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IntroductionSyncope management in acute settings is not universally standardized according to international guidelines, with limited awareness among many acute medical and nursing staff. Additionally, there is a lack of a structured approach to risk stratification, despite its importance given the significant mortality implications of non-neurally mediated syncope. A structured algorithm is essential to ensure appropriate patient triage, minimizing unnecessary admissions for low-risk patients while reserving telemetry and monitored beds for high-risk cases.MethodsRetrospective review of consecutive patients with syncope presenting to the Emergency Department and Medical Admissions Unit at the RVI from April to June 2024 was performed. Patients’ records were scrutinised for history, assessment, triage, investigations performed and subsequent management.Comparisons were then made with low-risk, intermediate-risk and high-risk classifications outlined in the ESC Syncope Guidelines 2018 with investigations, monitoring, admission patterns, and diagnoses.ResultsRecords of 99 patients were reviewed, with a range of 23–98 years and mean of 75 years.Abstract 7-025 Table 1Admission and telemetry rates for different risk categories of patients presenting with syncope Risk group Number of patients Admission rates (%) Admission for Telemetry (%) Low-risk 37 78 17 Medium-risk 27 95 61 High-risk 35 100 69 Additional findings revealed that lying and standing blood pressure was not properly documented in 41% of patients, and family history was not assessed in 85% of cases. Both assessments are recommended by the ESC Syncope Guidelines for the evaluation of syncopal patients.ConclusionESC 2018 Syncope guidelines were not consistently followed in terms of risk stratification. Furthermore, even among patients who were correctly stratified, appropriate inpatient monitoring was not always conducted. To address these gaps, we have developed an evidence-based algorithmic approach to acute management, which will be implemented and followed by a re-audit to assess its impact.Abstract 7-025 Figure 1[Image Omitted. See PDF.]

IntroductionSyncope management in acute settings is not universally standardized according to international guidelines, with limited awareness among many acute medical and nursing staff. Additionally, there is a lack of a structured approach to risk stratification, despite its importance given the significant mortality implications of non-neurally mediated syncope. A structured algorithm is essential to ensure appropriate patient triage, minimizing unnecessary admissions for low-risk patients while reserving telemetry and monitored beds for high-risk cases.MethodsRetrospective review of consecutive patients with syncope presenting to the Emergency Department and Medical Admissions Unit at the RVI from April to June 2024 was performed. Patients’ records were scrutinised for history, assessment, triage, investigations performed and subsequent management.Comparisons were then made with low-risk, intermediate-risk and high-risk classifications outlined in the ESC Syncope Guidelines 2018 with investigations, monitoring, admission patterns, and diagnoses.ResultsRecords of 99 patients were reviewed, with a range of 23–98 years and mean of 75 years (table 1). Abstract 3-008 Table 1Admission and Telemetry rates for different risk categories of patients presenting with syncopeRisk group Number of patients Admission rates (%) Admission for Telemetry (%) Low-risk 37 78 17 Medium-risk 27 95 61 High-risk 35 100 69 Additional findings revealed that lying and standing blood pressure was not properly documented in 41% of patients, and family history was not assessed in 85% of cases. Both assessments are recommended by the ESC Syncope Guidelines for the evaluation of syncopal patients.ConclusionESC 2018 Syncope guidelines were not consistently followed in terms of risk stratification. Furthermore, even among patients who were correctly stratified, appropriate inpatient monitoring was not always conducted. To address these gaps, we have developed an evidence-based algorithmic approach to acute management (figure 1), which will be implemented and followed by a re-audit to assess its impact.Abstract 3-008 Figure 1Abstract 3-008 Figure 2

