Advising patients on selecting trustful apps for diabetes self-care

BACKGROUND: There has been a dramatic increase in mobile apps for diabetes self-care. However, their quality is not guaranteed and patients do not have the appropriate tools for careful evaluation. OBJECTIVE: This work aims to propose a tool to help patients with diabetes select an appropriate app for self-care. METHODS: After identifying the conceptual framework of diabetes self-care, we searched Apple US app store and reviewed diabetes self-care apps, considering both generic and diabetes-specific features. Based on an existing tool for representing the benefits and weaknesses of medical apps, we created the pictorial identification schema/Diabetes Self-care tool, which specifically identified medical apps in the diabetes domain. RESULTS: Of the 952 apps retrieved, 67 were for diabetes self-care, while 26 were excluded because they were not updated in the last 12 months. Of the remaining 41, none cost more than 15 USD, and 36 implemented manual data entry. Basic features (data logging, data representation, and data delivery) were implemented in almost all apps, whereas advanced features (e.g., insulin calculator) were implemented in a small percentage of apps. The pictorial identification schema for diabetes was completed by one patient and one software developer for 13 apps. Both users highlighted weaknesses related to the functionalities offered and to their interface, but the patient focused on usability, whereas the software developer focused on technical implementation. CONCLUSIONS: The Pictorial Identification Schema/Diabetes Self-care is a promising graphical tool for perceiving the weaknesses and benefits of a diabetes self-care app that includes multiple user profile perspectives

Promoting Health for Chronic Conditions: a Novel Approach that integrates Clinical and Personal Decision Support

Direct and indirect economic costs related to chronic diseases are increasing in Europe due to the aging of population. One of the most challenging goals is to improve the quality of life of patients affected by chronic conditions, and enhance their self-management. In this paper, we propose a novel architecture of a scalable solution, based on mobile tools, aimed to keep patients with chronic diseases away from acute episodes, to improve their quality of life and, consequently, to reduce their economic impact. Our solution aims to provide patients with a personalized tool for improving self-management, and it supports both patients and clinicians in decision-making through the implementation of two different Decision Support Systems. Moreover, the proposed architecture takes into account the interoperability and, particularly, the compliance with data transfer protocols (e.g., BT4/LE, ANT+, ISO/IEEE 11073) to ensure integration with existing devices, and with the semantic web approaches and standards related to the content and structure of the information (e.g., HL7, ICD-10 and openEHR) to ensure correct sharing of information with hospital information systems, and classification of patient behaviors (Coelition). The solution will be implemented and validated in future study

Cathodal transcranial direct current stimulation improves focal hand dystonia in musicians: A two-case study

Focal hand dystonia (FHD) in musicians is a movement disorder causing abnormal movements and irregularities in playing. Since weak electrical currents applied to the brain induce persistent excitability changes in humans, cathodal tDCS was proposed as a possible non-invasive approach for modulating cortical excitability in patients with FHD. However, the optimal targets and modalities have still to be determined. In this pilot study, we delivered cathodal (2 mA), anodal (2 mA) and sham tDCS over the motor areas bilaterally for 20 min daily for five consecutive days in two musicians with FHD. After cathodal tDCS, both patients reported a sensation of general wellness and improved symptoms of FHD. In conclusion, our pilot results suggest that cathodal tDCS delivered bilaterally over motor-premotor (M-PM) cortex for 5 consecutive days may be effective in improving symptoms in FHD

Adaptive deep brain stimulation in a freely moving parkinsonian patient

The future of deep brain stimulation (DBS) for Parkinson\u2019s disease (PD) lies in new closed-loop systems that continuously supply the implanted stimulator with new settings obtained by analyzing a feedback signal related to the patient\u2019s current clinical condition

Transarterial radioembolization for hepatocellular carcinoma: a review

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and is the second cause of death due to malignancy in the world. The treatment of HCC is complex and includes potentially curative and palliative approaches. However, both curative and palliative treatments for HCC are often associated with a not-completely favorable safety/efficacy ratio. Therefore, other treatment options appear necessary in clinical practice. Transarterial radioembolization has shown a promising efficacy in terms of disease control and is associated with a good safety profile. This review discusses the use of transarterial radioembolization in HCC, with a focus on the clinical aspects of this therapeutic strategy

Adaptive deep brain stimulation controls levodopa-induced side effects in Parkinsonian patients

The potential superior benefits of adaptive deep brain stimulation (aDBS) approaches compared to classical, constantparameters DBS were already proven by scientific evidence from different research groups. aDBS provides better symptoms control in Parkinson\u2019s disease patients by adapting the stimulation parameters to the patient\u2019s clinical state estimated through the analysis of subthalamic neuronal oscillations (ie, local field potentials) in the beta band (13-30 Hz)

Circulating pre-treatment Epstein-Barr virus DNA as prognostic factor in locally-advanced nasopharyngeal cancer in a nonendemic area

The prognostic value of pre-treatment Epstein-Barr Virus (EBV) DNA viral load for non-endemic, locally-advanced, EBV-related nasopharyngeal cancer (NPC) patients is yet to be defined. All patients with EBV encoded RNA (EBER)-positive NPC treated at our Institution from 2005 to 2014 with chemotherapy (CT) concurrent with radiation (RT) +/- induction chemotherapy (ICT) were retrospectively reviewed. Pre-treatment baseline plasma EBV DNA (b-EBV DNA) viral load was detected and quantified by PCR. Median b-EBV DNA value was correlated to potential influencing factors by univariate analysis. Significant variables were then extrapolated and included in a multivariate linear regression model. The same variables, including b-EBV DNA, were correlated with Disease Free Survival (DFS) and Overall Survival (OS) by univariate and multivariate analysis. A total of 130 locally-advanced EBER positive NPC patients were evaluated. Overall, b-EBV DNA was detected in 103 patients (79.2%). Median viral load was 554 copies/mL (range 50-151075), and was positively correlated with T stage (p= 0.002), N3a-b vs N0-1-2 stage (p= 0.048), type of treatment (ICT followed by CTRT, p= 0.006) and locoregional and/or distant disease recurrence (p= 0.034). In the overall population, DFS and OS were significantly longer in patients with pre-treatment negative EBV DNA than in positive subjects at the multivariate analysis. Negative b-EBV DNA can be considered as prognostic biomarker of longer DFS and OS in NPC in non-endemic areas. This finding needs confirmation in larger prospective series, with standardized and inter-laboratory harmonized method of plasma EBV DNA quantificatio

Ingegneria biomedica e medicina di precisione. Analisi avanzata di biodati, biosegnali e bioimmagini per terapie personalizzate

Il laboratorio si svolge nell'ambito di Trieste Next -Big data-Deep Science e Notte dei Ricercatori: le nuove frontiere della salute che mirano alla personalizzazione della diagnosi e delle terapie, sono caratterizzate da un alto contenuto tecnologico e dalla capacità di analisi avanzata dei Big Data medicali. Accanto alle fonti di dati medici più comuni (cartelle cliniche elettroniche, letteratura scientifica...), l’ampia diffusione di dispositivi personali, come smartphone e sensori indossabili, ha portato a un aumento esponenziale della quantità di dati a disposizione sui pazienti. L’analisi di questa grande quantità di dati permette di raggiungere una medicina sempre più “di precisione”, a misura della singola persona. Il visitatore può indossare e testare i dispositivi biomedici, sperimentando su di sé alcune delle tecnologie innovative sviluppate dai bioingegneri dell’Università di Trieste per ottimizzare le terapie, potenziare prevenzione e diagnosi, supportare la riabilitazione