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Yoon M, Lee S, Choi JY, Jung MH, Youn JC, Shim CY, Choi JO, Kim EJ, Kim H, Yoo BS, Son YJ, Choi DJ. Effectiveness of a Smartphone App-Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial. J Med Internet Res 2024; 26:e52075. [PMID: 38683665 DOI: 10.2196/52075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. OBJECTIVE We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app-based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. METHODS In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. RESULTS At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean -1.3, SD 2.1 vs mean -0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. CONCLUSIONS The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app-based self-care strategies and feedback for patients with HF. TRIAL REGISTRATION ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Oh Choi
- Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Woonju, Republic of Korea
| | - Yeon Joo Son
- Healthcare Business Department, AI/DX Convergence Business Group, KT, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
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Abstract
This study uses data from the publicly available Medaval database to determine the number of upper arm cuff and wrist cuff blood pressure measuring devices sold globally as well as the percentages of those devices that have been clinically validated for accuracy.
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Affiliation(s)
- Dean S. Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Aletta E. Schutte
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Pedro Ordunez
- Department of Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Affiliation(s)
- David A Simon
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
| | - Carmel Shachar
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
| | - I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
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Aram SA, Saalidong BM, Appiah A, Utip IB. Occupational health and safety in mining: Predictive probabilities of Personal Protective Equipment (PPE) use among artisanal goldminers in Ghana. PLoS One 2021; 16:e0257772. [PMID: 34591870 PMCID: PMC8483302 DOI: 10.1371/journal.pone.0257772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
Artisanal goldminers in Ghana are exposed to various levels and forms of health, safety and environmental threats. Without the required legislation and regulations, artisanal miners are responsible for their own health and safety at work. Consequently, understanding the probabilities of self-protection at work by artisanal goldminers is crucial. A cross-sectional survey of 500 artisanal goldminers was conducted to examine the probabilities of personal protective equipment use among artisanal goldminers in Ghana. The data was subjected to both descriptive and inferential statistics. Initial findings showed that personal protective equipment use among artisanal miners was 77.4%. Overall, higher probabilities of personal protective equipment use was observed among artisanal goldminers who work in good health and safety conditions as compared to artisanal miners who work in poor health and safety conditions. Also, personal protective equipment use was more probable among the highly educated artisanal goldminers, miners who regularly go for medical screening and the most experienced miners. Additionally, personal protective equipment use was more probable among artisanal miners who work in non-production departments and miners who work in the medium scale subsector. Inversely, personal protective equipment use was less probable among female artisanal miners and miners who earn more monthly income ($174 and above). To increase self-care and safety consciousness in artisanal mining, there is the need for a national occupational health and safety legislation in Ghana. Also, interventions and health promotion campaigns for better occupational conditions in artisanal mining should target and revise the health and safety related workplace programs and conditions.
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Affiliation(s)
- Simon Appah Aram
- Research Center for Smart Mine and Intelligent Equipment, Taiyuan University of Technology, Taiyuan, People’s Republic of China
- College of Safety and Emergency Management Engineering, Taiyuan University of Technology, Taiyuan, People’s Republic of China
- * E-mail:
| | - Benjamin M. Saalidong
- Department of Geosciences, Taiyuan University of Technology, Taiyuan, People’s Republic of China
| | - Augustine Appiah
- College of Safety and Emergency Management Engineering, Taiyuan University of Technology, Taiyuan, People’s Republic of China
| | - Idongesit Bassey Utip
- College of Safety and Emergency Management Engineering, Taiyuan University of Technology, Taiyuan, People’s Republic of China
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Ansari S, Abdel-Malek M, Kenkre J, Choudhury SM, Barnes S, Misra S, Tan T, Cegla J. The use of whole blood capillary samples to measure 15 analytes for a home-collect biochemistry service during the SARS-CoV-2 pandemic: A proposed model from North West London Pathology. Ann Clin Biochem 2021; 58:411-421. [PMID: 33715443 PMCID: PMC8458673 DOI: 10.1177/00045632211004995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has drastically changed the delivery of secondary care services. Self-collection of capillary blood at home can facilitate the monitoring of patients with chronic disease to support virtual clinics while mitigating the risk of SARS-CoV-2 infection and transmission. OBJECTIVE To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely used biochemical analytes and to develop and pilot a user-friendly home-collection kit to support virtual outpatient clinical services. METHODS To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely requested biochemical analytes, simultaneous samples of venous and capillary blood were collected in EDTA and lithium-heparin plasma separation tubes that were of 4-6 mL and 400-600 µL draw volume, respectively. Venous samples were analysed within 4 h of collection while capillary samples were kept at ambient temperature for three days until centrifugation and analysis. Analyte results that were comparable between the matrices were then piloted in a feasibility study in three outpatient clinical services. RESULTS HbA1c, lipid profile and liver function tests were considered comparable and piloted in the patient feasibility study. The home-collect kit demonstrated good patient usability. CONCLUSION Home collection of capillary blood could be a clinically-useful tool to deliver virtual care to patients with chronic disease.
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Affiliation(s)
- Saleem Ansari
- Blood Sciences, North West London Pathology, London, UK
| | | | - Julia Kenkre
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Sirazum M Choudhury
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Sophie Barnes
- Blood Sciences, North West London Pathology, London, UK
| | - Shivani Misra
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Tricia Tan
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Jaimini Cegla
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Shah LM, Ding J, Spaulding EM, Yang WE, Lee MA, Demo R, Marvel FA, Martin SS. Sociodemographic Characteristics Predicting Digital Health Intervention Use After Acute Myocardial Infarction. J Cardiovasc Transl Res 2021; 14:951-961. [PMID: 33999374 PMCID: PMC8127845 DOI: 10.1007/s12265-021-10098-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggests that digital health interventions (DHIs) are an effective tool to reduce hospital readmissions by improving adherence to guideline-directed therapy. We investigated whether sociodemographic characteristics influence use of a DHI targeting 30-day readmission reduction after acute myocardial infarction (AMI). Covariates included age, sex, race, native versus loaner iPhone, access to a Bluetooth-enabled blood pressure monitor, and disease severity as marked by treatment with CABG. Age, sex, and race were not significantly associated with DHI use before or after covariate adjustment (fully adjusted OR 0.98 (95%CI: 0.95-1.01), 0.6 (95%CI: 0.29-1.25), and 1.22 (95% CI: 0.60-2.48), respectively). Being married was associated with high DHI use (OR 2.12; 95% CI 1.02-4.39). Our findings suggest that DHIs may have a role in achieving equity in cardiovascular health given similar use by age, sex, and race. The presence of a spouse, perhaps a proxy for enhanced caregiver support, may encourage DHI use.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jie Ding
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthias A Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A Marvel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA.