IntroductionInpatient telemetry monitoring makes up a large portion of non-invasive cardiology investigations available to general medical teams. Studies have shown that clinical care changes in 7–30% of patients may be attributed to telemetry findings. Overuse of telemetry amongst hospital patients results in longer waiting times for telemetry to other patients, prolongs length of admission and cost of healthcare. Although some centres have local proformas regarding the use of this limited resource, there are no standardised guidelines regarding its use in Irish hospitals. Furthermore, there is a lack of European guidelines on telemetry use.Aims and MethodsProspectively analyse the inpatient telemetry requests and use over a 60-day period in a single centre to identify areas of improvement. The aim of the audit was to create a standardised proforma for prioritisation of telemetry requests using American Heart Association (AHA) and British Heart Rhythm Society (BHRS) telemetry guidelines. Consecutive data was prospectively collected on telemetry use in a single centre using electronic health systems and patient records.ResultsA total of 10,796 telemetry hours of data was recorded and reviewed from 241 patients during the period. Demographics as per table 1. The mean time waiting for telemetry was 23.1hrs (+/- 21.8hrs). The mean time on telemetry was 44.8hrs (+/- 39.3hrs) with 0.385 arrythmias per telemetry day or 77 patients (32%) with an arrythmia detected. There was a change in management enacted in 70 patients (29%) due to telemetry findings. This included titration of medications in 54 patients (22%), diagnosis of new atrial fibrillation in 14 patients (5.8%), further diagnostics in 14 patients (5.8%), reversion to sinus rhythm in 9 patients (3.7%) and device insertion in 4 patients (1.6%). A total of 30 patient requests did not receive telemetry, 6 patients had telemetry refused due to inappropriate requests, 4 patients refused telemetry when offered to them, 14 patients had been discharged home when a box was assigned to them, 6 patients had electrolytes that had normalised prior to telemetry being made available. 202 (84%) of requests met criteria for telemetry according to BHRS and AHA guidelines. Of the 39 requests that did not meet criteria for telemetry as per guidelines, there was a change to patient management based on findings in 4 cases. 6 requests were monitored for shorter than the recommended duration. 66 telemetry requests were monitored for longer than the recommended duration.Abstract 36 Table 1Patient demographicsConclusionsTelemetry monitoring in-hospital is a valuable but limited resource with potential for overuse. Judicious telemetry use with suggested prioritisation (figure 1) and prescription of telemetry rather than automatic approval may result in better patient outcomes. A re-audit to complete the process after hospital staff education and implementation of new telemetry form will be carried out to evaluate the results.Abstract 36 Figure 1Telemetry use with suggested prioritisation[Figure omitted. See PDF]

In a drive towards Lowering C-section rate, providing consistent information to women and promoting ‘Normality’, a VBAC clinic was establised in York Teaching Hospital Foundation Hospital. The clinic also aims to provide an opprtunity to discuss women’s previous birth experiences, help distinguish ‘facts from fiction’ and beliefs, enabling informed choice for patients. The clinic is run by three midwives with a particular interest in VBAC. Patients are seen at around 14 weeks gestation following referrel by Community Midwives following a dating/NT scan. This ensures women receive consistent information before their 20 week appointment with their named Consultant. Results 193 patients were seen in VBAC clinic since its commencement in Nov 2011. Mean CS rate for the duration till March 2013 was 64.28% (30–88% range) and vaginal delivery rate of 35.8% (7.69%–70% range). Previous Vaginal delivery rates in York following attempted VBAC prior to introduction of VBAC Clinic was 34% in 2012. There was a slight increase in the success rate following Spontaneous onset of labour at term overall. Challenges we face: Conflicting opinions from obstetricians from varying clinical experience. Women being seen at 14 weeks gestation and then not again by VBAC midwives; Women’s expectations and time spent in VBAC clinic and external factors. Confidence of medical and midwifery practitioner looking after VBAC. Women who had a spontaneous onset of labour went on to have a her women in labour. Need for evalauating introduction of Telemetry and use of Pool for labouring women with revision of guidelines. Need for a lead VBAC consultant to ensure consistent policy for care of VBAC. Abstract PPO.48 Figure

