Evaluation of Real-World Smart Sock-Based Temperature Monitoring Data as a Physiological Indicator of Early Diabetic Foot Injury: Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Alexander M Reyzelman ◽  
Chia-Ding Shih ◽  
Gregory Tovmassian ◽  
Mohan Nathan ◽  
Ran Ma ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Monitoring Program ◽  
Temperature Monitoring ◽  
Lower Extremity Injury ◽  
Study Cohort ◽  
Temperature Differential ◽  
Comparator Group ◽  
Foot Injury ◽  
Useful Signal ◽  
Significant Difference

BACKGROUND Diabetic foot ulcers represent major health care complications both in terms of cost and impact to quality of life for patients with diabetic peripheral neuropathy. Temperature monitoring has been shown in previous studies to provide a useful signal of inflammation that may indicate the early presence of a foot injury. OBJECTIVE In this study we evaluated the temperature data for patients that presented with a diabetic foot injury while utilizing a sock-based remote temperature monitoring device. METHODS The study abstracted data from patients enrolled in a remote temperature monitoring program in year 2020-2021 using a smart sock (Siren Care, San Francisco, California, USA). In the study cohort, a total of 5 participants with a diabetes-related lower extremity injury during study period were identified. In the second comparison cohort, a total of 26 patients met the criteria for monitoring by the same methods that did not present with a diabetes-related podiatric injury during the same period. The 15-day temperature differential between six defined locations on each foot was the primary outcome measure among subjects who presented a diagnosed foot injury. Paired t-tests were used to compare the differences between the two groups. RESULTS A significant difference in temperature differential was observed in the group that presented with a podiatric injury over the course of evaluation vs. the comparator group that did not present with a podiatric injury with temperature measured in °F. The average difference from all six measured points was 1.4°F between the injury group (mean 3.6 +/- 3.0) and the comparator group (mean 2.2 +/- 2.5, t=-71.4; P<.000). CONCLUSIONS The presented study demonstrated significant temperature difference for patients presenting with a foot injury in a 15-day period prior to the diagnosis of an injury compared with a similar period for patients without an injury. The findings suggest temperature monitoring may be a predictor of a developing foot injury. The continuous temperature monitoring system employed has implications for further algorithm development to enable early detection. The study was limited by a nonrandomized, observational design with limited injuries present in the study period.

scholarly journals Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia

2020 ◽  
Author(s):  
Vilas Navapurkar ◽  
Josefin Bartholdson Scott ◽  
Mailis Maes ◽  
Ellen Higginson ◽  
Sally Forrest ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Severe Pneumonia ◽  
High Sensitivity ◽  
Study Cohort ◽  
Microbial Culture ◽  
Respiratory Pathogens ◽  
Metagenomic Sequencing ◽  
Conventional Culture ◽  
Comparator Group ◽  
Significant Difference

AbstractRationaleThe diagnosis of infectious diseases has been hampered by reliance on microbial culture. Cultures take several days to return a result and organisms frequently fail to grow. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and compromises effective stewardship.ObjectivesTo establish the performance and clinical utility of a syndromic diagnostic for severe pneumonia.MethodsSingle ICU observational cohort study with contemporaneous comparator group. We developed and implemented a TaqMan array card (TAC) covering 52 respiratory pathogens in ventilated patients with suspected pneumonia. The time to result was compared against conventional culture, and sensitivity compared to conventional microbiology and metagenomic sequencing. We observed the clinician decisions in response to array results, comparing antibiotic free days (AFD) between the study cohort and comparator group.Results95 patients were enrolled with 71 forming the comparator group. TAC returned results 61 hours (IQR 42-90) faster than culture. The test had an overall sensitivity of 93% (95% CI 88-97%) compared to a combined standard of conventional culture and metagenomic sequencing, with 100% sensitivity for most individual organisms. In 54% of cases the TAC results altered clinical management, with 62% of changes leading to deescalation, 30% to an increase in spectrum, and investigations for alternative diagnoses in 9%. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02).ConclusionsImplementation of a customised syndromic diagnostic for pneumonia led to faster results, with high sensitivity and measurable impact on clinical decision making.

