Comparison of the diagnostic performance of CT colonography interpreted by radiologists and radiographers

OBJECTIVE: To compare computed tomographic colonography (CTC) performance of four trained radiographers with the CTC performance of two experienced radiologists. METHODS: Four radiographers and two radiologists interpreted 87 cases with 40 polyps ≥6 mm. Sensitivity, specificity, and positive predictive value (PPV) were assessed on a per-patient basis. On a per-polyp basis, sensitivity was calculated according to the respective size categories (polyps ≥6 mm as well as polyps ≥10 mm). RESULTS: Overall per-patient sensitivity for polyps ≥6 mm was 76.2 % (95 % CI 61.4–91.0) and 76.2 % (95 % CI 61.7–90.6), for the radiographers and radiologists, respectively. Overall per-patient specificity for polyps ≥6 mm were 81.4 % (95 % CI 73.7–89.2) and 81.1 % (95 % CI 73.8–88.3) for the radiographers and the radiologists, respectively. For the radiographers, overall per-polyp sensitivity was 60.3 % (95 % CI 50.3–70.3) and 60.7 % (95 % CI 42.2–79.2) for polyps ≥6 mm and ≥10 mm, respectively. For the radiologists, overall per polyp sensitivity was 59.2 % (95 % CI 46.4–72.0) and 69.0 % (95 % CI 48.1–89.6) for polyps ≥6 mm and ≥10 mm, respectively. CONCLUSION: Radiographers with training in CT colonographic evaluation achieved sensitivity and specificity in polyp detection comparable with that of experienced radiologists. MAIN MESSAGES: • The diagnostic accuracy of trained radiographers was comparable to that of experienced radiologists. • The use of radiographers in reading CTC examinations is acceptable, however radiologists would still be necessary for the evaluation of extracolonic findings. • Skilled non-radiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal

The Effects of Free-Living Interval-Walking Training on Glycemic Control, Body Composition, and Physical Fitness in Type 2 Diabetes Patients:A randomized, controlled trial

OBJECTIVE: To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness, body composition, and glycemic control. RESEARCH DESIGN AND METHODS: Subjects with type 2 diabetes were randomized to a control (n = 8), continuous-walking (n = 12), or interval-walking group (n = 12). Training groups were prescribed five sessions per week (60 min/session) and were controlled with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO(2)max, body composition, and glycemic control (fasting glucose, HbA(1c), oral glucose tolerance test, and continuous glucose monitoring [CGM]). RESULTS: Training adherence was high (89 ± 4%), and training energy expenditure and mean intensity were comparable. VO(2)max increased 16.1 ± 3.7% in the interval-walking group (P < 0.05), whereas no changes were observed in the continuous-walking or control group. Body mass and adiposity (fat mass and visceral fat) decreased in the interval-walking group only (P < 0.05). Glycemic control (elevated mean CGM glucose levels and increased fasting insulin) worsened in the control group (P < 0.05), whereas mean (P = 0.05) and maximum (P < 0.05) CGM glucose levels decreased in the interval-walking group. The continuous walkers showed no changes in glycemic control. CONCLUSIONS: Free-living walking training is feasible in type 2 diabetic patients. Continuous walking offsets the deterioration in glycemia seen in the control group, and interval walking is superior to energy expenditure–matched continuous walking for improving physical fitness, body composition, and glycemic control

Resting Metabolic Rate Does Not Change in Response to Different Types of Training in Subjects with Type 2 Diabetes

Background and objectivesAmbiguous results have been reported regarding the effects of training on resting metabolic rate (RMR), and the importance of training type and intensity is unclear. Moreover, studies in subjects with type 2 diabetes (T2D) are sparse. In this study, we evaluated the effects of interval and continuous training on RMR in subjects with T2D. Furthermore, we explored the determinants for training-induced alterations in RMR.MethodsData from two studies, both including T2D subjects, were encompassed in this manuscript. Study 1 was a randomized, crossover study where subjects (n = 14) completed three, 2-week interventions [control, continuous walking training (CWT), interval-walking training (IWT)] separated by washout periods. Training included 10 supervised treadmill sessions, 60 min/session. CWT was performed at moderate walking speed [aiming for 73% of walking peak oxygen uptake (VO2peak)], while IWT was performed as alternating 3-min repetitions at slow (54% VO2peak) and fast (89% VO2peak) walking speed. Study 2 was a single-arm training intervention study where subjects (n = 23) were prescribed 12 weeks of free-living IWT (at least 3 sessions/week, 30 min/session). Before and after interventions, RMR, physical fitness, body composition, and glycemic control parameters were assessed.ResultsNo overall intervention-induced changes in RMR were seen across the studies, but considerable inter-individual differences in RMR changes were seen in Study 2. At baseline, total body mass (TBM), fat-free mass (FFM), and fat mass were all associated with RMR. Changes in RMR were associated with changes in TBM and fat mass, and subjects who decreased body mass and fat mass also decreased their RMR. No associations were seen between changes in physical fitness, glycemic control, or FFM and changes in RMR.ConclusionNeither short-term continuous or interval-type training, nor longer term interval training affects RMR in subjects with T2D when no overall changes in body composition are seen. If training occurs concomitant with a reduction in fat mass, however, RMR is decreased.Clinical Trials Registration (www.ClinicalTrials.gov)NCT02320526 and NCT02089477

Criterion validity and reliability of a smartphone delivered sub-maximal fitness test for people with type 2 diabetes

