Interpreting the results of the Semmes-Weinstein monofilament test: accounting for false-positive answers in the international consensus on the diabetic foot protocol by a new model

2014 ◽  
Vol 30 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Robert A. Slater ◽  
Shlomit Koren ◽  
Yoram Ramot ◽  
Andreas Buchs ◽  
Micha J. Rapoport
Keyword(s):  
Diabetic Foot ◽  
False Positive ◽  
International Consensus ◽  
New Model ◽  
Monofilament Test

The diabetic foot

2011 ◽  
pp. 1976-1989
Author(s):  
Michael Edmonds ◽  
Alethea. Foster
Keyword(s):  
Diabetic Foot ◽  
Early Recognition ◽  
Treatment Plan ◽  
Staging System ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Tissue Destruction ◽  
National Guidelines ◽  
International Consensus

At some time in their life, 15% of people with diabetes develop foot ulcers, which are highly susceptible to infection. This may spread rapidly leading to overwhelming tissue destruction and amputation: indeed, 85% of amputations are preceded by an ulcer and there is an amputation in a person with diabetes every 30 seconds throughout the world (1). Evidence-based protocols for diabetic foot ulcers have been developed (2), and diabetic foot programmes that have promoted a multidisciplinary approach to heal foot ulcers with aggressive management of infection and ischaemia have achieved a substantial decrease in amputation rates (3, 4). Furthermore, a reduction in amputations has been reported nationwide in diabetic patients throughout the Netherlands (5). Recently, a decrease in major amputation incidence has been reported in diabetic as well as in nondiabetic patients in Helsinki (6). These reports have stressed the importance of early recognition of the ‘at-risk’ foot, the prompt institution of preventive measures, and the provision of rapid and intensive treatment of foot infection and also evascularization in multidisciplinary foot clinics. Such measures can reduce the number of amputations in diabetic patients. Systematic reviews on prevention and treatment have been carried out, e.g. see Eldor et al. (7), and national guidelines have recently been formulated (8, 9). An International Consensus developed in 1999 was re-launched in revised form as an interactive DVD (10, 11) in 2007. This chapter outlines a simple classification of the diabetic foot into the neuropathic and neuroischaemic foot. It then describes a simple staging system of the natural history of the diabetic foot and a treatment plan for each stage. Successful management of the diabetic foot needs the expertise of a multidisciplinary team which should include physician, podiatrist, nurse, orthotist, radiologist, and surgeon working closely together, within the focus of a diabetic foot clinic.

scholarly journals International consensus on the diabetic foot

2000 ◽  
Vol 32 (3) ◽  
pp. 623-624
Author(s):  
Frank Pomposelli
Keyword(s):  
Diabetic Foot ◽  
International Consensus

scholarly journals Actor Critic Deep Reinforcement Learning for Neural Malware Control

2020 ◽  
Vol 34 (01) ◽  
pp. 1005-1012
Author(s):  
Yu Wang ◽  
Jack Stokes ◽  
Mady Marinescu
Keyword(s):  
Operating System ◽  
Reinforcement Learning ◽  
False Positive ◽  
Partial Information ◽  
False Positive Rate ◽  
True Positive Rate ◽  
True Positive ◽  
New Model ◽  
Positive Rate ◽  
Execution Speed

In addition to using signatures, antimalware products also detect malicious attacks by evaluating unknown files in an emulated environment, i.e. sandbox, prior to execution on a computer's native operating system. During emulation, a file cannot be scanned indefinitely, and antimalware engines often set the number of instructions to be executed based on a set of heuristics. These heuristics only make the decision of when to halt emulation using partial information leading to the execution of the file for either too many or too few instructions. Also this method is vulnerable if the attackers learn this set of heuristics. Recent research uses a deep reinforcement learning (DRL) model employing a Deep Q-Network (DQN) to learn when to halt the emulation of a file. In this paper, we propose a new DRL-based system which instead employs a modified actor critic (AC) framework for the emulation halting task. This AC model dynamically predicts the best time to halt the file's execution based on a sequence of system API calls. Compared to the earlier models, the new model is capable of handling adversarial attacks by simulating their behaviors using the critic model. The new AC model demonstrates much better performance than both the DQN model and antimalware engine's heuristics. In terms of execution speed (evaluated by the halting decision), the new model halts the execution of unknown files by up to 2.5% earlier than the DQN model and 93.6% earlier than the heuristics. For the task of detecting malicious files, the proposed AC model increases the true positive rate by 9.9% from 69.5% to 76.4% at a false positive rate of 1% compared to the DQN model, and by 83.4% from 41.2% to 76.4% at a false positive rate of 1% compared to a recently proposed LSTM model.

