1
|
Barsotti E, Goodman B, Samuelson R, Carvour ML. A Scoping Review of Wearable Technologies for Use in Individuals With Intellectual Disabilities and Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2024:19322968241231279. [PMID: 38439547 DOI: 10.1177/19322968241231279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) are at risk of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), which can lead to foot ulcers and lower-extremity amputations. However, cognitive differences and communication barriers may impede some methods for screening and prevention of DPN. Wearable and mobile technologies-such as smartphone apps and pressure-sensitive insoles-could help to offset these barriers, yet little is known about the effectiveness of these technologies among individuals with ID. METHODS We conducted a scoping review of the databases Embase, PubMed, and Web of Science using search terms for DM, DPN, ID, and technology to diagnose or monitor DPN. Finding a lack of research in this area, we broadened our search terms to include any literature on technology to diagnose or monitor DPN and then applied these findings within the context of ID. RESULTS We identified 88 articles; 43 of 88 (48.9%) articles were concerned with gait mechanics or foot pressures. No articles explicitly included individuals with ID as the target population, although three articles involved individuals with other cognitive impairments (two among patients with a history of stroke, one among patients with hemodialysis-related cognitive changes). CONCLUSIONS Individuals with ID are not represented in studies using technology to diagnose or monitor DPN. This is a concern given the risk of DM complications among patients with ID and the potential for added benefit of such technologies to reduce barriers to screening and prevention. More studies should investigate how wearable devices can be used among patients with ID.
Collapse
Affiliation(s)
- Ercole Barsotti
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Bailey Goodman
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Riley Samuelson
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Martha L Carvour
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
2
|
van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Paton J, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3652. [PMID: 37243880 DOI: 10.1002/dmrr.3652] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
AIMS Prevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta-analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof. MATERIALS AND METHODS We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. RESULTS From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non-controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31-0.84) and pressure-optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26-1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37-1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24-1.17), flexor tenotomy (1 RCT, 7 non-controlled studies, no meta-analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58-1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration. CONCLUSIONS Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure-optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high-quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low-to-moderate risk of ulceration.
Collapse
Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine, Oporto University, Porto, Portugal
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Faus Camarena M, Izquierdo-Renau M, Julian-Rochina I, Arrébola M, Miralles M. Update on the Use of Infrared Thermography in the Early Detection of Diabetic Foot Complications: A Bibliographic Review. SENSORS (BASEL, SWITZERLAND) 2023; 24:252. [PMID: 38203114 PMCID: PMC10781348 DOI: 10.3390/s24010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
Foot lesions are among the most frequent causes of morbidity and disability in the diabetic population. Thus, the exploration of preventive control measures is vital for detecting early signs and symptoms of this disease. Infrared thermography is one of the complementary diagnostic tools available that has proven to be effective in the control of diabetic foot. The last review on this topic was published in 2015 and so, we conducted a bibliographic review of the main databases (PubMed, the Web of Science, Cochrane library, and Scopus) during the third quarter of 2023. We aimed to identify the effectiveness of infrared thermography as a diagnostic element in pre-ulcerous states in diabetic patients and to detect diabetic foot ulcer complications. We obtained a total of 1199 articles, 26 of which were finally included in the present review and published after 2013. After analyzing the use of infrared thermography in diabetic patients both with and without ulcers, as well as in healthy individuals, we concluded that is an effective tool for detecting early-stage ulcers in diabetic foot patients.
Collapse
Affiliation(s)
- Marina Faus Camarena
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Marta Izquierdo-Renau
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Iván Julian-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Manel Arrébola
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
| | - Manuel Miralles
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
- Department of Surgery, University of Valencia, 46010 Valencia, Spain
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute, Hospital La Fe, 46026 Valencia, Spain
| |
Collapse
|
4
|
Lieber J, Banjara SK, Mallinson PAC, Mahajan H, Bhogadi S, Addanki S, Birk N, Song W, Shah AS, Kurmi O, Iyer G, Kamalakannan S, Kishore Galla R, Sadanand S, Dasi T, Kulkarni B, Kinra S. Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort. BMJ Open 2023; 13:e073897. [PMID: 38011977 PMCID: PMC10685937 DOI: 10.1136/bmjopen-2023-073897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The epidemiological and demographic transitions are leading to a rising burden of multimorbidity (co-occurrence of two or more chronic conditions) worldwide. Evidence on the burden, determinants, consequences and care of multimorbidity in rural and urbanising India is limited, partly due to a lack of longitudinal and objectively measured data on chronic health conditions. We will conduct a mixed-methods study nested in the prospective Andhra Pradesh Children and Parents' Study (APCAPS) cohort to develop a data resource for understanding the epidemiology of multimorbidity in rural and urbanising India and developing interventions to improve the prevention and care of multimorbidity. METHODS AND ANALYSIS We aim to recruit 2100 APCAPS cohort members aged 45+ who have clinical and lifestyle data collected during a previous cohort follow-up (2010-2012). We will screen for locally prevalent non-communicable, infectious and mental health conditions, alongside cognitive impairments, disabilities and frailty, using a combination of self-reported clinical diagnosis, symptom-based questionnaires, physical examinations and biochemical assays. We will conduct in-depth interviews with people with varying multimorbidity clusters, their informal carers and local healthcare providers. Deidentified data will be made available to external researchers. ETHICS AND DISSEMINATION The study has received approval from the ethics committees of the National Institute of Nutrition and Indian Institute of Public Health Hyderabad, India and the London School of Hygiene and Tropical Medicine, UK. Meta-data and data collection instruments will be published on the APCAPS website alongside details of existing APCAPS data and the data access process (www.lshtm.ac.uk/research/centres-projects-groups/apcaps).
Collapse
Affiliation(s)
- Judith Lieber
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Hemant Mahajan
- National Institute of Nutrition, Hyderabad, Telangana, India
| | | | | | - Nick Birk
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Wenbo Song
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- Nagasaki University, Nagasaki, Japan
| | - Anoop Sv Shah
- Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Om Kurmi
- Coventry University, Coventry, UK
| | - Gowri Iyer
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Shilpa Sadanand
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Teena Dasi
- National Institute of Nutrition, Hyderabad, Telangana, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Hyderabad, Telangana, India
- Indian Council of Medical Research, New Delhi, India
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|
5
|
Godavarty A, Leiva K, Amadi N, Klonoff DC, Armstrong DG. Diabetic Foot Ulcer Imaging: An Overview and Future Directions. J Diabetes Sci Technol 2023; 17:1662-1675. [PMID: 37594136 PMCID: PMC10658670 DOI: 10.1177/19322968231187660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Diabetic foot ulcers (DFUs) affect one in every three people with diabetes. Imaging plays a vital role in objectively complementing the gold-standard visual yet subjective clinical assessments of DFUs during the wound treatment process. Herein, an overview of the various imaging techniques used to image DFUs is summarized. Conventional imaging modalities (e.g., computed tomography, magnetic resonance imaging, positron emission tomography, single-photon emitted computed tomography, and ultrasound) are used to diagnose infections, impact on the bones, foot deformities, and blood flow in patients with DFUs. Transcutaneous oximetry is a gold standard to assess perfusion in DFU cases with vascular issues. For a wound to heal, an adequate oxygen supply is needed to facilitate reparative processes. Several optical imaging modalities can assess tissue oxygenation changes in and around the wounds apart from perfusion measurements. These include hyperspectral imaging, multispectral imaging, diffuse reflectance spectroscopy, near-infrared (NIR) spectroscopy, laser Doppler flowmetry or imaging, and spatial frequency domain imaging. While perfusion measurements are dynamically monitored at point locations, tissue oxygenation measurements are static two-dimensional spatial maps. Recently, we developed a spatio-temporal NIR-based tissue oxygenation imaging approach to map for the extent of asynchrony in the oxygenation flow patterns in and around DFUs. Researchers also measure other parameters such as thermal maps, bacterial infections (from fluorescence maps), pH, collagen, and trans-epidermal water loss to assess DFUs. A future direction for DFU imaging would ideally be a low-cost, portable, multi-modal imaging platform that can provide a visual and physiological assessment of wounds for comprehensive wound care intervention and management.
