Novel sensor technology integration for outcome-based risk analysis in diabetes

Novel sensor-based continuous biomedical monitoring technologies have a major role in chronic disease management for early detection and prevention of known adverse trends. In the future, a diversity of physiological, biochemical and mechanical sensing principles will be available through sensor device 'ecosystems'. In anticipation of these sensor-based ecosystems, we have developed Healthcare@Home (HH) - a research-phase generic intervention-outcome monitoring framework. HH incorporates a closed-loop intervention effect analysis engine to evaluate the relevance of measured (sensor) input variables to system-defined outcomes. HH offers real-world sensor type validation by evaluating the degree to which sensor-derived variables are relevant to the predicted outcome. This 'index of relevance' is essential where clinical decision support applications depend on sensor inputs. HH can help determine system-integrated cost-utility ratios of bespoke sensor families within defined applications - taking into account critical factors like device robustness / reliability / reproducibility, mobility / interoperability, authentication / security and scalability / usability. Through examples of hardware / software technologies incorporated in the HH end-to-end monitoring system, this paper discusses aspects of novel sensor technology integration for outcome-based risk analysis in diabetes

Reducing the burden of hypoglycaemia in people with diabetes through increased understanding:design of the Hypoglycaemia Redefining Solutions for Better Lives (Hypo-RESOLVE) project

Background Hypoglycaemia is the most frequent complication of treatment with insulin or insulin secretagogues in people with diabetes. Severe hypoglycaemia, i.e. an event requiring external help because of cognitive dysfunction, is associated with a higher risk of adverse cardiovascular outcomes and all‐cause mortality, but underlying mechanism(s) are poorly understood. There is also a gap in the understanding of the clinical, psychological and health economic impact of ‘non‐severe’ hypoglycaemia and the glucose level below which hypoglycaemia causes harm. Aim To increase understanding of hypoglycaemia by addressing the above issues over a 4‐year period. Methods Hypo‐RESOLVE is structured across eight work packages, each with a distinct focus. We will construct a large, sustainable database including hypoglycaemia data from >100 clinical trials to examine predictors of hypoglycaemia and establish glucose threshold(s) below which hypoglycaemia constitutes a risk for adverse biomedical and psychological outcomes, and increases healthcare costs. We will also investigate the mechanism(s) underlying the antecedents and consequences of hypoglycaemia, the significance of glucose sensor‐detected hypoglycaemia, the impact of hypoglycaemia in families, and the costs of hypoglycaemia for healthcare systems. Results The outcomes of Hypo‐RESOLVE will inform evidence‐based definitions regarding the classification of hypoglycaemia in diabetes for use in daily clinical practice, future clinical trials and as a benchmark for comparing glucose‐lowering interventions and strategies across trials. Stakeholders will be engaged to achieve broadly adopted agreement. Conclusion Hypo‐RESOLVE will advance our understanding and refine the classification of hypoglycaemia, with the ultimate aim being to alleviate the burden and consequences of hypoglycaemia in people with diabetes

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Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Clinical evaluation of a novel adaptive bolus calculator and safety system in Type 1 diabetes

Bolus calculators are considered state-of-the-art for insulin dosing decision support for people with Type 1 diabetes (T1D). However, they all lack the ability to automatically adapt in real-time to respond to an individual’s needs or changes in insulin sensitivity. A novel insulin recommender system based on artificial intelligence has been developed to provide personalised bolus advice, namely the Patient Empowerment through Predictive Personalised Decision Support (PEPPER) system. Besides adaptive bolus advice, the decision support system is coupled with a safety system which includes alarms, predictive glucose alerts, predictive low glucose suspend for insulin pump users, personalised carbohydrate recommendations and dynamic bolus insulin constraint. This thesis outlines the clinical evaluation of the PEPPER system in adults with T1D on multiple daily injections (MDI) and insulin pump therapy. The hypothesis was that the PEPPER system is safe, feasible and effective for use in people with TID using MDI or pump therapy. Safety and feasibility of the safety system was initially evaluated in the first phase, with the second phase evaluating feasibility of the complete system (safety system and adaptive bolus advisor). Finally, the whole system was clinically evaluated in a randomised crossover trial with 58 participants. No significant differences were observed for percentage times in range between the PEPPER and Control groups. For quality of life, participants reported higher perceived hypoglycaemia with the PEPPER system despite no objective difference in time spent in hypoglycaemia. Overall, the studies demonstrated that the PEPPER system is safe and feasible for use when compared to conventional therapy (continuous glucose monitoring and standard bolus calculator). Further studies are required to confirm overall effectiveness.Open Acces