scholarly journals Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia

2021 ◽  
Vol 6 ◽  
pp. 256
Author(s):  
Vilas Navapurkar ◽  
Josefin Bartholdson Scott ◽  
Mailis Maes ◽  
Thomas P Hellyer ◽  
Ellen Higginson ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
High Sensitivity ◽  
Diagnostic Approach ◽  
Molecular Diagnostic ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Respiratory Pathogens ◽  
Metagenomic Sequencing ◽  
Comparator Group ◽  
Significant Difference

Background: The diagnosis of pneumonia has been hampered by a reliance on bacterial cultures which take several days to return a result, and are frequently negative. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and compromises good antimicrobial stewardship. The objective of this study was to establish the performance of a syndromic molecular diagnostic approach, using a custom TaqMan array card (TAC) covering 52 respiratory pathogens, and assess its impact on antimicrobial prescribing. Methods: The TAC was validated against a retrospective multi-centre cohort of broncho-alveolar lavage samples. The TAC was assessed prospectively in patients undergoing investigation for suspected pneumonia, with a comparator cohort formed of patients investigated when the TAC laboratory team were unavailable. Co-primary outcomes were sensitivity compared to conventional microbiology and, for the prospective study, time to result. Metagenomic sequencing was performed to validate findings in prospective samples. Antibiotic free days (AFD) were compared between the study cohort and comparator group. Results: 128 stored samples were tested, with sensitivity of 97% (95% confidence interval (CI) 88-100%). Prospectively, 95 patients were tested by TAC, with 71 forming the comparator group. TAC returned results 51 hours (interquartile range 41-69 hours) faster than culture and with sensitivity of 92% (95% CI 83-98%) compared to conventional microbiology. 94% of organisms identified by sequencing were detected by TAC. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02). TAC group were more likely to experience antimicrobial de-escalation (odds ratio 2.9 (95%1.5-5.5)). Conclusions: Implementation of a syndromic molecular diagnostic approach to pneumonia led to faster results, with high sensitivity and impact on antibiotic prescribing.

Efficacy of Aloe vera/ Plantago Major Gel in Diabetic Foot Ulcer: A Randomized Double-Blind Clinical Trial

2019 ◽  
Vol 16 (2) ◽  
pp. 223-231 ◽  
Author(s):  
Younes Najafian ◽  
Zahra M. Khorasani ◽  
Mona N. Najafi ◽  
Shokouh S. Hamedi ◽  
Marjan Mahjour ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Diabetic Foot ◽  
Intervention Group ◽  
Aloe Vera ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Control Group ◽  
Plantago Major ◽  
Double Blind ◽  
Significant Difference

Background:Diabetic foot ulcer (DFU) is one of the most common complications of diabetic patients. Mostly, non-healing DFU leads to infection, gangrene, amputation and even death. High costs and poor healing of the wounds need a new treatment such as alternative medicine. So, the aim of this study was to evaluate the efficacy of Aloe vera/ Plantago major gel (Plantavera gel) in healing of DFUMethods:Forty patients with DFU enrolled in a double-blind randomized clinical trial. The patients who were randomly assigned into the intervention group (n = 20), received topical Plantavera gel in addition to the routine cares, whereas the patients in the control group (n = 20), received topical Placebo gel in addition to the routine cares. Intervention was done twice a day for 4 weeks in the both groups. Photography and an evaluation of DFU healing were conducted by a checklist and then were scored at baseline and at the end of each week. The collected data was analyzed by SPSS software.Results:At the end of the study, there was a significant difference between the two groups in terms of total ulcer score (P<0.001) and Plantavera gel significantly reduced the ulcer surface comparing with the control group (P=0.039). However, there was not a significant difference between the two groups (P=0.263) in terms of the ulcer depth. During this study, no side effect was observed for Plantavera gel in the intervention group.Conclusion:Topical Plantavera gel seems to be an effective, cheap and safe treatment. Of course, further studies are required to confirm the properties of the wound healing of this gel.

scholarly journals Complete remission of metastatic osteosarcoma using combined modality therapy: a retrospective analysis of unselected patients in China

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lu Xie ◽  
Jie Xu ◽  
Xiaowei Li ◽  
Zuli Zhou ◽  
Hongqing Zhuang ◽  
...  
Keyword(s):  
Pulmonary Metastases ◽  
Local Therapy ◽  
Hypofractionated Radiotherapy ◽  
Study Cohort ◽  
Sufficient Information ◽  
Progression Rate ◽  
Entire Study ◽  
Pulmonary Lesions ◽  
Metastatic Osteosarcoma ◽  
Significant Difference