Collapse
Affiliation(s)
- Anuradha Godavarty
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Kevin Leiva
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Noble Amadi
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
6
|
Cassidy B, Hoon Yap M, Pappachan JM, Ahmad N, Haycocks S, O'Shea C, Fernandez CJ, Chacko E, Jacob K, Reeves ND. Artificial intelligence for automated detection of diabetic foot ulcers: A real-world proof-of-concept clinical evaluation. Diabetes Res Clin Pract 2023; 205:110951. [PMID: 37848163 DOI: 10.1016/j.diabres.2023.110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Conduct a multicenter proof-of-concept clinical evaluation to assess the accuracy of an artificial intelligence system on a smartphone for automated detection of diabetic foot ulcers. METHODS The evaluation was undertaken with patients with diabetes (n = 81) from September 2020 to January 2021. A total of 203 foot photographs were collected using a smartphone, analysed using the artificial intelligence system, and compared against expert clinician judgement, with 162 images showing at least one ulcer, and 41 showing no ulcer. Sensitivity and specificity of the system against clinician decisions was determined and inter- and intra-rater reliability analysed. RESULTS Predictions/decisions made by the system showed excellent sensitivity (0.9157) and high specificity (0.8857). Merging of intersecting predictions improved specificity to 0.9243. High levels of inter- and intra-rater reliability for clinician agreement on the ability of the artificial intelligence system to detect diabetic foot ulcers was also demonstrated (Kα > 0.8000 for all studies, between and within raters). CONCLUSIONS We demonstrate highly accurate automated diabetic foot ulcer detection using an artificial intelligence system with a low-end smartphone. This is the first key stage in the creation of a fully automated diabetic foot ulcer detection and monitoring system, with these findings underpinning medical device development.
Collapse
Affiliation(s)
- Bill Cassidy
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Moi Hoon Yap
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Joseph M Pappachan
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
| | - Naseer Ahmad
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
| | | | - Claire O'Shea
- Te Whatu Ora Health New Zealand Waikato, Pembroke Street, Hamilton 3240, New Zealand. claire.o'
| | - Cornelious J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston LN2 5QY, UK.
| | - Elias Chacko
- Jersey General Hospital, The Parade, St Helier, JE1 3QS Jersey, UK.
| | - Koshy Jacob
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
| | - Neil D Reeves
- Faculty of Science & Engineering, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| |
Collapse
|
7
|
Cutti AG, Morosato F, Gentile C, Gariboldi F, Hamoui G, Santi MG, Teti G, Gruppioni E. A Workflow for Studying the Stump-Socket Interface in Persons with Transtibial Amputation through 3D Thermographic Mapping. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115035. [PMID: 37299763 DOI: 10.3390/s23115035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
The design and fitting of prosthetic sockets can significantly affect the acceptance of an artificial limb by persons with lower limb amputations. Clinical fitting is typically an iterative process, which requires patients' feedback and professional assessment. When feedback is unreliable due to the patient's physical or psychological conditions, quantitative measures can support decision-making. Specifically, monitoring the skin temperature of the residual limb can provide valuable information regarding unwanted mechanical stresses and reduced vascularization, which can lead to inflammation, skin sores and ulcerations. Multiple 2D images to examine a real-life 3D limb can be cumbersome and might only offer a partial assessment of critical areas. To overcome these issues, we developed a workflow for integrating thermographic information on the 3D scan of a residual limb, with intrinsic reconstruction quality measures. Specifically, workflow allows us to calculate a 3D thermal map of the skin of the stump at rest and after walking, and summarize this information with a single 3D differential map. The workflow was tested on a person with transtibial amputation, with a reconstruction accuracy lower than 3 mm, which is adequate for socket adaptation. We expect the workflow to improve socket acceptance and patients' quality of life.
Collapse
Affiliation(s)
| | - Federico Morosato
- Centro Protesi Inail, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy
| | - Cosimo Gentile
- Centro Protesi Inail, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy
| | - Francesca Gariboldi
- Department of Industrial Engineering, University of Padova, Via VIII Febbraio, 2, 35122 Padova, Italy
| | - Giovanni Hamoui
- Centro Protesi Inail, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy
| | - Maria Grazia Santi
- Department of Industrial Engineering, University of Padova, Via VIII Febbraio, 2, 35122 Padova, Italy
| | - Gregorio Teti
- Centro Protesi Inail, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy
| | - Emanuele Gruppioni
- Centro Protesi Inail, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy
| |
Collapse
|
8
|
Shoji M, Kuwahara H, Osumi M, Akaishi S, Ogawa R. Lumbar Sympathetic Ganglion Block Facilitates Wound Healing in a Rat Ischemic Hindquarter Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5010. [PMID: 37235134 PMCID: PMC10208715 DOI: 10.1097/gox.0000000000005010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 05/28/2023]
Abstract
Lumbar sympathetic nerve block (LSNB) improves blood flow in the lower limbs and relieves pain involving the sympathetic afferents. This study examines the use of LSNB, but there are no reports of its use for the purpose of wound healing. Therefore, the authors planned the following study. Methods An ischemic limb ulcer was created on both lower limbs using a rat model (N = 18). The rats were divided into three groups, namely, A, B, and C. Group A received LSNB on one side (N = 6). Group B was sprayed with basic fibroblast growth factor preparation (trafermin/fiblast) on one side (N = 6). Group C was used as a control (N = 6). Lower limb temperature and the ulcer area were measured over time in each group. Furthermore, the correlation between the ulcer temperature and the ulcer area reduction rate was analyzed. Results Group A had higher skin temperature on the LSNB-treated side than on the nontreated side (P = 0.0022 < 0.05). Regarding the correlation between the average temperature and the ulcer area reduction rate, the correlation coefficient was as high as 0.691 in group A. Conclusions In the LSNB group, the skin temperature increased and the ulcer area decreased significantly. Conventionally, LSNB has been used for pain relief purposes, although the authors consider that it will be useful in the treatment of ischemic ulcers and that it is a potential treatment option for future chronic limb ischemia/chronic limb-threatening ischemia cases.
Collapse
Affiliation(s)
- Mami Shoji
- From the Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Hiroaki Kuwahara
- From the Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Makoto Osumi
- Department of Anesthesiology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Satoshi Akaishi
- From the Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| |
Collapse
|
9
|
Martin JK, Davis BL. Diabetic Foot Considerations Related to Plantar Pressures and Shear. Foot Ankle Clin 2023; 28:13-25. [PMID: 36822683 PMCID: PMC10111339 DOI: 10.1016/j.fcl.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diabetic foot ulcers are a complex, multifaceted, and widespread complication of diabetes mellitus. Although there are a multitude of risk factors contributing to diabetic foot ulcer development, pressure and (more recently) shear stresses are two biomechanical metrics that are gaining popularity for monitoring risk factors predisposing skin breakdown. Other areas of diabetic foot ulcers under research include plantar temperature measuring, as well as monitoring wear-time compliance and machine learning/AI algorithms. Charcot arthropathy is another diabetes complication that has a relationship with diabetic foot ulcer development, which should be monitored for development alongside ulcer development. The ability to monitor and prevent diabetic foot ulcer development and Charcot neuroarthropathy will lead to increased patient outcomes and patient quality of life.
Collapse
Affiliation(s)
- Jessi K Martin
- Center for Human Machine Systems, Cleveland State University, WH 305, Cleveland, OH 44115, USA
| | - Brian L Davis
- Center for Human Machine Systems, Cleveland State University, WH 305, Cleveland, OH 44115, USA.
| |
Collapse
|
10
|
Qin Q, Nakagami G, Ohashi Y, Dai M, Sanada H, Oe M. Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment. Drug Discov Ther 2022; 16:169-176. [PMID: 36002308 DOI: 10.5582/ddt.2022.01050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thermography is a well-known risk-assessment tool for diabetic foot ulcers but is not widely used in the home setting due to the influence of the complicated home environment on thermographic images. This study investigated changes in thermographic images in complicated home environments to determine the feasibility of smartphone-based thermography in home settings. Healthy volunteers (age > 20 years) were recruited and required to take plantar thermal images using smartphone-based thermography attached to a selfie stick at different times of the day for 4 days. The thermal images and associated activities and environmental factors were then analyzed using content analysis. Areas with the highest temperature on the plantar thermal images were described and categorized. Device usability was evaluated using 10-point Likert scales, with 10 representing the highest satisfaction. A total of 140 plantar thermal images from 10 participants were analyzed. In 12 classifications, the three commonest patterns based on the highest temperature location were medial arch (42.1%), whole plantar (10.7%), and forefoot and medial arch (7.9%). The medial arch pattern is most frequently seen after awakening (67.5%) compared to other time points. Device usability was rated 7.5 out of 10 on average. This study was the first to investigate the plantar thermal patterns in the home settings, and the medial arch pattern was the most common hot area, which matches previous findings in well-controlled clinical settings. Therefore, smartphone-based thermography may be feasible as a self-assessment tool in the home setting.
