83 research outputs found
Ecological validity of a deep learning algorithm to detect gait events from real-life walking bouts in mobility-limiting diseases
Introduction: The clinical assessment of mobility, and walking specifically, is still mainly based on functional tests that lack ecological validity. Thanks to inertial measurement units (IMUs), gait analysis is shifting to unsupervised monitoring in naturalistic and unconstrained settings. However, the extraction of clinically relevant gait parameters from IMU data often depends on heuristics-based algorithms that rely on empirically determined thresholds. These were mainly validated on small cohorts in supervised settings.
Methods: Here, a deep learning (DL) algorithm was developed and validated for gait event detection in a heterogeneous population of different mobility-limiting disease cohorts and a cohort of healthy adults. Participants wore pressure insoles and IMUs on both feet for 2.5 h in their habitual environment. The raw accelerometer and gyroscope data from both feet were used as input to a deep convolutional neural network, while reference timings for gait events were based on the combined IMU and pressure insoles data.
Results and discussion: The results showed a high-detection performance for initial contacts (ICs) (recall: 98%, precision: 96%) and final contacts (FCs) (recall: 99%, precision: 94%) and a maximum median time error of −0.02 s for ICs and 0.03 s for FCs. Subsequently derived temporal gait parameters were in good agreement with a pressure insoles-based reference with a maximum mean difference of 0.07, −0.07, and <0.01 s for stance, swing, and stride time, respectively. Thus, the DL algorithm is considered successful in detecting gait events in ecologically valid environments across different mobility-limiting diseases
Hematopoietic stem cell transplantation for CD40 ligand deficiency: results from an EBMT/ESID-IEWP-SCETIDE-PIDTC Study
BACKGROUND: CD40 ligand (CD40L) deficiency, an X-linked primary immunodeficiency, causes recurrent sinopulmonary, Pneumocystis and Cryptosporidium infections. Long-term survival with supportive therapy is poor. Currently, the only curative treatment is hematopoietic stem cell transplantation (HSCT). OBJECTIVE: We performed an international collaborative study to improve patients' management, aiming to individualize risk factors and determine optimal HSCT characteristics. METHODS: We retrospectively collected data on 130 patients who underwent HSCT for CD40L deficiency between 1993-2015. We analyzed outcome and variables relevance with respect to survival and cure. RESULTS: Overall survival (OS), event-free survival (EFS) and disease-free survival (DFS) were 78.2%, 58.1% and 72.3% 5 years post-HSCT. Results were better in transplants performed ≥2000 and in children <10 years old at HSCT. Pre-existing organ damage negatively influenced outcome. Sclerosing cholangitis was the most important risk factor. After 2000, superior OS was achieved with matched donors. Use of myeloablative regimens and HSCT ≤2 years from diagnosis associated with higher OS and DFS. EFS was best with matched sibling donors, myeloablative conditioning (MAC) and bone marrow-derived stem cells. Most rejections occurred after reduced intensity or non-myeloablative conditioning, which associated with poor donor cell engraftment. Mortality occurred mainly early after HSCT, predominantly from infections. Among survivors who ceased immunoglobulin replacement, T-lymphocyte chimerism was ≥50% donor in 85.2%. CONCLUSION: HSCT is curative in CD40L deficiency, with improved outcome if performed before organ damage development. MAC is associated with better OS, EFS and DFS. Prospective studies are required to compare risks of HSCT with those of life-long supportive therapy
The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set
Background
Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables.
Methods
Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set.
Results
Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001).
Conclusions
The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy
Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts: an economic decision model
Objectives: To estimate the costs of commonly used
treatments for cutaneous warts, as well as their health
benefits and risk. To create an economic decision model
to evaluate the cost-effectiveness of these treatments,
and, as a result, assess whether a randomised controlled
trial (RCT) would be feasible and cost-effective.
Data sources: Focus groups, structured interviews
and observation of practice. Postal survey sent to 723
patients. A recently updated Cochrane systematic
review and published cost and prescribing data.
Review methods: Primary and secondary data
collection methods were used to inform the
development of an economic decision model. Data from
the postal survey provided estimates of the
effectiveness of wart treatments in a primary care
setting. These estimates were compared with outcomes
reported in the Cochrane review of wart treatment,
which were largely obtained from RCTs conducted in
secondary care. A decision model was developed
including a variety of over-the-counter (OTC) and GPprescribed
treatments. The model simulated 10,000
patients and adopted a societal perspective.