BACKGROUND: Prevention of multi-morbidities following non-communicable diseases requires a systematic registration of adverse modifiable risk factors, including low physical fitness. The aim of the study was to establish criterion validity and reliability of a smartphone app (InterWalk) delivered fitness test in patients with type 2 diabetes. METHODS: Patients with type 2 diabetes (N = 27, mean (SD) age 64.2 (5.9) years, BMI 30.0 (5.1) kg/m(2), (30 % male)) completed a 7-min progressive walking protocol twice (with and without encouragement). VO(2) during the test was assessed using indirect calorimetry and the acceleration (vector magnitude) from the smartphone was obtained. The vector magnitude was used to predict VO(2peak) along with the co-variates weight, height and sex. The validity of the algorithm was tested when the smartphone was placed in the right pocket of the pants or jacket. The algorithm was validated using leave-one-out cross validation. Test-retest reliability was tested in a subset of participants (N = 10). RESULTS: The overall VO(2peak) prediction of the algorithm (R(2)) was 0.60 and 0.45 when the smartphone was placed in the pockets of the pants and jacket, respectively (p < 0.001). The mean bias (limits of agreement) in the cross validation was−0.4 (38) % (pants) and−0.1 (46) % (jacket). When the smartphone was placed in the jacket a significant intensity dependent bias (r = 0.5, p = 0.02) was observed. The test-retest intraclass correlations were 0.85 and 0.86 (p < 0.001), for the pants and jacket, respectively. No effects of encouragement were observed on test performance. CONCLUSION: In conclusion, the InterWalk Fitness Test is accurate and reliable for persons with type 2 diabetes when the smartphone is placed in the side pocket of the pants for. The test could give a fair estimate of the CRF in absence of a progressive maximal test during standardized conditions with the appropriate equipment. TRIAL REGISTRATION: www.clinicaltrials.org (NCT02089477), first registered (prospectively) on March 14th 201

Effect of ecological momentary assessment, goal-setting and personalized phone-calls on adherence to interval walking training using the InterWalk application among patients with type 2 diabetes-A pilot randomized controlled trial

<div><p>Objectives</p><p>The objective was to investigate the feasibility and usability of electronic momentary assessment, goal-setting and personalized phone-calls on adherence to a 12-week self-conducted interval walking training (IWT) program, delivered by the InterWalk smartphone among patients with type 2 diabetes (T2D).</p><p>Methods</p><p>In a two-arm pilot randomized controlled trial (Denmark, March 2014 to February 2015), patients with T2D (18–80 years with a Body Mass Index of 18 and 40 kg/m2) were randomly allocated to 12 weeks of IWT with (experimental) or without additional support (control). The primary outcome was the difference between groups in accumulated time of interval walking training across 12 weeks. All patients were encouraged to use the InterWalk application to perform IWT for ≥90 minute/week. Patients in the experimental group made individual goals regarding lifestyle change. Once a week inquiries about exercise adherence was made using an ecological momentary assessment (EMA). In case of consistent self-reported non-adherence, the patients would receive a phone-call inquiring about the reason for non-adherence. The control group did not receive additional support. Information about training adherence was assessed objectively. Usability of the EMA was assessed based on response rates and self-reported satisfaction after 12-weeks.</p><p>Results</p><p>Thirty-seven patients with T2D (66 years, 65% female, hemoglobin 1Ac 50.3 mmol/mol) where included (n = 18 and n = 19 in experimental and control group, respectively). The retention rate was 83%. The experimental group accumulated [95%CI] 345 [-7, 698] minutes of IWT more than the control group. The response rate for the text-messages was 83% (68% for males and 90% for females). Forty-one percent of the experimental and 25% of the control group were very satisfied with their participation.</p><p>Conclusion</p><p>The combination inquiry about adherence using EMA, goal-setting with the possibility of follow-up phone calls are considered feasible interventions to attain training adherence when using the InterWalk app during a 12-week period in patients with T2D. Some uncertainty about the effect size of adherence remains.</p><p>Trial registration</p><p>Clinicaltrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02089477" target="_blank">NCT02089477</a></p></div

The association between renal function and structural parameters: a pig study

<p>Abstract</p> <p>Background</p> <p>The objective was to investigate the association between renal structural parameters and renal function. The structural parameters were renal cortical volume, total renal volume, number of glomeruli, and total glomerular volume, and renal function was expressed by the single kidney GFR (skGFR). Investigations were performed using both healthy and chronically diseased kidneys. We investigated which of the structural parameters showed the best correlation to renal function and evaluated the possibility of predicting the renal function from structural parameters.</p> <p>Methods</p> <p>Twenty-four pigs, twelve with healthy kidneys and twelve with diseased kidneys, underwent skGFR measurements. Nephrectomies were performed and structural parameters were estimated using stereological procedures. The correlation between the structural parameters and skGFR was analysed by Pearson's correlation test. The prediction of skGFR from structural parameters was analysed by a linear regression test.</p> <p>Results</p> <p>In general, we demonstrated a good correlation between structural parameters and skGFR. When all kidneys were evaluated together Pearson's correlation coefficient between skGFR and any stereological parameter was above 0.60 and highly significant (p < 0.001), and with r-values ranging from 0.62 regarding number of glomeruli, to 0.78 regarding cortical volume. The best correlation was found between cortical volume and skGFR. Prediction of single kidney GFR from any structural parameter showed to be quite imprecise.</p> <p>Conclusion</p> <p>The observed correlations between structural parameters and renal function suggest that these parameters may potentially be useful as surrogate markers of the renal function. At present, however, precise prediction of renal function based on a single structural parameter seems hard to obtain.</p