Collapse
Affiliation(s)
- Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Misako Dai
- Research Center for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| |
Collapse
|
11
|
Domino M, Borowska M, Zdrojkowski Ł, Jasiński T, Sikorska U, Skibniewski M, Maśko M. Application of the Two-Dimensional Entropy Measures in the Infrared Thermography-Based Detection of Rider: Horse Bodyweight Ratio in Horseback Riding. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166052. [PMID: 36015813 PMCID: PMC9414866 DOI: 10.3390/s22166052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 05/08/2023]
Abstract
As obesity is a serious problem in the human population, overloading of the horse's thoracolumbar region often affects sport and school horses. The advances in using infrared thermography (IRT) to assess the horse's back overload will shortly integrate the IRT-based rider-horse fit into everyday equine practice. This study aimed to evaluate the applicability of entropy measures to select the most informative measures and color components, and the accuracy of rider:horse bodyweight ratio detection. Twelve horses were ridden by each of the six riders assigned to the light, moderate, and heavy groups. Thermal images were taken pre- and post-exercise. For each thermal image, two-dimensional sample (SampEn), fuzzy (FuzzEn), permutation (PermEn), dispersion (DispEn), and distribution (DistEn) entropies were measured in the withers and the thoracic spine areas. Among 40 returned measures, 30 entropy measures were exercise-dependent, whereas 8 entropy measures were bodyweight ratio-dependent. Moreover, three entropy measures demonstrated similarities to entropy-related gray level co-occurrence matrix (GLCM) texture features, confirming the higher irregularity and complexity of thermal image texture when horses worked under heavy riders. An application of DispEn to red color components enables identification of the light and heavy rider groups with higher accuracy than the previously used entropy-related GLCM texture features.
Collapse
Affiliation(s)
- Małgorzata Domino
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland; (Ł.Z.); (T.J.)
- Correspondence: (M.D.); (M.M.)
| | - Marta Borowska
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Białystok University of Technology, 15-351 Bialystok, Poland;
| | - Łukasz Zdrojkowski
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland; (Ł.Z.); (T.J.)
| | - Tomasz Jasiński
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland; (Ł.Z.); (T.J.)
| | - Urszula Sikorska
- Department of Animal Breeding, Institute of Animal Science, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| | - Michał Skibniewski
- Department of Morphological Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-776 Warsaw, Poland;
| | - Małgorzata Maśko
- Department of Animal Breeding, Institute of Animal Science, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
- Correspondence: (M.D.); (M.M.)
| |
Collapse
|
12
|
Rovers FJ, Van Netten JJ, Busch-Westbroek TE, Aan de Stegge WB, Bus SA. Adherence to at-Home Monitoring of Foot Temperatures in People with Diabetes at High Risk of Ulceration. INT J LOW EXTR WOUND 2022:15347346221114565. [PMID: 35840892 DOI: 10.1177/15347346221114565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P < .001). Of 83 participants with a hotspot, 24 (28.9%) reduced ambulatory activity. Increasing age (P = .021, OR = 1.045) and better self-care (P = .007, OR = 1.513) were positively associated with adherence to measuring foot temperature. In conclusion, in people at high diabetes-related foot ulcer risk, adherence to measuring foot temperature was high in the first months after study commencing, but dropped over time. Adherence to reducing ambulatory activity when a hotspot was found was low over the entire study period.
Collapse
Affiliation(s)
- F J Rovers
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - J J Van Netten
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - T E Busch-Westbroek
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - W B Aan de Stegge
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - S A Bus
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Xiao M, Tian F, Liu X, Zhou Q, Pan J, Luo Z, Yang M, Yi C. Virus Detection: From State-of-the-Art Laboratories to Smartphone-Based Point-of-Care Testing. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105904. [PMID: 35393791 PMCID: PMC9110880 DOI: 10.1002/advs.202105904] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/27/2022] [Indexed: 05/07/2023]
Abstract
Infectious virus outbreaks pose a significant challenge to public healthcare systems. Early and accurate virus diagnosis is critical to prevent the spread of the virus, especially when no specific vaccine or effective medicine is available. In clinics, the most commonly used viral detection methods are molecular techniques that involve the measurement of nucleic acids or proteins biomarkers. However, most clinic-based methods require complex infrastructure and expensive equipment, which are not suitable for low-resource settings. Over the past years, smartphone-based point-of-care testing (POCT) has rapidly emerged as a potential alternative to laboratory-based clinical diagnosis. This review summarizes the latest development of virus detection. First, laboratory-based and POCT-based viral diagnostic techniques are compared, both of which rely on immunosensing and nucleic acid detection. Then, various smartphone-based POCT diagnostic techniques, including optical biosensors, electrochemical biosensors, and other types of biosensors are discussed. Moreover, this review covers the development of smartphone-based POCT diagnostics for various viruses including COVID-19, Ebola, influenza, Zika, HIV, et al. Finally, the prospects and challenges of smartphone-based POCT diagnostics are discussed. It is believed that this review will aid researchers better understand the current challenges and prospects for achieving the ultimate goal of containing disease-causing viruses worldwide.
Collapse
Affiliation(s)
- Meng Xiao
- Guangdong Provincial Key Laboratory of Sensing Technology and Biomedical Instrument, School of Biomedical EngineeringShenzhen Campus of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| | - Feng Tian
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHunghomHong Kong999077P. R. China
| | - Xin Liu
- Guangdong Provincial Key Laboratory of Sensing Technology and Biomedical Instrument, School of Biomedical EngineeringShenzhen Campus of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| | - Qiaoqiao Zhou
- Guangdong Provincial Key Laboratory of Sensing Technology and Biomedical Instrument, School of Biomedical EngineeringShenzhen Campus of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| | - Jiangfei Pan
- Guangdong Provincial Key Laboratory of Sensing Technology and Biomedical Instrument, School of Biomedical EngineeringShenzhen Campus of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| | - Zhaofan Luo
- Department of Clinical LaboratoryThe Seventh Affiliated Hospital of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| | - Mo Yang
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHunghomHong Kong999077P. R. China
| | - Changqing Yi
- Guangdong Provincial Key Laboratory of Sensing Technology and Biomedical Instrument, School of Biomedical EngineeringShenzhen Campus of Sun Yat‐Sen UniversityShenzhen518107P. R. China
| |
Collapse
|
14
|
Li N, Fei X, Li C, Zhao T, Jin H, Chen H. A Rat Model of Esophagogastric Anastomotic Stricture. Eur Surg Res 2022; 63:294-301. [PMID: 35605582 DOI: 10.1159/000525168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/11/2022] [Indexed: 01/31/2023]
Abstract
Esophagogastric anastomosis stricture is one of the most common postoperative complications after esophagectomy; yet, its pathogenesis is still not fully understood, and the treatment and prevention of anastomotic stricture are limited due to the lack of a proper animal model. The insufficient blood supply in the gastric tube is considered a risk factor for postoperative anastomotic strictures. In this study, we used thermal imaging to develop a stable rodent model with esophagogastric anastomotic stricture caused by ischemia. Briefly, 30 male Sprague-Dawley rats have been divided into the control group and the ischemia group. The esophagogastric ischemia anastomosis was performed with the help of intraoperative thermal imaging to identify the poor perfusion area. An unpaired t test with Welch's correction was used to analyze the difference between the two groups. On postoperative day 84, in the control group, no anastomosis stricture was observed, while in the ischemia group, 12 out of 15 animals (80%) developed obvious anastomosis stricture which could not let a 2.7-mm endoscope pass through. The diameter of the anastomosis in the control group and the ischemia group were 2.80 ± 0.15 mm and 1.73 ± 0.44 mm (p < 0.01), respectively (evaluated by endoscopy examination and barium radiography). H&E stain and Masson's trichrome showed that the anastomosis in the ischemia group had more connective tissue hyperplasia and collagen deposition than control group. Thus, this new rat model can be used as a platform to further investigate the potential interventions for prevention of esophagogastric anastomotic stricture.
Collapse
Affiliation(s)
- Nan Li
- Department of Thoracic and Cardiac Surgery, Changhai Hospital, Shanghai, China
| | - Xiang Fei
- Department of Thoracic and Cardiac Surgery, Changhai Hospital, Shanghai, China
| | - Chunguang Li
- Department of Thoracic and Cardiac Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Tiejun Zhao
- Department of Thoracic and Cardiac Surgery, Changhai Hospital, Shanghai, China
| | - Hai Jin
- Department of Thoracic and Cardiac Surgery, Changhai Hospital, Shanghai, China
| | - Hezhong Chen
- Department of Thoracic and Cardiac Surgery, Changhai Hospital, Shanghai, China
| |
Collapse
|
15
|
Pereyra Irujo G. IRimage: open source software for processing images from infrared thermal cameras. PeerJ Comput Sci 2022; 8:e977. [PMID: 35634096 PMCID: PMC9138121 DOI: 10.7717/peerj-cs.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
IRimage aims at increasing throughput, accuracy and reproducibility of results obtained from thermal images, especially those produced with affordable, consumer-oriented cameras. IRimage processes thermal images, extracting raw data and calculating temperature values with an open and fully documented algorithm, making this data available for further processing using image analysis software. It also allows the making of reproducible measurements of the temperature of objects in a series of images, and produce visual outputs (images and videos) suitable for scientific reporting. IRimage is implemented in a scripting language of the scientific image analysis software ImageJ, allowing its use through a graphical user interface and also allowing for an easy modification or expansion of its functionality. IRimage's results were consistent with those of standard software for 15 camera models of the most widely used brand. An example use case is also presented, in which IRimage was used to efficiently process hundreds of thermal images to reveal subtle differences in the daily pattern of leaf temperature of plants subjected to different soil water contents. IRimage's functionalities make it better suited for research purposes than many currently available alternatives, and could contribute to making affordable consumer-grade thermal cameras useful for reproducible research.