Abstract Background Complete surgical remission (CSR) is the best predictor of overall survival (OS) for patients with metastatic osteosarcoma. However, metastasectomy has not been widely implemented in China in the last decade due to various factors, and instead, most physicians choose hypofractionated radiotherapy to treat pulmonary lesions. This study aimed to retrospectively evaluate the outcomes of different local treatments for pulmonary lesions and identify the best local therapy strategies for these patients. Methods We reviewed the clinical courses of osteosarcoma patients with pulmonary metastases who were initially treated in two sarcoma centres in Beijing, China, from June 1st, 2009, to March 26th, 2020. With a median follow-up of 32.4 (95% confidence interval (CI): 30.8, 36.1) months, a total of 127 patients with 605 pulmonary nodules, all of whom had received local therapy and firstly achieved CSR or complete radiated/metabolic remission (CRR), were included in the analysis. A total of 102 patients with 525 nodules were initially diagnosed with resectable lung metastases, while 25 patients had 80 indeterminate nodules at presentation and relapsed with pulmonary metastases within 6 months after the completion of adjuvant chemotherapy. Results Eighty-eight of 127 (69.3%) patients had fewer than 5 nodules at the time of local therapy, with 48 of 127 (37.8%) located in the unilateral pleura. No patient underwent thoracotomy, and 42 of 127 patients (85 nodules) received video-assisted thoracoscopic surgery (VATS). In addition, 79 of 127 patients (520 nodules) received hypofractionated stereotactic body radiotherapy (RT), such as Gamma Knife radiosurgery or CyberKnife radiosurgery. The twelve-month event-free survival (EFS) (from local therapy to progression) rate of this entire study cohort was 35.6% (95% CI: 26.8, 44.4%), without a significant difference between the two groups (44.7% for VATS vs. 28.4% for RT, P = 0.755). Radiation-induced pneumonitis was observed in 62 of 86 (72.1%) patients, with one patient (1/86, 1.2%) in grade 4. Conclusions Our past data showed a similar prognosis with the use of hypofractionated radiotherapy and VATS for the treatment of pulmonary metastasis and no inferiority to thoracotomy regarding historical outcomes. Currently, high-resolution chest computed tomography (CT) provides sufficient information on nodules, and less invasive modalities can thus be considered for treatment.

scholarly journals Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

2019 ◽  
Author(s):  
Yuhan Wang ◽  
Guangliang Shan ◽  
Linyang Gan ◽  
Yonggang Qian ◽  
Ting Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Rural Areas ◽  
Inner Mongolia ◽  
Univariate Analysis ◽  
Education Level ◽  
Study Cohort ◽  
Sectional Study ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

Spatial Resolution and Frequency Characteristics for Dose Modulation on the TrueBeam Medical Accelerator

2021 ◽  
Vol 91 (3) ◽  
pp. 17-26
Author(s):  
V. N. Vasiliev ◽  
A. Yu. Smyslov
Keyword(s):  
Power Spectrum ◽  
Frequency Domain ◽  
Spatial Resolution ◽  
Dose Response ◽  
Peak Width ◽  
Multi Leaf Collimator ◽  
Useful Signal ◽  
Significant Difference ◽  
Dose Modulation ◽  
Statistical Noise

Purpose: To study the spatial resolution achievable by dose modulation in a water phantom using a multi-leaf collimator, jaws and their combination. To estimate the power spectrum density of the useful signal (dose distribution) and statistical noise, evaluate the frequency interval containing the useful signal. Material and methods: Using the Gafchromic EBT2 radiochromic film, nested squares dose patterns formed in a water-equivalent phantom by 6 and 15 MV photon beams of the TrueBeam medical accelerator, jaws, a multi-leaf collimator, and a combination of these devices were measured. Dose response to step function (ESF) data was extracted from the penumbra and the linear photon source dose response function (LSF) was calculated. To move to frequency domain, fast Fourier transform was performed over the obtained datasets, as well as over individual LSF peaks, and then power spectra densities were calculated. The Nyquist frequency associated with data sampling was 1.42 mm-1, the Hann window was used to minimize leakage effect. Results: The shape of the obtained LSF peaks was approximated by a sum of two Gaussian distributions with the same center positions but different widths. The LSF peak width at half maximum (FWHM) was 1.7-3.9 mm depending on the modulation device. No significant difference was observed in the peak widths at energies of 6 and 15 MV. In most cases, the width of the peak along the X-axis was wider than along the Y-axis. The power spectrum of the useful signal had a maximum near zero frequency, a 50 % level was near 0.09 mm-1 and its high frequency limit was about 0.4 mm-1. Above this value, only the spectrum of statistical noise was recorded, uniformly distributed over frequency. Conclusion: The obtained values of the LSF peak width in the range 1.7-3.9 mm characterize the ability of dose modulation by the considered devices or their combination, which can be significant for treatment of small targets (less than 3-4 cm), where these limits of spatial resolution can be reached. The obtained relationships in frequency domain can be used for optimal removal of statistical noise using Wiener filters from profiles or two-dimensional dose distributions.