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
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Fenrich KK, Hallworth BW, Vavrek R, Raposo PJF, Misiaszek JE, Bennett DJ, Fouad K, Torres-Espin A. Self-directed rehabilitation training intensity thresholds for efficient recovery of skilled forelimb function in rats with cervical spinal cord injury. Exp Neurol 2020; 339:113543. [PMID: 33290776 DOI: 10.1016/j.expneurol.2020.113543] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023]
Abstract
Task specific rehabilitation training is commonly used to treat motor dysfunction after neurological injures such as spinal cord injury (SCI), yet the use of task specific training in preclinical animal studies of SCI is not common. This is due in part to the difficulty in training animals to perform specific motor tasks, but also due to the lack of knowledge about optimal rehabilitation training parameters to maximize recovery. The single pellet reaching, grasping and retrieval (SPRGR) task (a.k.a. single pellet reaching task or Whishaw task) is a skilled forelimb motor task used to provide rehabilitation training and test motor recovery in rodents with cervical SCI. However, the relationships between the amount, duration, intensity, and timing of training remain poorly understood. In this study, using automated robots that allow rats with cervical SCI ad libitum access to self-directed SPRGR rehabilitation training, we show clear relationships between the total amount of rehabilitation training, the intensity of training (i.e., number of attempts/h), and performance in the task. Specifically, we found that rats naturally segregate into High and Low performance groups based on training strategy and performance in the task. Analysis of the different training strategies showed that more training (i.e., increased number of attempts in the SPRGR task throughout rehabilitation training) at higher intensities (i.e., number of attempts per hour) increased performance in the task, and that improved performance in the SPRGR task was linked to differences in corticospinal tract axon collateral densities in the injured spinal cords. Importantly, however, our data also indicate that rehabilitation training becomes progressively less efficient (i.e., less recovery for each attempt) as both the amount and intensity of rehabilitation training increases. Finally, we found that Low performing animals could increase their training intensity and transition to High performing animals in chronic SCI. These results highlight the rehabilitation training strategies that are most effective to regain skilled forelimb motor function after SCI, which will facilitate pre-clinical rehabilitation studies using animal models and could be beneficial in the development of more efficient clinical rehabilitation training strategies.
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Affiliation(s)
- Keith K Fenrich
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Ben W Hallworth
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Romana Vavrek
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Pamela J F Raposo
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - David J Bennett
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Karim Fouad
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Abel Torres-Espin
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Brain and Spinal Injury Center (BASIC), Department of Neurosurgery, University of California San Francisco, San Francisco 94110, USA.
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Alexiades M. At-Home Transvaginal Device Following Fractional Carbon Dioxide Laser Treatment for Genitourinary Syndrome of Menopause. J Drugs Dermatol 2020; 19:1076-1079. [PMID: 33196757 DOI: 10.36849/jdd.2020.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Device-based therapeutic approaches have been developed to treat women’s genitourinary post-menopausal symptoms. Fractional carbon dioxide laser resurfacing (FxCO2) has been demonstrated to be safe and effective in the treatment of GSM symptoms, however the results begin to wane by 12-months post-treatment. OBJECTIVE This study aims at assessing the application of an at-home transvaginal red and infrared light device as a maintenance treatment commencing 12 months following FxCO2 laser treatment for genitourinary syndrome of menopause (GSM). STUDY DESIGN Subjects completing 12-month follow-up after three fractional CO2 laser vulvovaginal treatments received an at-home device and monitored for GSM symptoms with long-term follow-up to 12 months (2 years post-laser). METHODS 10 post-menopausal subjects completing 12-months follow-up after three FxCO2 vulvovaginal treatments for GSM were treated with an at-home red and infrared LED device. Treatment consisted of intravaginal application three times per week, and subjects were followed to 1, 3, 6, and 12 months. Subjects completed the vaginal assessment scale subject satisfaction, and QUID to assess for vulvovaginal and stress urinary incontinence (SUI) symptoms. RESULTS Vulvovaginal symptoms measured by VAS were mean 89% improved at 12-month follow-up after FxCO2 and maintained at 73% improved over baseline (2 years post-laser) following an additional 12 months of at-home transvaginal light therapy (P<0.05). VAS symptoms gradually increased over the 12 months maintenance period by a mean of 17% (P<0.05). Mean subject satisfaction was 0 at baseline, 1.86 at 1 year following FxCO2, and 1.00 after an additional 1 year of at-home light therapy. SUI symptoms as measured by QUID were mean 81% improved at 12-month follow-up after FxCO2and maintained at 38% improved over baseline (2 years post-laser) following an additional 12-months of at-home light therapy (P<0.05). SUI symptoms gradually increased by a mean of 43% over the 12-month maintenance period (P<0.05). CONCLUSIONS At-home transvaginal red and near infrared light therapy commencing at 12 months post-FxCO2 vulvovaginal treatment in a post-menopausal population maintained statistically significant improvements in vulvovaginal and SUI symptoms over the additional12-month period (2 years post-laser); however, a gradual return of symptoms suggests that laser re-treatment or combination withhormone therapy may be necessary to maintain optimal outcomes.J Drugs Dermatol. 2020;19(11):1076-1079. doi:10.36849/JDD.2020.1012.
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Cotovad-Bellas L, Tejera-Pérez C, Prieto-Tenreiro A, Sánchez-Bao A, Bellido-Guerrero D. The challenge of diabetes home control in COVID-19 times: Proof is in the pudding. Diabetes Res Clin Pract 2020; 168:108379. [PMID: 32853692 PMCID: PMC7445133 DOI: 10.1016/j.diabres.2020.108379] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
SARS-CoV-2 pandemic had changed self-care in diabetes. The aim of this work is to analyze the effect of lockdown on glycemic control in people with type 1 diabetes on multiple daily insulin injections using FGM. During lockdown no deleterious effect on glycemic control measured by FGM.
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Affiliation(s)
- Laura Cotovad-Bellas
- Endocrinology and Nutrition Unit, University Hospital of Ferrol, Spain, Avda de la Residencia S/N, Ferrol, 15401 La Coruña, Spain
| | - Cristina Tejera-Pérez
- Endocrinology and Nutrition Unit, University Hospital of Ferrol, Spain, Avda de la Residencia S/N, Ferrol, 15401 La Coruña, Spain.
| | - Alma Prieto-Tenreiro
- Endocrinology and Nutrition Unit, University Hospital of Ferrol, Spain, Avda de la Residencia S/N, Ferrol, 15401 La Coruña, Spain
| | - Ana Sánchez-Bao
- Endocrinology and Nutrition Unit, University Hospital of Ferrol, Spain, Avda de la Residencia S/N, Ferrol, 15401 La Coruña, Spain
| | - Diego Bellido-Guerrero
- Endocrinology and Nutrition Unit, University Hospital of Ferrol, Spain, Avda de la Residencia S/N, Ferrol, 15401 La Coruña, Spain
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Bramante CT, Lee G, Amsili SS, Linde JA, Phelan SM, Appel LJ, Bennett WL, Clark JM, Gudzune KA. Minority and low-income patients are less likely to have a scale for self-weighing in their home: A survey in primary care. Clin Obes 2020; 10:e12363. [PMID: 32383356 PMCID: PMC7382396 DOI: 10.1111/cob.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/28/2020] [Accepted: 03/13/2020] [Indexed: 01/07/2023]
Abstract
Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m2 . Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance.
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Affiliation(s)
- Carolyn T Bramante
- University of Minnesota Medical School, Division of General Internal Medicine, Minneapolis, Minnesota, USA
| | - Grace Lee
- Johns Hopkins University, Homewood Campus, Baltimore, Maryland, USA
| | - Safira S Amsili
- Johns Hopkins University, Homewood Campus, Baltimore, Maryland, USA
| | - Jennifer A Linde
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA
| | - Sean M Phelan
- Mayo Clinic, Division of Health Care Policy and Research, Rochester, Minnesota, USA
| | - Lawrence J Appel
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Jeanne M Clark
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
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Nakajima M, Ono S, Michihata N, Kaszynski RH, Matsui H, Yamaguchi Y, Yasunaga H. Epinephrine autoinjector prescription patterns for severe anaphylactic patients in Japan: A retrospective analysis of health insurance claims data. Allergol Int 2020; 69:424-428. [PMID: 32253115 DOI: 10.1016/j.alit.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/06/2020] [Accepted: 02/29/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Current guidelines recommend that any patient who has experienced anaphylaxis should be prescribed one or more epinephrine autoinjectors (EAI) for immediate self-treatment. However, the etiology of anaphylaxis and prescription patterns of EAI have not been widely examined in Japan. METHODS This was a retrospective cohort study using a large Japanese claims database (JMDC, Tokyo, Japan). We included patients with severe anaphylaxis who received epinephrine in a hospital or outpatient clinic from 2011 to 2016. We extracted patients who were prescribed EAIs and examined the annual trend of EAI prescription rates and refill patterns. RESULTS We identified 1255 eligible patients. Among them, 361 patients (28.8%) were prescribed EAIs within 30 days after their initial severe anaphylactic episode. In patients who were prescribed EAIs, 65.9% were prescribed EAIs from the same facility in which initial treatment was given for severe anaphylaxis. The prescription rates of EAI significantly increased from 11.1% in 2011 to 30.9% in 2016. Among patients with initial EAI prescriptions, 97.3% refilled their EAI prescriptions at least once and 40.5% refilled their prescriptions annually during the 3 year follow up period. CONCLUSIONS EAI prescription rates were relatively low in patients who experienced severe anaphylaxis in Japan. Physicians should prescribe EAIs to all patients who were treated for anaphylaxis under their care and avoid delegating the responsibility of prescribing EAIs to other facilities. Initial prescription of EAIs can result in improved regular refill and dissemination practices.