Book Reviews: International Consensus on the Diabetic Foot

2001 ◽  
Vol 22 (9) ◽  
pp. 753-753
Author(s):  
Michael S. Pinzur ◽  
Lowell D. Lutter
Keyword(s):  
Diabetic Foot ◽  
International Consensus

scholarly journals PENGARUH SENAM KAKI DIABETES TERHADAP LEG SENSITIVITY MONOFILAMENT TEST PADA PENDERITA DIABETES MELITUS DI WILAYAH POSYANDU LANSIA ENDROSONO SURABAYA

2019 ◽  
Vol 4 (2) ◽  
pp. 29
Author(s):  
Susanti Susanti
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Random Sampling ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
P Value ◽  
Patients With Diabetes ◽  
The Right ◽  
Monofilament Test ◽  
Diabetes Melitus

ABSTRAK Penderita Diabetes Mellitus (DM) berisiko mengalami penurunan sensitivitas pada kaki. Kebiasaan maupun perilaku penderita seperti kurang menjaga kebersihan kaki dan tidak menggunakan alas kaki saat beraktivitas akan beresiko terjadi perlukaan pada daerah kaki. Keadaan kaki diabetik lanjut yang tidak ditangani secara tepat dapat memicu dilakukannya tindakan amputasi kaki.  Tujuan penelitian untuk menganalisis Pengaruh Senam Kaki Diabetes terhadap Leg Sensitivity Monofilament Test pada penderita Diabetes Melitus di Wilayah Posyandu Lansia Endrosono Surabaya. Penelitian ini menggunakan metode pre-experiment designs dengan rancangan yang digunakan yaitu one group pretest-postest dengan sample 54 responden lansia di Posyandu Lansia Endrosono Kelurahan Wonokusumo Kecamatan Semampir Kota Surabaya diambil menggunakan tehnik sampling Simple Random Sampling. Pengukuran Leg Sensitivity dipeoleh dari observasi menggunakan Monofilament Test. Data dianalisis menggunakan Uji Mc. Nemar didapatkan p value = 0,008 pada kaki kanan dan p value = 0,003 pada kaki kiri dengan α=0,05 (p< α). Hal ini berarti tidak terdapat pengaruh antara senam kaki diabetes dengan leg sensitivity monofilament test (H0 diterima, H1 ditolak). Implikasi hasil penelitian bahwa senam kaki diabetes tidak dapat mempengaruhi leg sensitivity monofilament test. sehingga perlu lebih ditingkatkan aktivitasnya sehari-harinya dan melakukan senam kaki diabetes 5-7x perhari. Kata Kunci : Senam Kaki Diabetes, Leg Sensitivity, Monofilament Test   ABSTRACT Patients with Diabetes Mellitus (DM) are risked with Leg Sensitivity decreasing. Patient’s habits or behavior such as less maintaining of their cleanliness and not wearing footwear or slippers will make the risk of them infect their feet increase. If the conditions of further diabetics are not handled properly, it can increase the act of foot amputations.  This research objective is to analyze the effect of Diabetics Foot Exercise against Leg Sensitivity Monofilament Test to patients with Diabetes Mellitus in Posyandu Lansia Endorsono Surabaya. This research is using pre-experiment designs methods and the design used is one group pretest-posttest with 54 elderly respondents from Posyandu Lansia Endorsono Wonokusumo Village, Semampir sub-district, Surabaya as sample and using Simple Random Sampling as the sampling technique. Leg sensitivity measuring is collected from Monofilament Test observation. The Data are analyzed by SPSS 16.0 program and using Mc. Nemar obtained p value = 0,008 for the right foot and p value = 0,003 for the left foot α=0,05 (p< α). It means that there is no effect between Diabetic Foot Exercise with the Leg Sensitivity Monofilament test (H0 is approved, H1 is disapproved). The implication of the research is that Diabetic Foot Exercise cannot be affecting Leg Sensitivity Monofilament Sensitivity Test. As the result patients with diabetes mellitus need to increase their daily activity and do the Diabetic Foot Exercise 5-7 times per-day. Key words: Diabetic Foot Exercise, Leg Sensitivity, Monofilament Test

International consensus and practical guidelines on the management and the prevention of the diabetic foot