Collapse
Affiliation(s)
- Gustavo Pereyra Irujo
- Instituto Nacional de Tecnología Agropecuaria (INTA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Balcarce, Buenos Aires, Argentina
| |
Collapse
|
16
|
Bellomo TR, Lee S, McCarthy M, Tong KPS, Ferreira SS, Cheung TP, Rose-Sauld S. Management of the Diabetic Foot. Semin Vasc Surg 2022; 35:219-227. [DOI: 10.1053/j.semvascsurg.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
|
17
|
Domino M, Borowska M, Kozłowska N, Trojakowska A, Zdrojkowski Ł, Jasiński T, Smyth G, Maśko M. Selection of Image Texture Analysis and Color Model in the Advanced Image Processing of Thermal Images of Horses following Exercise. Animals (Basel) 2022; 12:ani12040444. [PMID: 35203152 PMCID: PMC8868218 DOI: 10.3390/ani12040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Detecting horse state after exercise is critical for maximizing athletic performance. The horse’s response to fatigue includes exercise termination or exercise continuation at a lower intensity, which significantly limit the results achieved in races and equestrian competition. As conventional methods of detecting and quantifying exercise effort have shown some limitations, infrared thermography was proposed as a method of contactless detection of exercise effect. The promising correlation between body surface temperature and exercise-dependent blood biomarkers has been demonstrated. As the application of conventional thermography is limited by low specificity, advanced thermal image analysis was proposed here to visualize the link between blood biomarkers and texture of thermal images. Twelve horses underwent standardized exercise tests for six consecutive days, and both thermal images and blood samples were collected before and after each test. The images were analyzed using four color models (RGB, red-green-blue; YUV, brightness-UV-components; YIQ, brightness-IQ-components; HSB, hue-saturation-brightness) and eight texture-features approaches, including 88 features in total. In contrast to conventional temperature measures, as many as twelve texture features in two color models (RGB, YIQ) were linked with blood biomarker levels as part of the horse’s response to exercise. Abstract As the detection of horse state after exercise is constantly developing, a link between blood biomarkers and infrared thermography (IRT) was investigated using advanced image texture analysis. The aim of the study was to determine which combinations of RGB (red-green-blue), YUI (brightness-UV-components), YIQ (brightness-IQ-components), and HSB (hue-saturation-brightness) color models, components, and texture features are related to the blood biomarkers of exercise effect. Twelve Polish warmblood horses underwent standardized exercise tests for six consecutive days. Both thermal images and blood samples were collected before and after each test. All 144 obtained IRT images were analyzed independently for 12 color components in four color models using eight texture-feature approaches, including 88 features. The similarity between blood biomarker levels and texture features was determined using linear regression models. In the horses’ thoracolumbar region, 12 texture features (nine in RGB, one in YIQ, and two in HSB) were related to blood biomarkers. Variance, sum of squares, and sum of variance in the RGB were highly repeatable between image processing protocols. The combination of two approaches of image texture (histogram statistics and gray-level co-occurrence matrix) and two color models (RGB, YIQ), should be considered in the application of digital image processing of equine IRT.
Collapse
Affiliation(s)
- Małgorzata Domino
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Marta Borowska
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Białystok University of Technology, 15-351 Bialystok, Poland;
| | - Natalia Kozłowska
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Anna Trojakowska
- The Scientific Society of Veterinary Medicine Students, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland;
| | - Łukasz Zdrojkowski
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
- Correspondence: (Ł.Z.); (M.M.)
| | - Tomasz Jasiński
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Graham Smyth
- Menzies Health Institute Queensland, Griffith University School of Medicine, Southport, QLD 4222, Australia;
| | - Małgorzata Maśko
- Department of Animal Breeding, Institute of Animal Science, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland
- Correspondence: (Ł.Z.); (M.M.)
| |
Collapse
|
18
|
Solutions for Exposed Structural Concrete Bridged Elements for a More Sustainable Concrete Construction in Hot Climates. BUILDINGS 2022. [DOI: 10.3390/buildings12020176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
New energy-efficiency regulations have been established and applied in many Gulf countries to improve building energy performance. Thermal bridging reduces the building envelop performance, and this is not a focus of these regulations. This paper investigates the concrete construction of residential housing in hot climates and identifies more sustainable concrete construction methods. Both experimental and numerical methods are used to identify the impact of thermal bridging. Using finite element analysis, the impact of solar radiation on a building’s thermal bridging was analyzed. It is identified as an essential element for accurate modelling of bridging across concrete in a hot climate. The FE model was evaluated against monitored data and assessed using common statistical indicators. The results show that the heat loss across uninsulated cast in situ structural elements is more than double the heat loss across portions of insulated walls. Moreover, neglecting solar radiation on the westerly façade can result in errors of >50%. Additionally, the impact of thermal bridging is increasingly evident when accounting for solar radiation. Modelling studies show that the impact of thermal bridging could be reduced by up to 73% by covering the structural elements with external insulation. Compliance with the various codes of the different Gulf states can be achieved through externally insulating with between 40 and 80 mm, and this is shown to have wide-ranging benefits in enhancing building energy efficiency.
Collapse
|
19
|
Domino M, Borowska M, Trojakowska A, Kozłowska N, Zdrojkowski Ł, Jasiński T, Smyth G, Maśko M. The Effect of Rider:Horse Bodyweight Ratio on the Superficial Body Temperature of Horse's Thoracolumbar Region Evaluated by Advanced Thermal Image Processing. Animals (Basel) 2022; 12:195. [PMID: 35049815 PMCID: PMC8772910 DOI: 10.3390/ani12020195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 01/17/2023] Open
Abstract
Appropriate matching of rider-horse sizes is becoming an increasingly important issue of riding horses' care, as the human population becomes heavier. Recently, infrared thermography (IRT) was considered to be effective in differing the effect of 10.6% and 21.3% of the rider:horse bodyweight ratio, but not 10.1% and 15.3%. As IRT images contain many pixels reflecting the complexity of the body's surface, the pixel relations were assessed by image texture analysis using histogram statistics (HS), gray-level run-length matrix (GLRLM), and gray level co-occurrence matrix (GLCM) approaches. The study aimed to determine differences in texture features of thermal images under the impact of 10-12%, >12 ≤15%, >15 <18% rider:horse bodyweight ratios, respectively. Twelve horses were ridden by each of six riders assigned to light (L), moderate (M), and heavy (H) groups. Thermal images were taken pre- and post-standard exercise and underwent conventional and texture analysis. Texture analysis required image decomposition into red, green, and blue components. Among 372 returned features, 95 HS features, 48 GLRLM features, and 96 GLCH features differed dependent on exercise; whereas 29 HS features, 16 GLRLM features, and 30 GLCH features differed dependent on bodyweight ratio. Contrary to conventional thermal features, the texture heterogeneity measures, InvDefMom, SumEntrp, Entropy, DifVarnc, and DifEntrp, expressed consistent measurable differences when the red component was considered.
Collapse
Affiliation(s)
- Małgorzata Domino
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Marta Borowska
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Białystok University of Technology, 15-351 Bialystok, Poland;
| | - Anna Trojakowska
- The Scientific Society of Veterinary Medicine Students, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| | - Natalia Kozłowska
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Łukasz Zdrojkowski
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Tomasz Jasiński
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland; (M.D.); (N.K.); (T.J.)
| | - Graham Smyth
- Menzies Health Institute Queensland, Griffith University School of Medicine, Southport, QLD 4222, Australia;
| | - Małgorzata Maśko
- Department of Animal Breeding, Institute of Animal Science, Warsaw University of Life Sciences (WULS–SGGW), 02-787 Warsaw, Poland
| |
Collapse
|
20
|
Hyperbaric Oxygen Therapy in Management of Diabetic Foot Ulcers: Indocyanine Green Angiography May Be Used as a Biomarker to Analyze Perfusion and Predict Response to Treatment. Plast Reconstr Surg 2021; 149:346e-347e. [PMID: 34965220 DOI: 10.1097/prs.0000000000008758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Featherston J, Wijlens AM, van Netten JJ. Is a Left-to-Right >2.2°C Difference a Valid Measurement to Predict Diabetic Foot Ulceration in People with Diabetes and a History of Diabetic Foot Ulceration? INT J LOW EXTR WOUND 2021:15347346211062719. [PMID: 34923865 DOI: 10.1177/15347346211062719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Monitoring foot skin temperatures at home have been shown to be effective at preventing the occurrence of diabetic foot ulcers. In this study, the construct validity of using >2.2°C difference between contralateral areas on the foot as a warning sign of imminent ulceration is explored. Thirty participants with diabetes at high risk of ulceration (loss of protective sensation and previous ulceration and/or amputation) monitored their foot temperatures at six sites, four times a day for six days using a handheld infrared thermometer. Walking activity, time of day, and environmental temperature were also monitored and correlated with foot temperatures. We found that contralateral mean skin temperature difference was 0.78°C at baseline. At single sites, left-to-right temperature differences exceeding the threshold were found in 9.6% of measurements (n = 365), which reduced to 0.4% when individually corrected and confirmed the next day. No correlation was found between contralateral temperature differences and activity, time of day, and environmental temperature. We conclude that using a >2.2°C difference is invalid as a single measurement in people at high risk of ulceration, but the construct validity is appropriate if both individual corrections and next day confirmation are applied.