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Affiliation(s)
- Mikio Nakajima
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | - Sachiko Ono
- Department of Biostatistics & Bioinformatics, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Richard H Kaszynski
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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12
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Okoboi S, Lazarus O, Castelnuovo B, Nanfuka M, Kambugu A, Mujugira A, King R. Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study. PLoS One 2020; 15:e0227741. [PMID: 31971991 PMCID: PMC6977761 DOI: 10.1371/journal.pone.0227741] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/28/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. Methods From June to August 2018, we conducted a pilot study of secondary distribution of HIV self-testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. Results A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22–28) compared to 28 years IQR (25–35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy. Conclusion Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.
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Affiliation(s)
- Stephen Okoboi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Clarke International University, Kampala, Uganda
- * E-mail: ,
| | - Oucul Lazarus
- The AIDS Support Organization (TASO), Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Rachel King
- School of Public Health, Makerere University, Kampala, Uganda
- Department of Global Health, University of California San Francisco, San Francisco, California, United States of America
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Pérez-Rodríguez R, Guevara-Guevara T, Moreno-Sánchez PA, Villalba-Mora E, Valdés-Aragonés M, Oviedo-Briones M, Carnicero JA, Rodríguez-Mañas L. Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study. Front Endocrinol (Lausanne) 2020; 11:300. [PMID: 32528409 PMCID: PMC7247856 DOI: 10.3389/fendo.2020.00300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.
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Affiliation(s)
- Rodrigo Pérez-Rodríguez
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Pedro A Moreno-Sánchez
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Elena Villalba-Mora
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Myriam Valdés-Aragonés
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Geriatrics Service, Getafe University Hospital, Getafe, Spain
| | | | - José A Carnicero
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Geriatrics Service, Getafe University Hospital, Getafe, Spain
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14
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Makic MB, Gilbert D, Jankowski C, Reeder B, Al-Salmi N, Starr W, Cook PF. Sensor and Survey Measures Associated With Daily Fatigue in HIV: Findings From a Mixed-Method Study. J Assoc Nurses AIDS Care 2020; 31:12-24. [PMID: 31860594 PMCID: PMC8626233 DOI: 10.1097/jnc.0000000000000152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fatigue is the most common symptom among people living with HIV (PLWH), but may have many causes. This mixed-method study was designed to characterize PLWH's fatigue experiences and associated self-management behaviors, using Two Minds Theory. Fifty-five PLWH completed daily smartphone surveys on psychological states and fatigue at random times for 30 days and used a Fitbit Alta™ wristband. Within-person multilevel models were used to identify univariate correlates of fatigue. The first 25 participants also completed qualitative interviews about their experiences, and results were compared across methods. Participants had significant fatigue despite well-controlled HIV. Fatigue varied between persons and over time. Fatigue was associated with physical activity, sleep, daily psychological states, and barriers to self-care. PLWH reported new insights into fatigue from self-monitoring. There are potential opportunities for PLWH to improve sleep, activity, or stress management to alleviate fatigue. PLWH were interested in reducing fatigue and willing to use self-monitoring technology.
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Affiliation(s)
- Mary Beth Makic
- University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Danielle Gilbert
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Blaine Reeder
- University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
| | - Nasser Al-Salmi
- University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Whitney Starr
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Paul F. Cook
- University of Colorado College of Nursing, Aurora, Colorado, USA
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Stretch R, Ryden A, Fung CH, Martires J, Liu S, Balasubramanian V, Saedi B, Hwang D, Martin JL, Della Penna N, Zeidler MR. Predicting Nondiagnostic Home Sleep Apnea Tests Using Machine Learning. J Clin Sleep Med 2019; 15:1599-1608. [PMID: 31739849 PMCID: PMC6853403 DOI: 10.5664/jcsm.8020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Home sleep apnea testing (HSAT) is an efficient and cost-effective method of diagnosing obstructive sleep apnea (OSA). However, nondiagnostic HSAT necessitates additional tests that erode these benefits, delaying diagnoses and increasing costs. Our objective was to optimize this diagnostic pathway by using predictive modeling to identify patients who should be referred directly to polysomnography (PSG) due to their high probability of nondiagnostic HSAT. METHODS HSAT performed as the initial test for suspected OSA within the Veterans Administration Greater Los Angeles Healthcare System was analyzed retrospectively. Data were extracted from pre-HSAT questionnaires and the medical record. Tests were diagnostic if there was a respiratory event index (REI) ≥ 5 events/h. Tests with REI < 5 events/h or technical inadequacy-two outcomes requiring additional testing with PSG-were considered nondiagnostic. Standard logistic regression models were compared with models trained using machine learning techniques. RESULTS Models were trained using 80% of available data and validated on the remaining 20%. Performance was evaluated using partial area under the precision-recall curve (pAUPRC). Machine learning techniques consistently yielded higher pAUPRC than standard logistic regression, which had pAUPRC of 0.574. The random forest model outperformed all other models (pAUPRC 0.862). Preferred calibration of this model yielded the following: sensitivity 0.46, specificity 0.95, positive predictive value 0.81, negative predictive value 0.80. CONCLUSIONS Compared with standard logistic regression models, machine learning models improve prediction of patients requiring in-laboratory PSG. These models could be implemented into a clinical decision support tool to help clinicians select the optimal test to diagnose OSA.
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Affiliation(s)
- Robert Stretch
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Armand Ryden
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Constance H. Fung
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joanne Martires
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Stephen Liu
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Babak Saedi
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Dennis Hwang
- Southern California Permanente Medical Group, Los Angeles, California
| | - Jennifer L. Martin
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Nicolás Della Penna
- Laboratory of Computational Physiology at Massachusetts Institute of Technology, Boston, Massachusetts
| | - Michelle R. Zeidler
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
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Garcia-Larrea L, Perchet C, Hagiwara K, André-Obadia N. At-Home Cortical Stimulation for Neuropathic Pain: a Feasibility Study with Initial Clinical Results. Neurotherapeutics 2019; 16:1198-1209. [PMID: 31062295 PMCID: PMC6985395 DOI: 10.1007/s13311-019-00734-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The clinical use of noninvasive cortical stimulation procedures is hampered by the limited duration of the analgesic effects and the need to perform stimulation in hospital settings. Here, we tested the feasibility and pilot efficacy of an internet-based system for at-home, long-duration, medically controlled transcranial motor cortex stimulation (H-tDCS), via a double-blinded, sham-controlled trial in patients with neuropathic pain refractory to standard-of-care drug therapy. Each patient was first trained at hospital, received a stimulation kit, allotted a password-protected Web space, and completed daily tDCS sessions during 5 weeks, via a Bluetooth connection between stimulator and a minilaptop. Each session was validated and internet-controlled by hospital personnel. Daily pain ratings were obtained during 11 consecutive weeks, and afterwards via iterative visits/phone contacts. Twenty full procedures were completed in 12 consecutive patients (500 daily tDCS sessions, including 20% sham). No serious adverse effects were recorded. Superficial burning at electrode position occurred in 2 patients, and nausea/headache in two others, all of whom wished to pursue stimulation. Six out of the 12 patients achieved satisfactory relief on a scale combining pain scores, drug intake, and quality of life. Daily pain reports correlated with such combined assessment, and differentiated responders from nonresponders without overlap. Clinical improvement in responders could last up to 6 months. Five patients asked to repeat the whole procedure when pain resumed again, with comparable results. At-home, long-duration tDCS proved safe and technically feasible, and provided long-lasting relief in 50% of a small sample of patients with drug-resistant neuropathic pain.