2000 ◽  
Vol 16 (S1) ◽  
pp. S84-S92 ◽  
Author(s):  
J. Apelqvist ◽  
K. Bakker ◽  
W. H. van Houtum ◽  
M. H. Nabuurs-Franssen ◽  
N. C. Schaper ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
International Consensus ◽  
Practical Guidelines

scholarly journals Efektifitas buku panduan uji sentuh ipswich dalam meningkatkan keterampilan kader kesehatan mendeteksi neuropati diabetik

2020 ◽  
Vol 14 (4) ◽  
pp. 522-528
Author(s):  
Suyanto Suyanto ◽  
Sri Lestari Dwi Astuti
Keyword(s):  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
The Body ◽  
Control Group ◽  
P Value ◽  
Cluster Sampling ◽  
Simple Method ◽  
Before And After ◽  
Chi Squared ◽  
Monofilament Test

The ipswich touch test manual book in improving skills for health cadre members in detecting diabetic neuropathyBackground: Complications of diabetes can affect all organs of the body, especially the ends of the feet as diabetic foot. But this will not occur if diabetes treatment in properly and regularly. The early detection on nerve damage can do immediately to find neuropathy symptoms, which is a decrease in the sensitivity of the feet, by using a monofilament test. However, this tool is rarely available in health care units. Currently, a simple method for detecting neuropathy by the Ipswich Touch Test (IpTT). This technique can perform by health cadres, but it needs written instructions such as a guide or manual book.Purpose: Knowing of the skills for health cadre members in detecting diabetic neuropathy by using ipswich touch test manual book.Methods: The pretest-posttest quasi-experimental design with population was health cadre members taken by cluster sampling from Giri Roto and Dibal villages, Ngemplak District, Boyolali Regency. The sample divided by  2 groups and each a group of 60 participants of cadres. The evaluation by observing of the skills each health cadre members in detecting diabetic neuropathy before and after using ipswich touch test manual book.Results: Based on data analysis using the chi-squared test, the p-value was 0.000 (<0.005). This means that the research hypothesis accepted which states that there are differences in the skills on each health cadre members in detecting diabetic neuropathy before and after using ipswich touch test manual book.Conclusion: There is improving in skills on each health cadre member in detecting diabetic neuropathy by using ipswich touch test manual book.Keywords: Ipswich touch test; Diabetic neuropathy; Skills; CadrePendahuluan: Komplikasi diabetes dapat menyerang seluruh organ tubuh khususnya ujung kaki berupa diabetic foot. Tetapi hal tersebut tidak akan muncul apabila perawatan diabetes dilaksanakan dengan baik, dan teratur. Sehingga  terjadinya kerusakan saraf yang dapat segera terdeteksi seperi Neuropati yaitu penurunan sensitivitas rasa kaki. Neuropati dapat dideteksi dengan menggunakan monofilament test. Akan tetapi  alat ini belum tentu tersedia  di unit pelayanan kesehatan. Saat ini telah dibuat sebuah cara mendeteksi neuropati pada pasien diabetes yang sederhana tanpa alat  dinamakan Ipswich Touch Test (IpTT). Teknik ini bahkan dapat dilakukan oleh non profesional antara lain kader kesehatan namun perlu instruksi tertulis seperti buku panduan.Tujuan: Mengetahui perbedaan peningkatan keterampilan kader kesehatan dalam mendeteksi neuropati diabetik menggunakan buku panduan Ipswich Touch Test di Kecamatan  Ngemplak Kabupaten BoyolaliMetode : Desain kuasi eksperimen pretest-posttest with control group sebagai  populasi  adalah kader kesehatan di Kecamatan Ngemplak Kabupaten Boyolali. Pengambilan sampel dilakukan cluster sampling sebanyak 2 kelompok kader yaitu kader di desa Giri Roto dan  Dibal masing masing sebanyak 60 orang. Evaluasinya dengan melihat keterampilan kader sebelum dan sesudah menggunakan buku panduan uji sentuh ipswichHasil: Berdasarkan analisis data menggunakan uji Chi-Squared diperoleh hasil p-value 0.000 (< 0,005). Hal ini  berarti Hipotesis penelitian diterima yang menyatakan bahwa terdapat perbedaan  keterampilan kader dalam mendeteksi neuropati menggunakan buku panduan antara kader desa Dibal dan kader desa Giri Roto.Simpulan: Terdapat peningkatan keterampilan setelah menggunakan buku panduan IpTT pada kader desa Dibal dan desa Giri Roto.

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