Classification of Gastroparesis from Glycemic Variability in Type 1 Diabetes: A Proof-of-Concept Study

Background and Objective:Delayed gastric emptying is a substantial challenge for people with diabetes, affecting quality of life and blood glucose regulation. The complication is underdiagnosed, and current diagnostic tests are expensive or time consuming or have modest accuracy. The assessment of glycemic variations has potential use in gastroparesis screening. The aim of this study was to investigate the differences in glycemic variability between type 1 diabetes patients with gastroparesis and without a diagnosis of gastroparesis and the potential for using a classification model to differentiate between groups.Methods:Continuous glucose monitoring (CGM) from 425 patients with diabetes was included in the analytic cohort, including 16 patients with a diagnosis of gastroparesis and 409 without a known gastroparesis diagnosis. Sixteen features (9 daytime features and 7 nighttime features) describing glucose dynamics were extracted to assess differences between patients with and without a diagnosis of gastroparesis. A logistic regression model was trained using forward selection and cross-validation.Results:In total, 3 features were included in the model utilizing forward selection of features and cross-validation: mean absolute glucose (MAG), span, and standard deviation during the night. The Receiver operating characteristic (ROC) AUC for the classification model was 0.76.Conclusions:Gastroparesis seems to have an impact on glucose variability, especially during the night. Moreover, CGM could possibly be used as a part of the screening process for delayed gastric emptying, but more studies are needed to determine a realistic accuracy

Additional file 2 of Reablement professionals’ perspectives on client characteristics and factors associated with successful home-based reablement: a qualitative study

Additional file 2. The COREQ checklist

Reablement professionals’ perspectives on client characteristics and factors associated with successful home-based reablement: a qualitative study

Abstract Background To understand what is needed to achieve a successful Danish home-based reablement service from the perspective of reablement professionals. Methods Semi-structured interviews and observations were conducted with nine professionals within a municipal visitation unit in the Northern Denmark Region. Thematic analysis was used to analyze the interviews. Results Four major themes emerged during this study: “Heterogeneity of clients and mixed attitudes towards the reablement intervention”, “Shared understanding and acknowledging the need for help as the first step in reablement”, “Commitment and motivation are essential for successful reablement”, and “Homecare helpers as most important team players”. The findings indicate that the clients had both mixed characteristics and attitudes about participating in the reablement intervention. Essential factors for successful reablement included a shared understanding of the reablement intervention, commitment, and motivation in terms of client involvement and staff group collaboration. Conclusions Shared understanding of the reablement intervention, commitment, and motivation was found to be essential factors and the driving forces in relation to successful reablement

Additional file 1 of Reablement professionals’ perspectives on client characteristics and factors associated with successful home-based reablement: a qualitative study

Additional file 1. The interview guide

Additional file 2 of Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Additional file 2. is a .pdf file which contains a table with the general study characteristics of the included health economic evaluations

Additional file 3 of Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Additional file 3. is a .pdf file which presents an overview of the cost-effectiveness of the different delivery methods of FMT

Additional file 4 of Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Additional file 4. is a .pdf file which contains detailed quality assessments of each of the included health economic evaluations

Additional file 5 of Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Additional file 5. is a .pdf file which contains a table with the inputs applied in the health economic evaluations

Additional file 1 of Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Additional file 1. is a .pdf file which contains information on the complete search strategy used in the present systematic review

Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

Abstract Background Faecal microbiota transplantation (FMT) is increasingly being used in the treatment of recurrent Clostridioides difficile infection (rCDI). Health economic evaluations may support decision-making regarding the implementation of FMT in clinical practice. Previous reviews have highlighted several methodological concerns in published health economic evaluations examining FMT. However, the impact of these concerns on the conclusions of the studies remains unclear. Aims To present an overview and assess the methodological quality of health economic evaluations that compare FMT with antibiotics for treatment of rCDI. Furthermore, we aimed to evaluate the degree to which any methodological concerns would affect conclusions about the cost-effectiveness of FMT. Methods We conducted a systematic literature review based on a search in seven medical databases up to 16 July 2020. We included research articles reporting on full health economic evaluations comparing FMT with antibiotic treatment for rCDI. General study characteristics and input estimates for costs, effectiveness and utilities were extracted from the articles. The quality of the studies was assessed by two authors using the Drummonds ten-point checklist. Results We identified seven cost-utility analyses. All studies applied decision-analytic modelling and compared various FMT delivery methods with vancomycin, fidaxomicin, metronidazole or a combination of vancomycin and bezlotoxumab. The time horizons used in the analyses varied from 78 days to lifelong, and the perspectives differed between a societal, a healthcare system or a third-party payer perspective. The applied willingness-to-pay threshold ranged from 20,000 to 68,000 Great Britain pound sterling (GBP) per quality-adjusted life-year (QALY). FMT was considered the most cost-effective alternative in all studies. In five of the health economic evaluations, FMT was both more effective and cost saving than antibiotic treatment alternatives. The quality of the articles varied, and we identified several methodological concerns. Conclusions Economic evaluations consistently reported that FMT is a cost-effective and potentially cost-saving treatment for rCDI. Based on a comparison with recent evidence within the area, the multiple methodological concerns seem not to change this conclusion. Therefore, implementing FMT for rCDI in clinical practice should be strongly considered