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Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard Lyon 1, F-69677, Bron, France.
- Centre D'évaluation et de Traitement de la Douleur (CETD), Hôpital Neurologique, F-69000, Lyon, France.
| | - Caroline Perchet
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard Lyon 1, F-69677, Bron, France
| | - Koichi Hagiwara
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard Lyon 1, F-69677, Bron, France
| | - Nathalie André-Obadia
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard Lyon 1, F-69677, Bron, France
- Service de Neurologie Fonctionnelle et d'Epileptologie, Hôpital Neurologique, Hospices Civils de Lyon, F-69677, Bron, France
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Brewer N, Foliaki S, Bromhead C, Viliamu-Amusia I, Pelefoti-Gibson L, Jones T, Pearce N, Potter JD, Douwes J. Acceptability of human papillomavirus self-sampling for cervical-cancer screening in under-screened Māori and Pasifika women: a pilot study. N Z Med J 2019; 132:21-31. [PMID: 31220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To assess whether self-sampling for cervical-cancer screening is acceptable to New Zealand women. METHODS Māori, Pacific and Asian un- or under-screened women aged 30-69 years were asked to: 1) examine three self-sampling devices; 2) complete a questionnaire on demographics and experiences with the devices; and 3) take a self-sample. Samples were tested 'off-label' using the cobas® 4800 human papillomavirus (HPV) test (Roche Diagnostics NZ). RESULTS Thirty-one Pacific, 12 Māori, nine Asian and four women of other ethnicities participated (mean age, 39.5 years). Before trying any devices, 78% indicated a preference to self-sample, compared to 22% who preferred a physician-collected sample (PCS). After trying a device (HerSwab™, 91%; Delphi Screener™, 14%; cobas Swab, 13%; 12.5% used >1 device), fewer women (66%) preferred to self-sample next time, fewer (16%) preferred a PCS, while 18% expressed no preference. One of 32 samples with valid results (35 were tested) was positive for HPV 'other' oncogenic types. CONCLUSIONS This was the first New Zealand study to invite women, including Māori women, to take a self-sample for cervical-cancer screening. The pilot study suggests that un- and under-screened women generally find self-sampling acceptable and all sample types are suitable for use with the cobas HPV test.
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Affiliation(s)
- Naomi Brewer
- Research Officer, Centre for Public Health Research, Massey University, Wellington
| | - Sunia Foliaki
- Pacific Health Research Fellow, Centre for Public Health Research, Massey University, Wellington
| | - Collette Bromhead
- Senior Lecturer in Molecular Microbiology, School of Health Sciences, Massey University, Wellington
| | | | | | - Tegan Jones
- Registered Nurse, De Lautour Medical, Gisborne (previously at Porirua Union and Community Health Service, Porirua)
| | - Neil Pearce
- Professor of Epidemiology and Biostatistics, Department of Medical Statistics and Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - John D Potter
- Professor, Centre for Public Health Research, Massey University, Wellington
| | - Jeroen Douwes
- Professor and Director, Centre for Public Health Research, Massey University, Wellington
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19
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Abstract
A safe and sustainable waste management system for self care products requires education and multisectoral approaches say Ash Pachauri and colleagues
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Affiliation(s)
- Ash Pachauri
- Center for Human Progress, Ashburn, Virginia 20148, USA
| | - Prerna Shah
- Protect our Planet (POP) Movement, G-1, Jangpura Extension, New Delhi, India
| | - Bethanie C Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Norma P M Sevilla
- Interdisciplinary Center for Research and Studies on Environment and Development, National Polytechnic Institute, Mexico City, Mexico
| | - Manjulaa Narasimhan
- World Health Organization, including UNDP/UNFPA/Unicef/WHO/World Bank Special Programme (HRP), Geneva, Switzerland
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20
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Wang P, Wang Y, Ru F. Develop a home-used EMG sensor system to identify pathological gait with less data via frequency analysis. Rev Sci Instrum 2019; 90:043113. [PMID: 31043035 DOI: 10.1063/1.5052567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
In order to develop a low-cost wearable electromyography (EMG) sensor system that can be used at home, compacting the data size is studied first to extract potential features via frequency analysis. A low-cost wearable home-use EMG sensor is then developed. Results show the frequency band at 40-60 Hz of tibialis anterior offers significant differences to identify walking problems (p-value < 0.05), which can be used as a detection standard with a smaller data size. More significantly, data sizes are dramatically reduced by 95.06% compared to the original data size. This finding suggests a potential examining method for identifying pathological gait with the compacted data in satisfactory processing time that can be used at home.
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Affiliation(s)
- Ping Wang
- Key Laboratory of Road Construction and Equipment of MOE and School of Electronics and Control Engineering, Chang'an University, Xi'an, Shaanxi 710064, China
| | - Yabo Wang
- Key Laboratory of Road Construction and Equipment of MOE and School of Electronics and Control Engineering, Chang'an University, Xi'an, Shaanxi 710064, China
| | - Feng Ru
- Key Laboratory of Road Construction and Equipment of MOE and School of Electronics and Control Engineering, Chang'an University, Xi'an, Shaanxi 710064, China
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Köhnen M, Kriston L, Härter M, Dirmaier J, Liebherz S. Rationale and design of a systematic review: effectiveness and acceptance of technology-based psychological interventions in different clinical phases of depression management. BMJ Open 2019; 9:e028042. [PMID: 30918040 PMCID: PMC6475157 DOI: 10.1136/bmjopen-2018-028042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 01/22/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although many effective treatment options exist, depression is still undertreated indicating gaps in the healthcare system. The complementary provision of mental healthcare through technologies (eg, computer, smartphone) has the potential to fill treatment gaps and to overcome access barriers to mental healthcare. Until now, no systematic review integrates the evidence on different technology-based psychological interventions (TBIs) concerning their effectiveness and acceptance in different clinical phases of depression management (bridging waiting periods, acute treatment and aftercare). The aim of this project is to structure evidence on TBIs regarding different phases of depression management, and to determine effectiveness and acceptance for each clinical phase considering both active (eg, face-to-face treatment) and inactive (eg, waitlist) controls as comparators. METHODS AND ANALYSIS We will include studies on adults with a formal diagnosis of unipolar depression. Treatments delivered by technologies based on scientific psychological theories will be considered as experimental interventions. The primary effectiveness outcome will be depressive symptoms at study endpoint measured by symptom severity rating scales, and the primary acceptance outcome will be dropping out of the study due to any reason. We will consider only randomised controlled trials, which will be identified by key database searches (including Cochrane Central Register of Controlled Trials, Medline, PsycINFO, PSYNDEX, CINAHL) complemented through searches in clinical trial registries (eg, clinicaltrials.gov) and grey literature searches (eg, Open Grey). Two review authors will independently conduct study selection, data extraction and quality assessment of included studies (using the Cochrane Collaboration's tool for assessing risk of bias). Meta-analyses applying random-effect models as well as subgroup, meta-regression and sensitivity analyses will be performed. ETHICS AND DISSEMINATION Ethics approval is not required for this study, as we conduct research on secondary data. We will disseminate results via peer-reviewed journal publications, presentations on conferences and via plain language summaries. PROSPERO REGISTRATION NUMBER CRD42016050413; Pre-results.