Association of traditional complementary and alternate medicine usage with quality of life of diabetic patients in a Malaysian tertiary hospital

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Chinedum Ogbonnaya Eleazu ◽  
Aniza Abd Aziz ◽  
Tay Chuu Suen ◽  
Lam Chun-Hau ◽  
Chin Elynn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Heart Diseases ◽  
Tertiary Hospital ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Content Type ◽  
Significant Difference

Purpose This study aims to design to assess the traditional, complementary and alternate medicine (TCAM) usage and its association with the quality of life (QOL) of Type 2 diabetic patients in a tertiary hospital (Hospital Universiti Sains Malaysia) in Malaysia. Design/methodology/approach A total of 300 respondents included in this study were divided into the following two major categories: TCAM (34.33% of respondents) and non-TCAM users (65.67% of the respondents), respectively. The mean ages of the respondents were 59.3 ± 10.2 for the TCAM users and 57.7 ± 12.0 for the non-TCAM users. Findings A greater percentage of non-TCAM users reported poor control of diabetes (14.7%) and blood glucose (55.8%) compared with the TCAM users (9.7% and 48.5%, respectively). Further, the diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Additionally, the diabetic patients with TCAM usage had a significantly better physical (p = 0.02) and overall (p = 0.03) qualities of life compared to the non-TCAM users. However, psychological, social and environmental health did not show any significant difference. Originality/value The prevalence of TCAM usage among diabetic patients was lower than in other comparable studies. Diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Further, diabetes patients on TCAM reported better QOL compared to non-TCAM users especially in terms of physical health.

Kras mutation as a risk factor for venous thromboembolism in patients with metastatic pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16267-e16267
Author(s):  
Elena Serrano ◽  
Elizabeth Inga Saavedra ◽  
Maria Padilla Vico ◽  
Eduardo Perdomo ◽  
Maria Teresa Cano Osuna ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Venous Thromboembolism ◽  
Protective Factor ◽  
Performance Status ◽  
Locally Advanced ◽  
Venous Catheter ◽  
Serum Levels ◽  
Metastatic Pancreatic Cancer ◽  
Study Cohort ◽  
Significant Difference