Collapse
Affiliation(s)
- Jill Featherston
- 2787St Vincent's Hospital, Sydney, Australia
- 2111Cardiff University School of Medicine, Cardiff, Wales, UK
| | - Anke M Wijlens
- Twentse Huisartsen Onderneming Oost Nederland, Hengelo, the Netherlands
| | - Jaap J van Netten
- School of Public Health and Social Work, 1969Queensland University of Technology, Brisbane, Queensland, Australia
- 1234University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| |
Collapse
|
22
|
Yavuz E, Kürümlüoğlu H, Zengin S, Eren ŞH, Karaduman E, Yeşildağ CÖ, Al B, Yıldırım C. Use of infrared thermal camera in acute scrotal pain: a prospective study. IMC JOURNAL OF MEDICAL SCIENCE 2021. [DOI: 10.55010/imcjms.16.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and objectives: Infrared thermal (IR) camera is used to assess various clinical conditions such as diabetic foot, carotid artery stenosis, and superficial infection. The present study was designed to determine the usefulness of IR thermal camera in scrotal temperature measurement before color Doppler ultrasonography (CDUS) in patients admitted to the emergency department with acute scrotal pain.
Method: This study was prospectively conducted on 49 patients with acute scrotal pain and 30 control participants. The findings of CDUS and scrotal temperature measurements by an IR camera were separately evaluated by different physicians. In all patients, temperature measurements with IR camera were made under the same environmental conditions.
Results: Of the 49 patients included in the study, four were diagnosed with torsion, 12 with epididymitis, 4 with orchitis, 3 with epididymo-orchitis, and 2 with varicocele. A significant difference was observed between the scrotal temperature of the patients with scrotal pain and the mean testicular temperature of the control group based on the IR camera measurement (p<0.05). IR camera did not detect any difference between the two testicles of the same person in the patient group (p=0.615). Although the lowest temperature was in testicular torsion, the patients’ scrotal temperature did not significantly differ according to their diagnoses (p=0.087).
Conclusion: Testicular temperature measured by IR device was lower in patients presenting with scrotal pain compared to normal individuals. Although not statistically significant, the lowest temperature was found in cases of testicular torsion. IR camera may be useful in triage when used in conjunction with physical examination in patients presenting with acute scrotal pain.
IMC J Med Sci 2022; 16(1): 007
*Correspondence: Erdal Yavuz, Department of Emergency Medicine, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey. Email: erdal_yavuz15@hotmail.com, Orcid: 0000-0002-3168-6469
Collapse
Affiliation(s)
- Erdal Yavuz
- Department of Emergency Medicine, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Hakan Kürümlüoğlu
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Suat Zengin
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Şevki Hakan Eren
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Esat Karaduman
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cuma Önder Yeşildağ
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Behçet Al
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cuma Yıldırım
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
23
|
Bus SA, Aan de Stegge WB, van Baal JG, Busch-Westbroek TE, Nollet F, van Netten JJ. Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial (DIATEMP). BMJ Open Diabetes Res Care 2021; 9:9/1/e002392. [PMID: 34493496 PMCID: PMC8424833 DOI: 10.1136/bmjdrc-2021-002392] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The skin of people with diabetic foot disease is thought to heat up from ambulatory activity before it breaks down into ulceration. This allows for early recognition of imminent ulcers. We assessed whether at-home monitoring of plantar foot skin temperature can help prevent ulcer recurrence in diabetes. RESEARCH DESIGN AND METHODS In this parallel-group outcome-assessor-blinded multicenter randomized controlled trial (7 hospitals, 4 podiatry practices), we randomly assigned people with diabetes, neuropathy, foot ulcer history (<4 years, n=295), or Charcot's neuro-arthropathy (n=9) to usual care (ie, podiatric treatment, education, and therapeutic footwear) or usual care plus measuring skin temperatures at 6-8 plantar sites per foot each day (enhanced therapy). If ∆T>2.2°C between corresponding sites on the left and right foot for two consecutive days, participants were instructed to reduce ambulatory activity until this hotspot disappeared and contact their podiatrist. Primary outcome was ulcer recurrence in 18 months on the plantar foot, interdigital, or medial/lateral/anterior forefoot surfaces; secondary outcome was ulcer recurrence at any foot site. RESULTS On the basis of intention-to-treat, 44 of 151 (29.1%) participants in enhanced therapy and 57 of 153 (37.3%) in usual care had ulcer recurrence at a primary outcome site (RR: 0.782 (95%CI 0.566 to 1.080), p=0.133). Of the 83 participants in enhanced therapy who measured a hotspot, the 24 subsequently reducing their ambulatory activity had significantly fewer ulcer recurrences (n=3) than those in usual care (RR: 0.336 (95% CI 0.114 to 0.986), p=0.017). Enhanced therapy was effective over usual care for ulcer recurrence at any foot site (RR: 0.760 (95% CI 0.579 to 0.997), p=0.046). CONCLUSIONS At-home foot temperature monitoring does not significantly reduce incidence of diabetic foot ulcer recurrence at or adjacent to measurement sites over usual care, unless participants reduce ambulatory activity when hotspots are found, or when aiming to prevent ulcers at any foot site. TRIAL REGISTRATION NUMBER NTR5403.
Collapse
Affiliation(s)
- Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Wouter B Aan de Stegge
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Jeff G van Baal
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Oe M, Tsuruoka K, Ohashi Y, Takehara K, Noguchi H, Mori T, Yamauchi T, Sanada H. Prevention of diabetic foot ulcers using a smartphone and mobile thermography: a case study. J Wound Care 2021; 30:116-119. [PMID: 33573481 DOI: 10.12968/jowc.2021.30.2.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Early identification of pre-ulcerative pathology is important to preventing diabetic foot ulcers (DFU), but signs of inflammation are difficult to detect on the feet of patients with diabetic neuropathy due to decreased sensation. However, infrared thermography can objectively identify inflammation. Therefore, a device that allows patients to visualise thermograms of their feet might be an effective way to prevent DFU. We aimed to determine the effects of a novel self-monitoring device to prevent DFU using a thermograph attached to a smartphone. METHOD A self-monitoring device comprising a mobile thermograph attached to a smartphone on a selfie stick was created, and its effects in two patients with diabetic neuropathy and foot calluses assessed. RESULTS For one patient, he understood that walking too much increased the temperature in the skin of his feet (a sign of inflammation). The other patient could not detect high-risk findings, because the temperature of his skin did not increase during the study period. CONCLUSION This device might provide self-care incentives to prevent DFU, although some issues, such as the automatic detection of high-risk thermographic changes, need to be improved.
Collapse
Affiliation(s)
- Makoto Oe
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kahori Tsuruoka
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Kimie Takehara
- School of Health Sciences, Graduate School of Medicine Department of Nursing, Nagoya University, Aichi, Japan
| | - Hiroshi Noguchi
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hiromi Sanada
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
25
|
The Concurrent Validity, Test-Retest Reliability and Usability of a New Foot Temperature Monitoring System for Persons with Diabetes at High Risk of Foot Ulceration. SENSORS 2021; 21:s21113645. [PMID: 34073853 PMCID: PMC8197257 DOI: 10.3390/s21113645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
At-home foot temperature monitoring may be useful in the early recognition of imminent foot ulcers that occur through biomechanical loading in people with diabetes. We assessed the concurrent validity, test–retest reliability, and usability of a new plantar foot temperature monitoring device in 50 people with diabetes and peripheral neuropathy. We compared plantar foot temperature measurements with a platform system that consists of embedded temperature sensors with those from a handheld infrared thermometer that was used as a reference. Repeated platform assessments were compared for test–retest reliability. Usability was assessed in 15 participants who used both devices daily for two weeks at home, after which they completed a questionnaire. Agreement between devices was excellent for the metatarsal heads and heel (ICCs ≥ 0.98, LOA: −0.89 °C; 1.16 °C) and hallux and lateral midfoot (0.93 ≤ ICC ≤ 0.96, LOA: −2.87 °C; 2.2 °C), good for digits 2–5 (0.75 ≤ ICC ≤ 0.88, LOA: −5.04 °C; 2.76 °C), and poor for the medial midfoot (ICC = 0.19, LOA: −8.21 °C; −0.05 °C). Test–retest reliability was high (ICC = 0.99, LOA: −0.59 °C; 1.35 °C). Participants scored between 3.8 and 4.3 on a 5-point Likert scale for willingness to measure, ease of use, measurement comfort, and duration. In conclusion, the platform shows good concurrent validity in foot regions where most ulcers occur, good test–retest reliability, and good usability for measuring plantar foot temperature. Further research should assess the clinical validity of the platform to help prevent plantar diabetic foot ulcers.