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Affiliation(s)
- Moritz Köhnen
- Departement of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Departement of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Departement of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Departement of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Departement of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
By controlling robots comparable to the human body, people with profound motor deficits could potentially perform a variety of physical tasks for themselves, improving their quality of life. The extent to which this is achievable has been unclear due to the lack of suitable interfaces by which to control robotic body surrogates and a dearth of studies involving substantial numbers of people with profound motor deficits. We developed a novel, web-based augmented reality interface that enables people with profound motor deficits to remotely control a PR2 mobile manipulator from Willow Garage, which is a human-scale, wheeled robot with two arms. We then conducted two studies to investigate the use of robotic body surrogates. In the first study, 15 novice users with profound motor deficits from across the United States controlled a PR2 in Atlanta, GA to perform a modified Action Research Arm Test (ARAT) and a simulated self-care task. Participants achieved clinically meaningful improvements on the ARAT and 12 of 15 participants (80%) successfully completed the simulated self-care task. Participants agreed that the robotic system was easy to use, was useful, and would provide a meaningful improvement in their lives. In the second study, one expert user with profound motor deficits had free use of a PR2 in his home for seven days. He performed a variety of self-care and household tasks, and also used the robot in novel ways. Taking both studies together, our results suggest that people with profound motor deficits can improve their quality of life using robotic body surrogates, and that they can gain benefit with only low-level robot autonomy and without invasive interfaces. However, methods to reduce the rate of errors and increase operational speed merit further investigation.
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Affiliation(s)
- Phillip M. Grice
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - Charles C. Kemp
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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Sun JX, Li LF, Zhao YL, Lu GW. CONSORT-Assistive technology-180° rotating eating spoon improves the ability of eating of self-care patients with upper extremity dyskinesia: Rotating eating spoon improves eating ability. Medicine (Baltimore) 2019; 98:e14597. [PMID: 30817577 PMCID: PMC6831374 DOI: 10.1097/md.0000000000014597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia. METHODS The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI). RESULTS The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently. CONCLUSIONS The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.
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Affiliation(s)
| | | | | | - Gui-Wei Lu
- Department of Medicine, Jiangsu Taizhou People's Hospital, Taizhou, China
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Bianchi C, Aragona M, Rodia C, Baronti W, de Gennaro G, Bertolotto A, Del Prato S. Freestyle Libre trend arrows for the management of adults with insulin-treated diabetes: A practical approach. J Diabetes Complications 2019; 33:6-12. [PMID: 30446477 DOI: 10.1016/j.jdiacomp.2018.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
Freestyle Libre (FSL) system is a new method to detect glucose enabling a new paradigm in glucose monitoring and self-management. The sensor, reading the interstitial fluid glucose concentration, provides a numerical data of glucose level and a trend arrow that add context to static measurement of glucose level. Therefore, patients could easily follow the progression of their glucose levels over the time, allowing early detection and timely treatment of deviations from targeted glucose level range, thus preventing extreme fluctuations. In order to take full advantage of the system both the caregiver and the person with diabetes must appreciate the need of careful interpretation of the data generated by the FSL. To this purpose we have generated recommendations that are based on methods suggested for CGM, our clinical experience and discussion with experienced patients using FSL, to provide a pragmatic approach to use FSL trend arrow data for managing diabetes in adults.
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Affiliation(s)
- Cristina Bianchi
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Michele Aragona
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giovanni de Gennaro
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandra Bertolotto
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Abstract
Over recent years there has been an explosion in availability of technical devices to support diabetes self-management. But with this technology revolution comes new hurdles. On paper, the available diabetes technologies should mean that the vast majority of people with type 1 diabetes have optimal glycemic control and are using their preferred therapy choices. Yet, it does not appear to be universally the case. In parallel, suboptimal glycemic control remains stubbornly widespread. Barriers to improvement include access to technology, access to expert diabetes health care professionals, and prohibitive insurance costs. Until access can be improved to ensure the technologies are available and usable by those that need them, there are many people with diabetes who are still losing out.
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Affiliation(s)
- Katharine D. Barnard
- Bournemouth University, Bournemouth,
UK
- Katharine D. Barnard, PhD, Bournemouth
University, Royal London House, Christchurch Road, Bournemouth BH1 3LT.
| | - Marc D. Breton
- University of Virginia School of
Medicine, Charlottesville, VA, USA
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26
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Toschi E, Fisher L, Wolpert H, Love M, Dunn T, Hayter G. Evaluating a Glucose-Sensor-Based Tool to Help Clinicians and Adults With Type 1 Diabetes Improve Self-Management Skills. J Diabetes Sci Technol 2018; 12:1143-1151. [PMID: 30060682 PMCID: PMC6232736 DOI: 10.1177/1932296818791534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The goal of this uncontrolled pilot study was to assess the feasibility of a self-care management mobile app, called Sugar Sleuth, which incorporates the FreeStyle Libre™ glucose sensor, to help clinicians and people with type 1 diabetes (PWD) identify and mitigate self-care behaviors that contribute to glucose variability. METHODS PWDs with a baseline A1c between 7.5 and 9.0% used the mobile app for 14 weeks. The app prompted the PWD to enter the suspected cause of detected glycemic excursions, and to record food and insulin information. PWDs met with clinicians to collaboratively review data, identify challenges, and devise a specific self-care plan. Outcome measures included a single glycemic outcome score (SGOS) and attitude rating scales to better understand how participant attitudes could affect glycemic outcome. RESULTS Thirty enrolled PWDs had a mean age of 55 ± 2.6 years, and a mean diabetes duration of 32 ± 2.9 years. A significant average reduction in A1c of 0.5 ± 0.07% ( P < .01) and in mean daily carbohydrate intake of 43 ± 21 grams ( P = .05) was found. No statistically significant change in glycemic metrics, body weight, or total daily insulin dose was found. A significant negative association occurred between SGOS and "hypoglycemia tolerance" ( P = .04), and a positive correlation occurred that approached significance with "motivation to change behavior" ( P = .06). CONCLUSIONS These findings suggest that this mobile app system, in conjunction with CGM, provides a useful platform for helping clinicians and adults with T1D improve self-management skills to improve glycemic control.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical
School, Boston, MA, USA
- Elena Toschi, MD, Joslin Diabetes Center,
Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
| | - Lawrence Fisher
- Department of Family and Community
Medicine, University of California, San Francisco, CA, USA
| | - Howard Wolpert
- Joslin Diabetes Center, Harvard Medical
School, Boston, MA, USA
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Affiliation(s)
- Dinesh Edem
- Department of Endocrinology, Indiana
University School of Medicine, Lafayette, IN, USA
| | | | - Jason M. Ng
- Division of Endocrinology, UPMC Center
for Diabetes and Endocrinology, Pittsburgh, PA, USA
| | - Maja Stefanovic-Racic
- Division of Endocrinology, Department of
Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary T. Korytkowski
- Division of Endocrinology, Department of
Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Mary T. Korytkowski, MD, Division of
Endocrinology, Department of Medicine, University of Pittsburgh, 3601 Fifth Ave,
Ste 560, Pittsburgh, PA 15213, USA.
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28
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Affiliation(s)
| | | | - Kai Chin
- University of Texas Health Science
Center, San Antonio, TX, USA
| | - Christopher G. Parkin
- CGParkin Communications, Inc, Henderson,
NV, USA
- Christopher G. Parkin, MS, CGParkin
Communications, Inc, 2352 Martinique Ave, Henderson, NV 89005, USA.