Results: OTC treatments were used by a substantial
number of patients (57%) before attending the GP
surgery. By far the most commonly used OTC
preparation was salicylic acid (SA). The results of the
economic model suggested that of the treatments
prescribed by a GP, the most cost-effective treatment
was SA, with an incremental cost-effectiveness ratio
(ICER) of 2.20 £/% cured. The ICERs for cryotherapy
varied widely (from 1.95 to 7.06 £/% cured) depending
on the frequency of applications and the mode of
delivery. The most cost-effective mode of delivery was
through nurse-led cryotherapy clinics (ICER =
1.95 £/% cured) and this could be a cost-effective
alternative to GP-prescribed SA. Overall, the OTC
therapies were the most cost-effective treatment
options. ICERs ranged from 0.22 £/% cured for OTC
duct tape and 0.76 £/% cured for OTC cryotherapy to
1.12 £/% cured for OTC SA. However, evidence in
support of OTC duct tape and OTC cryotherapy is
very limited. Side-effects were commonly reported for
both SA and cryotherapy, particularly a burning
sensation, pain and blistering.
Conclusions: Cryotherapy delivered by a doctor is an
expensive option for the treatment of warts in primary
care. Alternative options such as GP-prescribed SA and
nurse-led cryotherapy clinics provide more costeffective
alternatives, but are still expensive compared
with self-treatment. Given the minor nature of most
cutaneous warts, coupled with the fact that the
majority spontaneously resolve in time, it may be
concluded that a shift towards self-treatment is
warranted. Although both duct tape and OTC
cryotherapy appear promising new self-treatment
options from both a cost and an effectiveness
perspective, more research is required to confirm the
efficacy of these two methods of wart treatment. If
these treatments are shown to be as cost-effective as
or more cost-effective than conventional treatments,
then a shift in service delivery away from primary care
towards more OTC treatment is likely. A public
awareness campaign would be useful to educate
patients about the self-limiting nature of warts and the
possible alternative OTC treatment options available.
Two future RCTs are recommended for consideration:
a trial of SA compared with nurse-led cryotherapy in
primary care, and a trial of home treatments. Greater
understanding of the efficacy of these home treatments
will give doctors a wider choice of treatment options,
and may help to reduce the overall demand for
cryotherapy in primary care
Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts: an economic decision model
Objectives: To estimate the costs of commonly used
treatments for cutaneous warts, as well as their health
benefits and risk. To create an economic decision model
to evaluate the cost-effectiveness of these treatments,
and, as a result, assess whether a randomised controlled
trial (RCT) would be feasible and cost-effective.
Data sources: Focus groups, structured interviews
and observation of practice. Postal survey sent to 723
patients. A recently updated Cochrane systematic
review and published cost and prescribing data.
Review methods: Primary and secondary data
collection methods were used to inform the
development of an economic decision model. Data from
the postal survey provided estimates of the
effectiveness of wart treatments in a primary care
setting. These estimates were compared with outcomes
reported in the Cochrane review of wart treatment,
which were largely obtained from RCTs conducted in
secondary care. A decision model was developed
including a variety of over-the-counter (OTC) and GPprescribed
treatments. The model simulated 10,000
patients and adopted a societal perspective.
Results: OTC treatments were used by a substantial
number of patients (57%) before attending the GP
surgery. By far the most commonly used OTC
preparation was salicylic acid (SA). The results of the
economic model suggested that of the treatments
prescribed by a GP, the most cost-effective treatment
was SA, with an incremental cost-effectiveness ratio
(ICER) of 2.20 £/% cured. The ICERs for cryotherapy
varied widely (from 1.95 to 7.06 £/% cured) depending
on the frequency of applications and the mode of
delivery. The most cost-effective mode of delivery was
through nurse-led cryotherapy clinics (ICER =
1.95 £/% cured) and this could be a cost-effective
alternative to GP-prescribed SA. Overall, the OTC
therapies were the most cost-effective treatment
options. ICERs ranged from 0.22 £/% cured for OTC
duct tape and 0.76 £/% cured for OTC cryotherapy to
1.12 £/% cured for OTC SA. However, evidence in
support of OTC duct tape and OTC cryotherapy is
very limited. Side-effects were commonly reported for
both SA and cryotherapy, particularly a burning
sensation, pain and blistering.
Conclusions: Cryotherapy delivered by a doctor is an
expensive option for the treatment of warts in primary
care. Alternative options such as GP-prescribed SA and
nurse-led cryotherapy clinics provide more costeffective
alternatives, but are still expensive compared
with self-treatment. Given the minor nature of most
cutaneous warts, coupled with the fact that the
majority spontaneously resolve in time, it may be
concluded that a shift towards self-treatment is
warranted. Although both duct tape and OTC
cryotherapy appear promising new self-treatment
options from both a cost and an effectiveness
perspective, more research is required to confirm the
efficacy of these two methods of wart treatment. If
these treatments are shown to be as cost-effective as
or more cost-effective than conventional treatments,
then a shift in service delivery away from primary care
towards more OTC treatment is likely. A public\ud
awareness campaign would be useful to educate
patients about the self-limiting nature of warts and the
possible alternative OTC treatment options available.
Two future RCTs are recommended for consideration:
a trial of SA compared with nurse-led cryotherapy in
primary care, and a trial of home treatments. Greater
understanding of the efficacy of these home treatments
will give doctors a wider choice of treatment options,
and may help to reduce the overall demand for
cryotherapy in primary care
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