Understanding the efficacy of marine protected areas (MPAs) for wide-ranging predators is essential to designing effective management and conservation approaches. The use of acoustic monitoring and network analysis can improve our understanding of the spatial ecology and functional connectivity of reef-associated species, providing a useful approach for reef-based conservation planning. This study compared and contrasted the movement and connectivity of sharks with different degrees of reef association. We examined the residency, dispersal, degree of reef connectivity, and MPA use of grey reef ( Carcharhinus amblyrhynchos ), silvertip ( C. albimarginatus ), and bull ( C. leucas ) sharks monitored in the central Great Barrier Reef (GBR). An array of 56 acoustic receivers was used to monitor shark movements on 17 semi-isolated reefs. Carcharhinus amblyrhynchos and C. albimarginatus were detected most days at or near their tagging reef. However, while C. amblyrhynchos spent 80% of monitoring days in the array, C. albimarginatus was only detected 50% of the time. Despite both species moving similar distances (<50 km), a large portion of the population of C. albimarginatus (71%) was detected on multiple reefs and moved more frequently between reefs and management zones than C. amblyrhynchos . Carcharhinus leucas was detected less than 20% of the time within the tagging array, and 42% of the population undertook long-range migrations to other arrays in the GBR. Networks derived for C. leucas were larger and more complex than those for C. amblyrhynchos and C. albimarginatus . Our findings suggest that protecting specific reefs based on prior knowledge (e.g., healthier reefs with high fish biomass) and increasing the level of protection to include nearby, closely spaced reef habitats (<20 km) may perform better for species like C. albimarginatus than having either a single or a network of isolated MPAs. This design would also provide protection for larger male C. amblyrhynchos , which tend to disperse more and use larger areas than females. For wide-ranging sharks like C. leucas , a combination of spatial planning and other alternative measures is critical. Our findings demonstrate that acoustic monitoring can serve as a useful platform for designing more effective MPA networks for reef predators displaying a range of movement patterns.

This paper reviews the use of acoustic telemetry as a tool for addressing issues in fisheries management, and serves as the lead to the special Feature Issue of Ecological Applications titled Acoustic Telemetry and Fisheries Management. Specifically, we provide an overview of the ways in which acoustic telemetry can be used to inform issues central to the ecology, conservation, and management of exploited and/or imperiled fish species. Despite great strides in this area in recent years, there are comparatively few examples where data have been applied directly to influence fisheries management and policy. We review the literature on this issue, identify the strengths and weaknesses of work done to date, and highlight knowledge gaps and difficulties in applying empirical fish telemetry studies to fisheries policy and practice. We then highlight the key areas of management and policy addressed, as well as the challenges that needed to be overcome to do this. We conclude with a set of recommendations about how researchers can, in consultation with stock assessment scientists and managers, formulate testable scientific questions to address and design future studies to generate data that can be used in a meaningful way by fisheries management and conservation practitioners. We also urge the involvement of relevant stakeholders (managers, fishers, conservation societies, etc.) early on in the process (i.e., in the co-creation of research projects), so that all priority questions and issues can be addressed effectively.

The concept of 'patient experience' has become central to how to improve healthcare. Remote communication with patients is today a frequent practice in healthcare services, showing similar outcomes to standard outpatient care while enabling cost reduction in both formal and informal care. The purpose of this study was to analyse the experiences of people with telemonitoring pacemakers. Patients were randomly allocated to either the telemonitoring or hospital monitoring follow-ups. Using the 'Generic Short Patient Experiences Questionnaire' (GS-PEQ), as well as an ad-hoc survey from the 'telehealth patient satisfaction survey' and 'costs survey', patients' experiences were measured six months after the pacemaker implant in a cohort of 50 consecutive patients. The mean age was 74.8 (± 11.75) years and 26 (52%) patients were male of which 1 was lost in follow-up. Finally, 24 patients were followed up with standard hospital monitoring, while 25 used the telemonitoring system. Differences in baseline characteristics between groups were not found. Findings showed overall positive and similar experiences in patients living with telemonitoring and hospital monitoring pacemakers. Significant differences were found in GS-PEQ concerning how telemonitoring patients received less information about their diagnosis/afflictions (p = 0.046). We did not find significant differences in other items such as 'confidence in the clinicians' professional skills', 'treatment perception adapted to their situation', 'involvement in decisions regarding the treatment', 'perception of hospital organisation', 'waiting before admission', 'satisfaction of help and treatment received', 'benefit received', and 'incorrect treatment'. The remote communication of pacemakers was met with positive levels of patients' experiences similarly to patients in the hospital monitoring follow-up. However, telemonitoring patients received less information. Thus, improving the quality and timing of information is required in telemonitoring patients in the planning and organisation of future remote communication healthcare services for people living with a pacemaker implant.