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29
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Grazzi L, Tassorelli C, de Tommaso M, Pierangeli G, Martelletti P, Rainero I, Geppetti P, Ambrosini A, Sarchielli P, Liebler E, Barbanti P. Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: a post hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial. J Headache Pain 2018; 19:98. [PMID: 30340460 PMCID: PMC6742918 DOI: 10.1186/s10194-018-0928-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/03/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. METHODS Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. RESULTS A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). CONCLUSIONS This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02686034 .
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Affiliation(s)
- Licia Grazzi
- Neuroalgology Unit, Carlo Besta Neurological Institute and Foundation, Milan, Italy
- Department of Fondazione IRCCS Istituto Neurologico C. Besta, U.O. Neurologia III – Cefalee e Neuroalgologia, Via Celoria 11, 20133 Milan, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marina de Tommaso
- Neurophysiology and Pain Unit, University of Bari Aldo Moro, Bari, Italy
| | - Giulia Pierangeli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Paola Sarchielli
- Neurologic Clinic, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Pisana, Rome, Italy
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30
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Affiliation(s)
- Sue Woodward
- Head of Clinical Education, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London
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31
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Tasak T. Case Study: Trialling a catheter. Br J Nurs 2018; 27:S18. [PMID: 30088976 DOI: 10.12968/bjon.2018.27.sup15.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Tony Tasak
- Senior Continence Nurse, Wirral Integrated Bladder and Bowel Service, Fender Way Health Centre
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Ferreira RC, Ribeiro MTDF, Vargas-Ferreira F, Sampaio AA, Pereira ACM, Vargas AMD, de Jesus RM, Ferreira EFE. Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil. PLoS One 2018; 13:e0200503. [PMID: 30044849 PMCID: PMC6059442 DOI: 10.1371/journal.pone.0200503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.
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Affiliation(s)
- Raquel Conceição Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fabiana Vargas-Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- * E-mail:
| | - Aline Araujo Sampaio
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andrea Maria Duarte Vargas
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafaella Mendes de Jesus
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Efigênia Ferreira e Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Akpolat T, Arici M, Sengul S, Derici U, Ulusoy S, Erturk S, Erdem Y. Home sphygmomanometers can help in the control of blood pressure: a nationwide field survey. Hypertens Res 2018; 41:460-468. [PMID: 29556094 PMCID: PMC8075910 DOI: 10.1038/s41440-018-0030-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/16/2017] [Accepted: 11/25/2017] [Indexed: 11/09/2022]
Abstract
Home blood pressure monitoring (HBPM), which integrates patients into their treatment program, is a self-management tool. The prevalence of home sphygmomanometer ownership and patient compliance with HBPM guidelines are not well known, especially in developing and underdeveloped countries. The aims of this study were to measure the prevalence of home sphygmomanometer ownership among hypertensive subjects through a nationwide field survey (PatenT2), to investigate the validation of sphygmomanometers and consistency of the user arm circumference and cuff size of the upper-arm device owned, as well as to compare blood pressure (BP) readings between hypertensive subjects who have or do not have a sphygmomanometer. Sample selection was based on a multistratified proportional sampling procedure to select a nationally representative sample of the adult population (n = 5437). Of 1650 hypertensive subjects, 332 (20.1%) owned a device, but the percentage of patients who owned a sphygmomanometer was 28.8% among patients who were aware of their hypertension (260/902). The usage of wrist devices and nonvalidated devices is common, and selection of an appropriate cuff size is ignored. Linear-regression analysis showed that owning a BP monitor is associated with decreases of 3.7 mmHg and 2.8 mmHg for systolic and diastolic BPs, respectively. Many patients do not own a sphygmomanometer. The decrease of systolic and diastolic BPs among BP monitor owners is a striking finding. The implementation of a hypertension care program consisting of sphygmomanometer reimbursement and training of patients in its use for HBPM might be cost-effective.
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Affiliation(s)
| | - Mustafa Arici
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sule Sengul
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ulver Derici
- Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sukru Ulusoy
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Yunus Erdem
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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34
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Abstract
Male catheterisation can be difficult to perform, especially in patients with an enlarged prostate gland or other potentially obstructive conditions in the lower urinary tract. Repeated and unsuccessful catheterisations, as well as causing trauma, pain and distress, can cause other conditions such as urethral strictures and 'false passages' (when the catheter is pushed through the urethral wall instead of passing down the urethra), which then require more costly interventions to correct. With an increasingly ageing population these complications are expected to rise, putting added strain on an already stretched health service. This article discusses the use of the Coudé (or Tiemann) tip catheter in patients presenting with these challenging catheterisations and, in particular, male patients performing intermittent self-catheterisation. Device design can help overcome obstructive difficulties, making catheterisation easier, less traumatic and more comfortable for the patient. A survey of 200 nurses working in the urology and continence field was undertaken to understand their awareness and usage of Coudé/Tiemann tip catheters in practice. It was found that many nurses and doctors were unaware of this type of catheter and its advantages and therefore did not use or offer it as an alternative to the more commonly used straight-tipped catheter. In the vast majority of cases when Tiemann tip catheters were used this occurred after failure with a straight-tipped catheter, or they were used with patients with benign prostatic hyperplasia or other potentially obstructive conditions. In many cases, the catheterisation was consultant initiated, despite the fact that intermittent self-catheterisation is instigated and taught mainly by nurses. This survey highlighted the need for better education for nurses and doctors in assessing the alternative catheter tips available to ensure successful catheterisation on first attempt.
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Affiliation(s)
| | - Helen Lake
- Clinical Nurse Specialist Urology/Stoma, B.Braun Medical Ltd, Honorary Nurse Specialist, Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust
| | - Kayleigh Brownlee-Moore
- Clinical Nurse Specialist, B.Braun Medical Ltd, Honorary Nurse Specialist, Newcastle upon Tyne Hospitals NHS Foundation Trust
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35
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Agrafiotis M, Kotsifou E, Renessis V, Athanassiadou A, Kousta A, Chloros D. Decelerating flow shape for volume-targeted mouthpiece ventilation. Clin Respir J 2018; 12:1770-1771. [PMID: 28759168 DOI: 10.1111/crj.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Michalis Agrafiotis
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Efstathia Kotsifou
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Vassilios Renessis
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Anastassia Athanassiadou
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Aekaterini Kousta
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Diamantis Chloros
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
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Iwahori T, Ueshima H, Ohgami N, Yamashita H, Miyagawa N, Kondo K, Torii S, Yoshita K, Shiga T, Ohkubo T, Arima H, Miura K. Effectiveness of a Self-monitoring Device for Urinary Sodium-to-Potassium Ratio on Dietary Improvement in Free-Living Adults: a Randomized Controlled Trial. J Epidemiol 2018; 28:41-47. [PMID: 29093302 PMCID: PMC5742378 DOI: 10.2188/jea.je20160144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 02/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reducing the urinary sodium-to-potassium ratio is important for reducing both blood pressure and risk of cardiovascular disease. Among free-living Japanese individuals, we carried out a randomized trial to clarify the effect of lifestyle modification for lowering urinary sodium-to-potassium ratio using a self-monitoring device. METHODS This was an open, prospective, parallel randomized, controlled trial. Ninety-two individuals were recruited from Japanese volunteers. Participants were randomly allocated into intervention and control groups. A month-long dietary intervention on self-monitoring urinary sodium-to-potassium ratio was carried out using monitors (HEU-001F, OMRON Healthcare Co., Ltd., Kyoto, Japan). All participants had brief dietary education and received a leaflet as usual care. Monitors were handed out to the intervention group, but not to the control group. The intervention group was asked to measure at least one spot urine sodium-to-potassium ratio daily, and advised to lower their sodium-to-potassium ratio toward the target of less than 1. Outcomes included changes in 24-hour urinary sodium-to-potassium ratio, sodium excretion, potassium excretion, blood pressure, and body weight in both groups. RESULTS Mean measurement frequency of monitoring was 2.8 times/day during the intervention. Changes in urinary sodium-to-potassium ratio were -0.55 in the intervention group and -0.06 in the control group (P = 0.088); respective sodium excretion changes were -18.5 mmol/24 hours and -8.7 mmol/24 hours (P = 0.528); and corresponding potassium excretion was 2.6 mmol/24 hours and -1.5 mmol/24 hours (P = 0.300). No significant reductions were observed in either blood pressure or body weight after the intervention. CONCLUSIONS Providing the device to self-monitor a sodium-to-potassium ratio did not achieve the targeted reduction of the ratio in "pure self-management" settings, indicating further needs to study an effective method to enhance the synergetic effect of dietary programs and self-monitoring practice to achieve the reduction. However, we cannot deny the possibility of reducing sodium-to-potassium ratio using a self-monitoring device.