Collapse
|
26
|
Development of a Smartphone-Based Optical Device to Measure Hemoglobin Concentration Changes for Remote Monitoring of Wounds. BIOSENSORS-BASEL 2021; 11:bios11060165. [PMID: 34063972 PMCID: PMC8223975 DOI: 10.3390/bios11060165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 01/13/2023]
Abstract
Telemedicine (TM) can revolutionize the impact of diabetic wound care management, along with tools for remote patient monitoring (RPM). There are no low-cost mobile RPM devices for TM technology to provide comprehensive (visual and physiological) clinical assessments. Here, a novel low-cost smartphone-based optical imaging device has been developed to provide physiological measurements of tissues in terms of hemoglobin concentration maps. The device (SmartPhone Oxygenation Tool—SPOT) constitutes an add-on optical module, a smartphone, and a custom app to automate data acquisition while syncing a multi-wavelength near-infrared light-emitting diode (LED) light source (690, 810, 830 nm). The optimal imaging conditions of the SPOT device were determined from signal-to-noise maps. A standard vascular occlusion test was performed in three control subjects to observe changes in hemoglobin concentration maps between rest, occlusion, and release time points on the dorsal of the hand. Hemoglobin concentration maps were compared with and without applying an image de-noising algorithm, single value decomposition. Statistical analysis demonstrated that the hemoglobin concentrations changed significantly across the three-time stamps. Ongoing efforts are in imaging diabetic foot ulcers using the SPOT device to assess its potential as a smart health device for physiological monitoring of wounds remotely.
Collapse
|
27
|
Evaluation risk of diabetic foot ulcers (DFUs) using infrared thermography based on mobile phone as advanced risk assessment tool in the community setting: A multisite cross-sectional study. ENFERMERIA CLINICA 2021. [PMID: 32204210 DOI: 10.1016/j.enfcli.2019.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the risk of DFUs using infrared thermography based on the mobile phone as an advanced risk assessment tool in the community setting. METHOD A multisite cross-sectional study design involving one hundred DM patients in ten health centers in the city of Makassar. Temperature measurement in both feet is done using infrared thermography based on mobile phones in four zones of foot, namely Medial Plantar Artery (MPA), Lateral Plantar Artery (LPA), Medial Calcaneal Artery (MCA) and Lateral Calcaneal Artery (LCA). RESULTS The average foot temperature difference was 0.2-1.0°C between the risk groups in the International Working Group of Diabetic Foot (IWGDF) category (p=0.018). The risk zone for DFUs is MPA at risk 0 vs risk 1 (p=0.025), LPA (p=0.020) and MCA (p=0.017) at risk 1 vs risk 2B. CONCLUSION Thermography infrared based on the mobile phone can detect early differences in foot temperature within the risk groups.
Collapse
|
28
|
Alisi M, Al-Ajlouni J, Ibsais MK, Obeid Z, Hammad Y, Alelaumi A, Al-Saber M, Abuasbeh O, Abuhajleh F. Thermographic Assessment of Reperfusion Profile Following Using a Tourniquet in Total Knee Arthroplasty: A Prospective Observational Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:133-139. [PMID: 34007224 PMCID: PMC8122004 DOI: 10.2147/mder.s300726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Infrared thermal imaging is a non-invasive technique capable of detecting changes in temperature that could ultimately signify changes in blood supply. Flir One is a smartphone-based thermal camera, working by a downloadable application, capable of detecting the limb temperature through a non-contact method using infrared thermography technology. Using the Flir One camera, we will assess the lower limb reperfusion profile following the tourniquet release post total knee arthroplasty (TKA). Methods A prospective study included 46 patients who underwent primary TKA. We used the (Flir One Gen 3) thermographic camera to capture images at ankle joint preoperatively, and at 1, 10, and 20 minutes post tourniquet release on operation side. The contralateral ankle stands as control. Results The mean preoperative temperature (in Celsius) of ankle control side and operated side were 33.03 (SD=1.65) and 33.26 (SD=1.42), respectively. The mean ankle temperature on operation side was 19.73 (SD=2.85), 30.49 (SD=2), and 32.43 (SD=1.31) at 1, 10, and 20 minutes post tourniquet release, respectively, while the control side showed a mean temperature of 32.85 (SD=1.42), 32.84 (SD=0.91), and 33.15 (SD=0.95) at the same time intervals. There was a significant statistical difference between both ankle temperatures at 1 and 10 minutes (P=0.00 for each time). At 20 minutes, 37 ankles (80.4%) at operation side reached a temperature level similar but below the level of control side; however, the difference was not significant (P=0.692). Conclusion Infrared thermography using the smartphone-connected camera is a simple, non-invasive, feasible, and reliable technology. It provides an objective measure to assess the perfusion status of the limbs. In TKA, the distal limb will reach full reperfusion status after approximately 20 minutes of tourniquet release.
Collapse
Affiliation(s)
- Mohammed Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Jihad Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zeinab Obeid
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Alelaumi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Munther Al-Saber
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Odai Abuasbeh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Feras Abuhajleh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| |
Collapse
|
29
|
A Non-Invasive Photonics-Based Device for Monitoring of Diabetic Foot Ulcers: Architectural/Sensorial Components & Technical Specifications. INVENTIONS 2021. [DOI: 10.3390/inventions6020027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper proposes a new photonic-based non-invasive device for managing of Diabetic Foot Ulcers (DFUs) for people suffering from diabetes. DFUs are one of the main severe complications of diabetes, which may lead to major disabilities, such as foot amputation, or even to the death. The proposed device exploits hyperspectral (HSI) and thermal imaging to measure the status of an ulcer, in contrast to the current practice where invasive biopsies are often applied. In particular, these two photonic-based imaging techniques can estimate the biomarkers of oxyhaemoglobin (HbO2) and deoxyhaemoglobin (Hb), through which the Peripheral Oxygen Saturation (SpO2) and Tissue Oxygen Saturation (StO2) is computed. These factors are very important for the early prediction and prognosis of a DFU. The device is implemented at two editions: the in-home edition suitable for patients and the PRO (professional) edition for the medical staff. The latter is equipped with active photonic tools, such as tuneable diodes, to permit detailed diagnosis and treatment of an ulcer and its progress. The device is enriched with embedding signal processing tools for noise removal and enhancing pixel accuracy using super resolution schemes. In addition, a machine learning framework is adopted, through deep learning structures, to assist the doctors and the patients in understanding the effect of the biomarkers on DFU. The device is to be validated at large scales at three European hospitals (Charité–University Hospital in Berlin, Germany; Attikon in Athens, Greece, and Victor Babes in Timisoara, Romania) for its efficiency and performance.
Collapse
|
30
|
Hunt B, Ruiz AJ, Pogue BW. Smartphone-based imaging systems for medical applications: a critical review. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200421VR. [PMID: 33860648 PMCID: PMC8047775 DOI: 10.1117/1.jbo.26.4.040902] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/29/2021] [Indexed: 05/15/2023]
Abstract
SIGNIFICANCE Smartphones come with an enormous array of functionality and are being more widely utilized with specialized attachments in a range of healthcare applications. A review of key developments and uses, with an assessment of strengths/limitations in various clinical workflows, was completed. AIM Our review studies how smartphone-based imaging (SBI) systems are designed and tested for specialized applications in medicine and healthcare. An evaluation of current research studies is used to provide guidelines for improving the impact of these research advances. APPROACH First, the established and emerging smartphone capabilities that can be leveraged for biomedical imaging are detailed. Then, methods and materials for fabrication of optical, mechanical, and electrical interface components are summarized. Recent systems were categorized into four groups based on their intended application and clinical workflow: ex vivo diagnostic, in vivo diagnostic, monitoring, and treatment guidance. Lastly, strengths and limitations of current SBI systems within these various applications are discussed. RESULTS The native smartphone capabilities for biomedical imaging applications include cameras, touchscreens, networking, computation, 3D sensing, audio, and motion, in addition to commercial wearable peripheral devices. Through user-centered design of custom hardware and software interfaces, these capabilities have the potential to enable portable, easy-to-use, point-of-care biomedical imaging systems. However, due to barriers in programming of custom software and on-board image analysis pipelines, many research prototypes fail to achieve a prospective clinical evaluation as intended. Effective clinical use cases appear to be those in which handheld, noninvasive image guidance is needed and accommodated by the clinical workflow. Handheld systems for in vivo, multispectral, and quantitative fluorescence imaging are a promising development for diagnostic and treatment guidance applications. CONCLUSIONS A holistic assessment of SBI systems must include interpretation of their value for intended clinical settings and how their implementations enable better workflow. A set of six guidelines are proposed to evaluate appropriateness of smartphone utilization in terms of clinical context, completeness, compactness, connectivity, cost, and claims. Ongoing work should prioritize realistic clinical assessments with quantitative and qualitative comparison to non-smartphone systems to clearly demonstrate the value of smartphone-based systems. Improved hardware design to accommodate the rapidly changing smartphone ecosystem, creation of open-source image acquisition and analysis pipelines, and adoption of robust calibration techniques to address phone-to-phone variability are three high priority areas to move SBI research forward.