Passive acoustic telemetry provides an important tool to study the spatial ecology and behaviour of organisms in marine and freshwater systems, but understanding the detection range of acoustic receivers is critical for interpreting acoustic data and establishing receiver spacing to maximize study efficiency. This study presents a comprehensive review of how acoustic detection range has been considered and assessed to date, summarizes important variables to monitor when determining the detection range of a receiver array, and provides recommendations to account for detection range during experimental design, analysis and data interpretation. A total of 378 passive acoustic telemetry studies (1986–2012) were scored against a set of pre-defined criteria to provide a standardized assessment of how well detection range was accounted for, from a maximum possible score of 45. Scores ranged from 0 to 39 (11.1 ± 0.4; mean ± 1 SE). Over the past decade mean scores have been consistently between 6.7 and 12.9 which indicates that detection range has not been adequately considered in most contemporary acoustic telemetry studies. Given the highly variable nature of detection range over space and time, it is necessary to create a culture of detection range testing among the scientific community. For robust telemetry studies it is recommended that consideration of detection range should be given a greater focus within study design, execution and data analysis. To aid array design in new systems, short-term detection range tests should be conducted in the most representative area of the study system prior to deployment. As well, fixed distance sentinel tags should ideally be deployed at a representative receiver site within the array to provide a continuous assessment of detection range and influential environmental parameters should be monitored to facilitate modeling of detection range variability over time. When warranted, data analysis should incorporate modeled variation in detection ranges.

Purpose Telemonitoring might enhance continuous positive airway pressure (CPAP) adherence and save nursing time at the commencement of CPAP therapy. We tested wireless telemonitoring (ResTraxx Online System®, ResMed) during the habituation phase of the CPAP therapy in obstructive sleep apnea syndrome (OSAS). Methods In total, 111 consecutive OSAS patients were enrolled. After CPAP titration, patients were followed with the telemonitoring (TM, N  = 50) or the usual care (UC, N  = 61). The TM group used fixed pressure CPAP device with and the UC group similar device without wireless telemonitoring. Patients and study nurses were unblinded. The evaluated end-points were hours of CPAP use >4 h/day, mask leak <0.4 L/s, and AHI <5/h. Nursing time including extra phone calls, visits, and telemonitoring time was recorded during the habituation phase. CPAP adherence was controlled in the beginning and at the end of the habituation phase and after 1-year of use. Results TM and UC groups did not differ in terms of patient characteristics. The average length of the habituation phase was 4 weeks in the TM group and fixed 3 months in the UC group. Median nursing time was 39 min (range 12–132 min) in the TM group and shorter compared to that of 58 min (range 40–180 min) ( p  < 0.001) per patient in the UC group. Both treatment groups had high CPAP usage hours (>4 h/day) and the change in usage at the end of the habituation phase did not differ between the groups ( p  = 0.39). Patients in both groups were equally satisfied with the treatment protocol. CPAP adherence (6.4 h in TM vs. 6.1 h in UC group, p  = 0.63) and residual AHI (1.3 in TM vs. 3.2 in UC group, p  = 0.04) were good in both groups at 1-year follow-up. Conclusions Wireless telemonitoring of CPAP treatment could be relevant in closing the gap between the increasing demand and available health-care resources. It may save nursing time without compromising short- or long-term effectiveness of CPAP treatment in OSAS.

In biomedical research, telemetry is used to take automated physiological measurements wirelessly from animals, as it reduces their stress and allows recordings for large data collection over long periods. The ability to transmit high-throughput data from an in-body device (e.g., implantable systems, endoscopic capsules) to external devices can also be achieved by radiofrequency (RF), a standard wireless communication procedure. However, wireless in-body RF devices do not exceed a transmission speed of 2 Mbit/s, as signal absorption increases dramatically with tissue thickness and at higher frequencies. This paper presents the design of an optical wireless communication system (OWCS) for neural probes with an optical transmitter, sending out physiological data through an optical signal that is detected by an optical receiver. The optical receiver position is controlled by a tracking system of the small animal position, based on a cage with a piezoelectric floor. To validate the concept, an OWCS based on a wavelength of 850 nm for a data transfer of 5 Mbit/s, with an optical power of 55 mW, was demonstrated for a tissue thickness of approximately 10 mm, measured in an optical tissue phantom.