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Affiliation(s)
- Toshiyuki Iwahori
- OMRON Healthcare Co., Ltd., Kyoto, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | | | | | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University, Osaka, Japan
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University of Medicine, Tokyo, Japan
| | - Hisatomi Arima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
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Beaven A, Ballard M, Sellon E, Briard R, Parker PJ. The Combat Application Tourniquet Versus the Tactical Mechanical Tourniquet. J Spec Oper Med 2018; 18:75-78. [PMID: 30222842 DOI: 10.55460/p6z3-vn4b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Exsanguination from limb injury is an important battlefield consideration that is mitigated with the use of emergency tourniquets. The Combat Application Tourniquet (C-A-T®) is the current British military standard tourniquet. METHODS We tested the self-application of a newer tourniquet system, the Tactical Mechanical Tourniquet (TMT), against self-application of the C-A-T. A total of 24 healthy British military volunteers self-applied the C-A-T and the TMT to their mid thigh in a randomized, sequential manner. Popliteal artery flow was monitored with a portable ultrasound machine, and time until arterial occlusion was measured. Pain scores were also recorded. Results The volunteers allowed testing on their lower limbs (n = 48 legs). The C-A-T was applied successfully to 22 volunteers (92%), and the TMT was successfully applied to 17 (71%). Median time to reach complete arterial occlusion was 37.5 (interquartile range [IQR], 27-52) seconds with the C-A-T, and 35 (IQR, 29-42) seconds with the TMT. The 2.5-second difference in median times was not significant (ρ = .589). The 1-in-10 difference in median pain score was also not significant (ρ = .656). The success or failure of self-application between the two tourniquet models as assessed by contingency table was not significant (p= .137). CONCLUSION The TMT is effective when self-applied at the mid thigh. It does not offer an efficacy advantage over the C-A-T.
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Shastay A. Possible Reason for Hyperglycemia in Patients Using an Insulin Pen. Home Healthc Now 2018; 36:329-330. [PMID: 30192281 DOI: 10.1097/nhh.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ann Shastay
- Ann Shastay, MSN, RN, AOCN, is the Managing Editor, Institute for Safe Medication Practices, Horsham, Pennsylvania
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39
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Podina IR, Fodor LA, Cosmoiu A, Boian R. An evidence-based gamified mHealth intervention for overweight young adults with maladaptive eating habits: study protocol for a randomized controlled trial. Trials 2017; 18:592. [PMID: 29233169 PMCID: PMC5727945 DOI: 10.1186/s13063-017-2340-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/08/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) is the first-line of treatment for overweight and obesity patients whose problems originate in maladaptive eating habits (e.g., emotional eating). However, in-person CBT is currently difficult to access by large segments of the population. The proposed SIGMA intervention (i.e., the Self-help, Integrated, and Gamified Mobile-phone Application) is a mHealth intervention based on CBT principles. It specifically targets overweight young adults with underlying maladaptive behaviors and cognitions regarding food. The SIGMA app was designed as a serious game and intended to work as a standalone app for weight maintenance or alongside a calorie-restrictive diet for weight loss. It uses a complex and novel scoring system that allows points earned within the game to be supplemented by points earned during outdoor activities with the help of an embedded pedometer. METHODS/DESIGN The efficacy of the SIGMA mHealth intervention will be investigated within a randomized, placebo-controlled trial. The intervention will be set to last 2 months with a 3-month follow-up. Selected participants will be young overweight adults with non-clinical maladaptive eating habits embodied by food cravings, binge eating, and emotional eating. The primary outcomes will be represented by changes in (1) self-reported maladaptive thoughts related to eating and body weight, (2) self-reported maladaptive eating behaviors in the range of urgent food cravings, emotional eating or binge eating, (3) as well as biased attentional processing of food items as indexed by reaction times. Secondary outcomes will be represented by changes in weight, Body Mass Index, general mood, and physical activity as indexed by the number of steps per day. DISCUSSION Through an evidence-based cognitive behavioral approach and a user-friendly game interface, the SIGMA intervention offers a significant contribution to the development of a cost-effective and preventive self-help tool for young overweight adults with maladaptive eating habits. TRIAL REGISTRATION ISRCTN, ID: 70907354 . Registered on 6 February 2017. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.
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Affiliation(s)
- Ioana R. Podina
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, 90 Panduri Street, Bucharest, 050657 Romania
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 37 Republicii Street, Cluj-Napoca, 400015 Romania
| | - Liviu A. Fodor
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 37 Republicii Street, Cluj-Napoca, 400015 Romania
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, 37 Republicii Street, Cluj-Napoca, 400015 Romania
| | - Ana Cosmoiu
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, 90 Panduri Street, Bucharest, 050657 Romania
| | - Rareș Boian
- Department of Computer Science, Babeş-Bolyai University, Mihail Kogălniceanu Street, Cluj-Napoca, 400084 Romania
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Miettinen T, Myllymaa K, Westeren-Punnonen S, Ahlberg J, Hukkanen T, Toyras J, Lappalainen R, Mervaala E, Sipila K, Myllymaa S, Miettinen T, Myllymaa K, Westeren-Punnonen S, Ahlberg J, Hukkanen T, Toyras J, Lappalainen R, Mervaala E, Sipila K, Myllymaa S. Success Rate and Technical Quality of Home Polysomnography With Self-Applicable Electrode Set in Subjects With Possible Sleep Bruxism. IEEE J Biomed Health Inform 2017; 22:1124-1132. [PMID: 28829322 DOI: 10.1109/jbhi.2017.2741522] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Using sleep laboratory polysomnography (PSG) is restricted for the diagnosis of only the most severe sleep disorders due to its low availability and high cost. Home PSG is more affordable, but applying conventional electroencephalography (EEG) electrodes increases its overall complexity and lowers the availability. Simple, self-administered single-channel EEG monitors on the other hand suffer from poor reliability. In this study, we aimed to quantify the reliability of self-administrated home PSG recordings conducted with a newly designed ambulatory electrode set (AES) that enables multichannel EEG, electrooculography, electromyography, and electrocardiography recordings. We assessed the sleep study success rate and technical quality of the recordings performed in subjects with possible sleep bruxism (SB). Thirty-two females and five males aged 39.6 ± 11.6 years (mean±SD) with self-reported SB were recruited in the study. Self-administrated home PSG recordings with two AES designs were conducted (n = 19 and 21). The technical quality of the recordings was graded based on the proportion of interpretable data. Technical failure rate for AES (both designs) was 5% and SB was scorable for 96.9% of all recorded data. Only one recording failed due to mistakes in self-applying the AES. We found that the proportion of good quality self-administrated EEG recordings is significantly higher when multiple channels are used compared to using a single channel. Sleep study success rates and proportion of recordings with high quality interpretable data from EEG channels of AES were comparable to that of conventional home PSG. Self-applicable AES has potential to become a reliable tool for widely available home PSG.