Collapse
Affiliation(s)
- Brady Hunt
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Address all correspondence to Brady Hunt,
| | - Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| |
Collapse
|
31
|
Abstract
Human society is experiencing a serious aging process. Age-related arteriosclerotic cardiovascular diseases (ASCVD) are the most common cause of deaths around the world and bring a huge burden on the whole society. Vascular aging-related pathological alterations of the vasculature play an important role in the pathogenesis of ASCVD and morbidity and mortality of older adults. In this review, we describe the progress of clinical evaluation of vascular aging in humans, including functional evaluation, structural assessment, and cellular molecular markers. The significance of detection for vascular aging is highlighted, and we call for close attention to the evaluation for a better quality of life in the elderly population.
Collapse
|
32
|
Valga F, Monzón T, Henriquez F, Anton-Pérez G. Valoración del orificio de inserción del catéter tunelizado para hemodiálisis mediante el uso de cámara térmica acoplada a smartphone: estudio piloto. Nefrologia 2020; 40:673-674. [DOI: 10.1016/j.nefro.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 11/25/2022] Open
|
33
|
Fankhauser N, Kalberer N, Müller F, Leles CR, Schimmel M, Srinivasan M. Comparison of smartphone-camera and conventional flatbed scanner images for analytical evaluation of chewing function. J Oral Rehabil 2020; 47:1496-1502. [PMID: 32966643 DOI: 10.1111/joor.13094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The two-colour mixing test is a quick method to assess chewing function (CF). The use of smartphone cameras for acquiring images may help in further simplifying the process. OBJECTIVE This study evaluated the reliability of smartphone-camera images of chewing gums to assess CF. METHODS Five test samples of a bicoloured chewing gum were produced by a single fully dentate adult volunteer. The specimens were flattened to 1-mm thick wafers. The two sides of the wafers were digitised with a conventional flatbed scanner (control) and were photographed 20 times using 8 different smartphones. The images were assessed optoelectronically to obtain the variance of hue (VoH) and subjectively by visual assessment (SA) using a categorical scale (SA1-SA5). Spearman's correlation and regression models were used for statistical analyses. RESULTS The intra-group variability for SA1-SA3 was <1% for all smartphones, but significantly higher than controls for SA4 and SA5 (smartphone: SA4 = 5.57%; SA5 = 8.76%; control: SA4 = 2.5%; SA5 = 0.79%). VoH was progressively lower from SA1 to SA5 for all imaging devices (r > -.97; P < .001). VoH comparisons between control and smartphone images revealed significant differences for the individual SA categories, and however, the magnitude of differences was small and non-significant when the full range of SA levels were considered. The linear mixed model regression showed significant effects for all the smartphones (P < .001) and SA levels (P < .001) in relation to the flatbed scanner values. CONCLUSIONS Smartphone cameras may be used to evaluate colour mixture for a bolus-kneading test, however, the precision is lower with higher degrees of colour mixing.
Collapse
Affiliation(s)
- Nicolas Fankhauser
- Clinic of General, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Kalberer
- Clinic of General, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio R Leles
- Department of Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Brazil
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Murali Srinivasan
- Clinic of General, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
34
|
Validation of a Rapid Bronchoalveolar Lavage Fluid Colorimetric Evaluation for Assessing the Severity of Exercise-Induced Pulmonary Hemorrhage in Horses in Field Conditions. J Equine Vet Sci 2020; 95:103284. [PMID: 33276915 DOI: 10.1016/j.jevs.2020.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/22/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
Diagnosis and assessment of severity of exercise-induced pulmonary hemorrhage (EIPH) relies on postexercise visualization of fresh blood in the airways via tracheobronchoscopic examination (TBE) and/or counting erythrocytes in bronchoalveolar lavage fluid (BALFRBC). Determining the BALFRBC is more sensitive than TBE but its usefulness is hampered by the need to have BALFRBC counted at a laboratory. We explored the feasibility of evaluating the severity of EIPH by using a color chart comprised of five shades of red and matching those colors with the color of BALF immediately following collection. To validate the technique, sets of ten BALF samples with known BALFRBC numbers were created and randomly shown to two groups of 18 observers who independently matched the color of the BALF with one of the shades of red displayed on the screen of a smartphone. Interobserver and intra-observer agreements regarding colors were > 0.9. The utility of the color chart was further validated under field conditions at two barrel racing events where 63 BALF samples were collected from 21 horses and BALF color was graded independently by three observers. The number of BALFRBC in the 63 samples ranged from 25-1,100,000/μL. EIPH was diagnosed in 39 samples based on the detection of color, and all 5 colors were matched multiple times with BALF samples. Overall, the color of the BALF was related to the number of BALFRBC. Colorimetric evaluation of BALF represents a practical and reliable option for rapid postexercise assessment of the presence and severity of EIPH.
Collapse
|
35
|
Golledge J, Fernando M, Lazzarini P, Najafi B, G. Armstrong D. The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4527. [PMID: 32823514 PMCID: PMC7491197 DOI: 10.3390/s20164527] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.
Collapse
Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland 4814, Australia
| | - Malindu Fernando
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4000, Australia;
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland 4006, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90089, USA;
| |
Collapse
|
36
|
Alahakoon C, Fernando M, Galappaththy C, Matthews EO, Lazzarini P, Moxon JV, Golledge J. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020; 37:1266-1279. [PMID: 32426872 DOI: 10.1111/dme.14323] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim of this study was to perform an up-to-date systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of home foot temperature monitoring, patient education and offloading footwear in reducing the incidence of diabetes-related foot ulcers. METHODS A literature search was performed using MEDLINE, PubMed, CINAHL, Scopus and Cochrane databases to identify relevant original studies. Meta-analyses were performed using intention-to-treat principals for worst (main analysis) and best (sub-analysis) case scenarios. Leave-one-out sensitivity analyses were used to assess the consistency of findings. RESULTS Of 7575 unique records, 17 RCTs involving 2729 participants were included. Four tested home foot temperature monitoring (n = 468), six examined patient education (n = 823) and seven assessed offloading footwear (n = 1438). Participants' who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823). Sensitivity analyses suggested that offloading footwear findings were consistent, but home foot temperature findings were dependent on the individual inclusion of one trial. All RCTs had either high or unclear risk of bias. CONCLUSION This meta-analysis suggests that offloading footwear is effective in reducing the incidence of diabetes-related foot ulcers. Home foot temperature monitoring also appears beneficial but larger trials are needed (PROSPERO registration no.: CRD42019135226).
Collapse
Affiliation(s)
- C Alahakoon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Fernando
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - C Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
| | - E O Matthews
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
| | - P Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - J V Moxon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - J Golledge
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
| |
Collapse
|
37
|
Hutting KH, aan de Stegge WB, Kruse RR, van Baal JG, Bus SA, van Netten JJ. Infrared thermography for monitoring severity and treatment of diabetic foot infections. VASCULAR BIOLOGY (BRISTOL, ENGLAND) 2020; 2:1-10. [PMID: 32935076 PMCID: PMC7487596 DOI: 10.1530/vb-20-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
Monitoring of diabetic foot infections is largely based on clinical assessment, which is limited by moderate reliability. We conducted a prospective study to explore monitoring of thermal asymmetry (difference between mean plantar temperature of the affected and unaffected foot) for the assessment of severity of diabetic foot infections. In patients with moderate or severe diabetic foot infections (International Working Group on the Diabetic Foot infection-grades 3 or 4) we measured thermal asymmetry with an advanced infrared thermography setup during the first 4-5 days of in-hospital treatment, in addition to clinical assessments and tests of serum inflammatory markers (white blood cell counts and C-reactive protein levels). We assessed the change in thermal asymmetry from baseline to final assessment, and investigated its association with infection-grades and serum inflammatory markers. In seven included patients, thermal asymmetry decreased from median 1.8°C (range: -0.6 to 8.4) at baseline to 1.5°C (range: -0.1 to 5.1) at final assessment (P = 0.515). In three patients who improved to infection-grade 2, thermal asymmetry at baseline (median 1.6°C (range: -0.6 to 1.6)) and final assessment (1.5°C (range: 0.4 to 5.1)) remained similar (P = 0.302). In four patients who did not improve to infection-grade 2, thermal asymmetry decreased from median 4.3°C (range: 1.8 to 8.4) to 1.9°C (range: -0.1 to 4.4; P = 0.221). No correlations were found between thermal asymmetry and infection-grades (r = -0.347; P = 0.445), CRP-levels (r = 0.321; P = 0.482) or WBC (r = -0.250; P = 0.589) during the first 4-5 days of hospitalization. Based on these explorative findings we suggest that infrared thermography is of no value for monitoring diabetic foot infections during in-hospital treatment.
