demographic factors. This innovative approach has the potential to enhance patient autonomy, satisfaction, and self-management, while reducing the overall burden on the healthcare system.

Remote Cardiotocography Telemonitoring Within High-risk Pregnancy Care

The overall aim of this research proposal is to explore the feasibility and acceptability of home antenatal maternal-fetal monitoring technology within a high-risk pregnancy group. The investigators hypothesise that home monitoring is feasible and acceptable to both pregnant women and HCPs. 50 women from a single site will be recruited to use a home cardiotocography (CTG) device alongside routine antenatal care. Participants will use this device once a week, for an hour at a time, for up to 6 weeks or until delivery. The primary outcome is 20 minutes of continuous monitoring. Additional outcomes assess acceptability, adherence and safety.

EVOLVING AZIMUTH IN MUSA CONTEXT

Non-pharmacological, randomized, nonprofit medical device intervention. The study aims to identify the positive impacts (co-creation), and negative impacts (co-destruction), resulting from the use of telemedicine, and, in particular, the telemonitoring service for patients with heart failure

Effects of Telemonitoring in Quality of Life Amongst Cancer Patients

This interventional study aims to explore the potential of a smartphone app, Contigo, in enhancing the quality of life for patients with various cancers compared to standard care. The investigators will asses effects on quality of life, depressive symptoms, and appointment adherence.