e16267 Background: Venous thromboembolism (VTE) is a common complication in oncology patients. It has been reported that VTE increases morbidity and mortality in these patients. It’s prevalence in metastatic pancreatic cancer (mPC) ranges around 4-7.5% Preclinic studies suggest that the mutation of the KRAS oncogene (KRASm) is associated with a higher risk of VTE among patients with colorectal cancer. KRASm appears to increase the expression of tissue factor, a physiological trigger of coagulation that is found on the surface of tumor cells. This association has not been studied in mPC, where this mutation can be found in 90% of the cases. Our aim is to determine the prevalence and risk factors associated with VTE taking into consideration the status of KRAS. Methods: We conducted a retrospective study within a cohort of patients with mPC that had a determination of the KRAS status. These patients were treated at Medical Oncology between January 2017 and December 2020. We performed a descriptive and survival analysis of our sample. We also studied the prevalence of VTE among the. Results: Our study cohort was 88 patients (pts), 63 (61, 2%) men and 40 (38, 8%) women. The median age was 63 years (32-84). 19 pts (18, 4%) were KRAS wild type (KRASwt), 69 pts (67%) KRASm. There was no statistically significant difference in gender, age, performance status, comorbidities, primary tumor/metastases location, disease control rate and toxicity between KRASwt and KRASm. Median serum levels of Ca 19.9 were higher in KRASm (39.847 U/ml vs 2026 U/ml). At the time of diagnosis, 78 pts (88, 6%) were metastatic and 10 pts (11, 4%) were localized/locally-advanced. Most of metastatic pts (62/78) were KRASm (p = 0, 015). Most common histology (86, 4%) was adenocarcinoma. This histology was more frequent in KRASm, 61, 8% (p = 0, 02). At time of analysis, 72 pts (69, 9%) were dead, most of them (54, 4%) were KRASm (p = 0, 001). 31 pts developed VTE: 4 were KRASwt and 27 KRASm. The prevalence of VTE was 36, 3%. It was greater in KRASm (39, 1%) than in KRASwt (26, 3%). There were 7 cases of rethrombosis instead of anticoagulant treatment (1 KRASwt and 6 KRASm). KRASwt seems to be a protective factor in the development of VTE (OR 0, 55; CI 95% 0, 18-1, 71). The most common entity were VTE of splenoportomensenteric axis (16 pts), followed by pulmonary embolism, EP, (7 pts), deep venous thrombosis, DVT, (4 pts) EP + DVP (3 pts), thrombosis associated with central venous catheter (3 pts) and other locations (2 pts). There were no differences in VTE location between KRASwt and KRASm. The median overall survival (OS) was 12, 82 months (CI 95%: 7, 87-17, 78). It was higher in KRASwt (26 months; CI 95%: 12, 21-40, 48) than in KRASm (9, 8 months; CI 95%: 6, 07-13, 65). This difference was statistically significant (p = 0, 001). Conclusions: In our cohort, the prevalence of VTE is higher than de prevalence described in the literature and was greater in KRASm population. OS was significantly larger in KRASwt.

Estimating Trend in Occupancy for the Southern Sierra Fisher Martes pennanti Population

2013 ◽  
Vol 4 (1) ◽  
pp. 3-19 ◽  
Author(s):  
William J. Zielinski ◽  
James A. Baldwin ◽  
Richard L. Truex ◽  
Jody M. Tucker ◽  
Patricia A. Flebbe
Keyword(s):  
Sierra Nevada ◽  
Habitat Degradation ◽  
Monitoring Program ◽  
National Forest Inventory ◽  
Small Population ◽  
Probability Of Detection ◽  
Martes Pennanti ◽  
Entire Study ◽  
Significant Difference ◽  
The One

Abstract Carnivores are important elements of biodiversity, not only because of their role in transferring energy and nutrients, but also because they influence the structure of the communities where they occur. The fisher Martes pennanti is a mammalian carnivore that is associated with late-successional mixed forests in the Sierra Nevada in California, and is vulnerable to the effects of forest management. As a candidate for endangered species status, it is important to monitor its population to determine whether actions to conserve it are successful. We implemented a monitoring program to estimate change in occupancy of fishers across a 12,240-km2 area in the southern Sierra Nevada. Sample units were about 4 km apart, consisting of six enclosed, baited track-plate stations, and aligned with the national Forest Inventory and Analysis grid. We report here the results of 8 y (2002–2009) of sampling of a core set of 223 sample units. We model the combined effects of probability of detection and occupancy to estimate occupancy, persistence rates, and trend in occupancy. In combined models, we evaluated four forms of detection probability (1-group and 2-group both constant and varying by year) and nine forms of probability of occupancy (differing primarily by how occupancy and persistence vary among years). The best-fitting model assumed constant probability of occupancy, constant persistence, and two detection groups (AIC weight  =  0.707). This fit the data best for the entire study area as well as two of the three distinct geographic zones therein. The one zone with a trend parameter found no significant difference from zero for that parameter. This suggests that, over the 8-y period, that there was no trend or statistically significant variations in occupancy. The overall probability of occupancy, adjusted to account for uncertain detection, was 0.367 (SE  =  0.033) and estimates were lowest in the southeastern zone (0.261) and highest in the southwestern zone (0.583). Constant and positive persistence values suggested that sample units rarely changed status from occupied to unoccupied or vice versa. The small population of fishers in the southern Sierra (probably &lt;250 individuals) does not appear to be decreasing. However, given the habitat degradation that has occurred in forests of the region, we favor continued monitoring to determine whether fisher occupancy increases as land managers implement measures to restore conditions favorable to fishers.

Sign in / Sign up

Export Citation Format

Share Document