Collapse
Affiliation(s)
- Kor H Hutting
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
| | - Wouter B aan de Stegge
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rombout R Kruse
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
| | - Jeff G van Baal
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun, UK
| | - Sicco A Bus
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jaap J van Netten
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| |
Collapse
|
38
|
Rinkel WD, Fakkel TM, Castro Cabezas M, Birnie E, Coert JH. (Cost-)effectiveness of lower extremity nerve decompression surgery in subjects with diabetes: the DeCompression (DECO) trial-study protocol for a randomised controlled trial. BMJ Open 2020; 10:e035644. [PMID: 32341044 PMCID: PMC7204866 DOI: 10.1136/bmjopen-2019-035644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The peripheral nerves of patients with diabetes are often pathologically swollen, which results in entrapment at places of anatomical narrowing. This results in nerve dysfunction. Surgical treatment of compression neuropathies in the lower extremities (lower extremity nerve decompression (LEND)) results in relief of symptoms and gain in peripheral nerve function, which may lead to less sensory loss (short term) and less associated detrimental effects including foot ulceration and amputations, and lower costs (long term). The aim of the DeCompression trial is to evaluate the effectiveness and (cost-)effectiveness of surgical decompression of compressed lower extremity nerves (LEND surgery) compared with patients treated with conventional (non-surgical) care. METHODS AND ANALYSIS A stratified randomised (1 to 1) controlled trial comparing LEND surgery (intervention) with conventional non-surgical care (control strategy) in subjects with diabetes with problems of neuropathy due to compression neuropathies in the lower extremity. Randomisation is stratified for participating hospital (n=11) and gender. Patients and controls have the same follow-up at 1.5, 3, 6, 9, 12, 18, 24 and 48 months. Participants (n=344) will be recruited in 12 months and enrolled in all affiliated hospitals in which they receive both the intervention or conventional non-surgical care and follow-up. Outcome assessors are blinded to group assignment. PRIMARY OUTCOME disease-specific quality of life (Norfolk Quality of Life Questionnaire-Diabetic Neuropathy). SECONDARY OUTCOMES health-related quality of life (EuroQoL 5-dimension 5-level (EQ-5D5L), 36-item Short Form (SF-36)), plantar sensation (Rotterdam Diabetic Foot Test Battery), incidence of ulcerations/amputations, resource use and productivity loss (Medical Cost Questionnaire, Productivity Cost Questionnaire) during follow-up. The incremental cost-effectiveness ratio will be estimated on the basis of the collected empirical data and a cost-utility model. ETHICS AND DISSEMINATION Ethics approval has been granted by the Medical Research Ethics Committee of Utrecht University Medical Center (reference: NL68312.041.19v5, protocol number: 19-335/M). Dissemination of results will be via journal articles and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NetherlandsTrial Registry NL7664.
Collapse
Affiliation(s)
- Willem D Rinkel
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Tirzah M Fakkel
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - J Henk Coert
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
39
|
Najafi B, Reeves ND, Armstrong DG. Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3239. [PMID: 31909547 DOI: 10.1002/dmrr.3239] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 11/12/2022]
Abstract
The prevalent and long neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. Management of the DFU is multifaceted and requires constant monitoring from patients, caregivers, and healthcare providers. The alarmingly high rates of recurrence of ulcerations in the diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. Our efforts should be directed not only on healing of open wounds, but also on maximizing ulcer-free days for the patient in diabetic foot remission. The increasing development and use of technology within every aspect of our lives represents an opportunity for creative solutions to prevent or better manage this devastating condition. In particular, recent advances in wearable and mobile health technologies appear to show promise in measuring and modulating dangerous foot pressure and inflammation to extend remission and improve the quality of life for these most complex patients. This review article discusses how harnessing wearables and digital technologies may improve the management and optimize prevention of DFUs by identifying high-risk patients for triage and timely intervention, personalizing prescription of offloading, and improving adherence to protective footwear. While still in their infancy, we envisage a future network of skin-worn, jewellery-worn, and implantable sensors that, if allowed to effectively communicate with one another and the patient, could dramatically impact measuring, personalizing, and managing how we and the patients we serve move through our collective world.
Collapse
Affiliation(s)
- Bijan Najafi
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Neil D Reeves
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| |
Collapse
|
40
|
van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3270. [PMID: 31957213 DOI: 10.1002/dmrr.3270] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022]
Abstract
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
Collapse
Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS - Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
41
|
van Doremalen RFM, van Netten JJ, van Baal JG, Vollenbroek-Hutten MMR, van der Heijden F. Infrared 3D Thermography for Inflammation Detection in Diabetic Foot Disease: A Proof of Concept. J Diabetes Sci Technol 2020; 14:46-54. [PMID: 31200612 PMCID: PMC7189170 DOI: 10.1177/1932296819854062] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Thermal assessment of the plantar surface of the foot using spot thermometers and thermal imaging has been proven effective in diabetic foot ulcer prevention. However, with traditional cameras this is limited to single spots or a two-dimensional (2D) view of the plantar side of foot, where only 50% of the ulcers occur. To improve ulcer detection, the view has to be extended beyond 2D. Our aim is to explore for proof of concept the combination of three-dimensional (3D) models with thermal imaging for inflammation detection in diabetic foot disease. METHOD From eight participants with a current diabetic foot ulcer we simultaneously acquired a 3D foot model and three thermal infrared images using a high-resolution medical 3D imaging system aligned with three smartphone-based thermal infrared cameras. Using spatial transformations, we aimed to map thermal images onto the 3D model, to create the 3D visualizations. Expert clinicians assessed these for quality and face validity as +, +/-, -. RESULTS We could replace the texture maps (color definitions) of the 3D model with the thermal infrared images and created the first-ever 3D thermographs of the diabetic foot. We then converted these models to 3D PDF-files compatible with the hospital IT environment. Face validity was assessed as + in six and +/- in two cases. CONCLUSIONS We have provided a proof of concept for the creation of clinically useful 3D thermal foot images to assess the diabetic foot skin temperature in 3D in a hospital IT environment. Future developments are expected to improve the image-processing techniques to result in easier, handheld applications and driving further research.
Collapse
Affiliation(s)
- Rob F. M. van Doremalen
- University of Twente, Enschede, the
Netherlands
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Rob F. M. van Doremalen, University of
Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Jaap J. van Netten
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Amsterdam UMC, University of Amsterdam,
Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Queensland University of Technology,
School of Clinical Sciences, Brisbane, Australia
| | - Jeff G. van Baal
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Cardiff University, Cardiff, Wales,
UK
| | | | | |
Collapse
|
42
|
Macdonald A, Petrova N, Ainarker S, Allen J, Lomas C, Tang W, Plassmann P, Whittam A, Bevans J, Ring F, Kluwe B, Simpson R, Rogers L, Machin G, Edmonds M. Between visit variability of thermal imaging of feet in people attending podiatric clinics with diabetic neuropathy at high risk of developing foot ulcers. Physiol Meas 2019; 40:084004. [PMID: 31362275 DOI: 10.1088/1361-6579/ab36d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with diabetic neuropathy who have previously ulcerated are at high risk of re-ulceration. They should regularly attend podiatry clinics for surveillance and routine protective podiatric treatment. It has been suggested that inflammation prior to skin breakdown shows up as a hotspot on a thermal image even in the absence of clinical signs. The aim of this study is to quantify inter-patient and intra-patient thermal variations presented by diabetic feet at high risk of ulceration. APPROACH Whole foot and spot temperatures were recorded for 96 patients who attended two successive podiatry appointments without ulceration 28 [28, 31] days apart, median [interquartile range]. This was a part of a longer study into whether thermal imaging in clinic can reduce the rate of re-ulceration. MAIN RESULTS The variation in spot temperature right/left differences for single patients between visits was comparable to the variation observed between patients (0.8 [0.3, 1.5] °C compared with 0.9 [0.4, 1.7] °C). Similarly, whole foot temperature variation for a single patient between visits was comparable to the variation observed between patients (0.6 [0.2, 1.1] °C compared with 0.8 [0.2, 1.3] °C). SIGNIFICANCE Thresholds which depend on thermal differences from visit to visit are unlikely to have sufficient specificity to effectively target treatment designed to prevent the development of foot ulcers.
Collapse
Affiliation(s)
- Audrey Macdonald
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne NE7 7DN, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|