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Abstract
This study examined the effect of using an iPad for students with autism spectrum disorder (ASD) on self-monitoring their behaviors in class. Four students with ASD were taught on-task behaviors by watching self-modeled video saved in the application "Choiceworks" on their iPads, and collected data on their own behaviors. A single subject research design with ABAB phases was used. Student behaviors were observed using interval recording and behavioral occurrences were compared across phases. Results showed that the participating students' on-task behaviors (e.g., facing forward, looking at teacher, i.e. eye contact, and working on the assignment) were increased when an iPad was used for their self-monitoring.
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Affiliation(s)
- Joy F Xin
- Department of Interdisciplinary and Inclusive Education, Rowan University, 201, Mullica Hill Rd., Glassboro, NJ, 08028, USA.
| | - Mary E Sheppard
- Department of Interdisciplinary and Inclusive Education, Rowan University, 201, Mullica Hill Rd., Glassboro, NJ, 08028, USA
| | - Michelle Brown
- Salem County Special Services School, Bridgeton, NJ, 08302, USA
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Abstract
The threat of obesity, diabetes, anorexia, and bulimia in our society today has motivated extensive research on dietary monitoring. Standard self-report methods such as 24-h recall and food frequency questionnaires are expensive, burdensome, and unreliable to handle the growing health crisis. Long-term activity monitoring in daily living is a promising approach to provide individuals with quantitative feedback that can encourage healthier habits. Although several studies have attempted automating dietary monitoring using wearable, handheld, smart-object, and environmental systems, it remains an open research problem. This paper aims to provide a comprehensive review of wearable and hand-held approaches from 2004 to 2016. Emphasis is placed on sensor types used, signal analysis and machine learning methods, as well as a benchmark of state-of-the art work in this field. Key issues, challenges, and gaps are highlighted to motivate future work toward development of effective, reliable, and robust dietary monitoring systems.
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Bykov VN, Grebenyuk AN, Sidorov DA, Sidorov SP, Chubar OV. [Present condition and perspective of development of self-care decontamination products]. Voen Med Zh 2016; 337:42-48. [PMID: 30592822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Present condition and perspective of development of self-care decontamination products. This work provides data describing the current state and perspectives of development of self-care decontamination products for neutralization and removal of poisonous and highly toxic biologic and radioactive agents from open human body surfaces and close- fitting cloth. The history of self-care decontamination products creation in Russia and foreign countries is represented. The detailed performance characteristics of the developed individual anti-gas kits IPP-3, IPP-51, IPP-8, IPP-10, IPP-11, which were accepted to the Army and the Navy supply in the 1920-1930s, during the Great Patriotic war, in post-war period and now, are given. The individual anti-gas kits RSDL, M291, M295 and MKI for government-issue equipment of North Atlantic nations' armies are described in detail. It was showed that the general limitation both of the native and foreign anti-gas kit models is the poor efficacy against exposure of vesicants from the group of blister warfare agents. The most perspective research guidelines in creation of new self-care decontamination products. are validated.
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Schlebusch T, Fichtner W, Mertig M, Leonhardt S. Unobtrusive and comprehensive health screening using an intelligent toilet system. ACTA ACUST UNITED AC 2016; 60:17-29. [PMID: 25324433 DOI: 10.1515/bmt-2013-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 09/16/2014] [Indexed: 11/15/2022]
Abstract
Home monitoring is a promising technology to deal with the increasing amount of chronically ill patients while ensuring quality of medical care. Most systems available today depend on a high degree of interaction between the user and the device. Especially for people relying on advanced levels of care, this scheme is impracticable. In this paper, we are presenting an "intelligent toilet" performing an extensive health check while being as simple to use as a conventional toilet. The main focus of the system is to support the treatment of diabetes and chronic heart failure, but additional applications are possible.
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Ashoorkhani M, Bozorgi A, Majdzadeh R, Hosseini H, Yoonessi A, Ramezankhani A, Eftekhar H. Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30-60 years: study protocol for a randomized controlled trial. Trials 2016; 17:511. [PMID: 27769282 PMCID: PMC5073944 DOI: 10.1186/s13063-016-1638-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment. METHODS/DESIGN A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8th and 24th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information. DISCUSSION This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan. TRIAL REGISTRATION This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.
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Affiliation(s)
- Mahnaz Ashoorkhani
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bozorgi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Hosseini
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Yoonessi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ramezankhani
- Department of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Eftekhar
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Sun A, Venkatesh AG, Hall DA. A Multi-Technique Reconfigurable Electrochemical Biosensor: Enabling Personal Health Monitoring in Mobile Devices. IEEE Trans Biomed Circuits Syst 2016; 10:945-954. [PMID: 28113176 DOI: 10.1109/tbcas.2016.2586504] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper describes the design and characterization of a reconfigurable, multi-technique electrochemical biosensor designed for direct integration into smartphone and wearable technologies to enable remote and accurate personal health monitoring. By repurposing components from one mode to the next, the biosensor's potentiostat is able reconfigure itself into three different measurements modes to perform amperometric, potentiometric, and impedance spectroscopic tests all with minimal redundant devices. A [Formula: see text] PCB prototype of the module was developed with discrete components and tested using Google's Project Ara modular smartphone. The amperometric mode has a ±1 nA to [Formula: see text] measurement range. When used to detect pH, the potentiometric mode achieves a resolution of < 0.08 pH units. In impedance measurement mode, the device can measure 50 Ω-10 [Formula: see text] and has been shown to have of phase error. This prototype was used to perform several point-of-care health tracking assays suitable for use with mobile devices: 1) Blood glucose tests were conducted and shown to cover the diagnostic range for Diabetic patients ( ∼ 200 mg/dL). 2) Lactoferrin, a biomarker for urinary tract infections, was detected with a limit of detection of approximately 1 ng/mL. 3) pH tests of sweat were conducted to track dehydration during exercise. 4) EIS was used to determine the concentration of NeutrAvidin via a label-free assay.
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Abstract
Advances in technology continue to improve quality of life for people with diabetes and enhance their ability to perform diabetes self-management activities. Both insulin pumps and continuous glucose monitors (CGMs) are increasingly more popular among students with diabetes. This article will provide school nurses an overview of how insulin pumps and CGMs operate and the implications of their use in the school setting.
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Wee HE, Sin KY, Chiang P, Guo KW. Validation of the Use of a Point-of-Care Device in Monitoring the International Normalised Ratio in Postoperative Cardiac Patients. Ann Acad Med Singap 2016; 45:424-426. [PMID: 27748791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hide E Wee
- Department of Cardiology, National Heart Centre Singapore, Singapore
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49
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self-care and the Tablo. Nephrol News Issues 2016; 30:37. [PMID: 30512280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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50
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Abstract
The ubiquitous smart phone/device technology (SPT) has enabled the safe acquisition/transmission (A/T) of clinical and laboratory patient data, including the electrocardiogram (ECG). SPT-based A/T of the ECG has been found useful in the detection of atrial fibrillation, in monitoring of the QTc interval, in patients undergoing antiarrhythmic drug loading, and in management of patients with acute ST-elevation myocardial infarction. Previous work has shown a relationship between changes in the voltage of the ECG QRS complexes, with perturbations in the edematous state of various etiologies, including heart failure (HF). It is proposed herein to employ serially SPT-based 3-lead ECG A/T for the monitoring and management of patients with HF in their ambient environment. The proposed method will enable patients with HF to acquire/transmit their 3-lead ECG to the caring HF team, using only their smart phone and it takes into consideration the advanced degrees of physical incapacitation and age-related infirmities inherent to the HF population.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY.
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