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Cao T, Brady V, Whisenant M, Wang X, Gu Y, Wu H. Toward Reliable Symptom Coding in Electronic Health Records for Symptom Assessment and Research: Identification and Categorization of International Classification of Diseases, Ninth Revision, Clinical Modification Symptom Codes. Comput Inform Nurs 2024:00024665-990000000-00209. [PMID: 38968447 DOI: 10.1097/cin.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
To date, symptom documentation has mostly relied on clinical notes in electronic health records or patient-reported outcomes using disease-specific symptom inventories. To provide a common and precise language for symptom recording, assessment, and research, a comprehensive list of symptom codes is needed. The International Classification of Diseases, Ninth Revision or its clinical modification (International Classification of Diseases, Ninth Revision, Clinical Modification) has a range of codes designated for symptoms, but it does not contain codes for all possible symptoms, and not all codes in that range are symptom related. This study aimed to identify and categorize the first list of International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes for a general population and demonstrate their use to characterize symptoms of patients with type 2 diabetes mellitus in the Cerner database. A list of potential symptom codes was automatically extracted from the Unified Medical Language System Metathesaurus. Two clinical experts in symptom science and diabetes manually reviewed this list to identify and categorize codes as symptoms. A total of 1888 International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes were identified and categorized into 65 categories. The symptom characterization using the newly obtained symptom codes and categories was found to be more reasonable than that using the previous symptom codes and categories on the same Cerner diabetes cohort.
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Affiliation(s)
- Tru Cao
- Author Affiliations: UTHealth Houston School of Public Health (Drs Cao, Wang, and Wu and Mr Gu), UTHealth Houston Cizik School of Nursing (Dr Brady), and The University of Texas MD Anderson Cancer Center (Dr Whisenant)
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Abbott EM, Stephens JD, Simha SN, Wood L, Nardelli P, Cope TC, Sawicki GS, Ting LH. Attenuation of muscle spindle firing with artificially increased series compliance during stretch of relaxed muscle. Exp Physiol 2024; 109:148-158. [PMID: 37856330 PMCID: PMC10841431 DOI: 10.1113/ep090872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Muscle spindles relay vital mechanosensory information for movement and posture, but muscle spindle feedback is coupled to skeletal motion by a compliant tendon. Little is known about the effects of tendon compliance on muscle spindle feedback during movement, and the complex firing of muscle spindles makes these effects difficult to predict. Our goal was to investigate changes in muscle spindle firing using added series elastic elements (SEEs) to mimic a more compliant tendon, and to characterize the accompanying changes in firing with respect to muscle-tendon unit (MTU) and muscle fascicle displacements (recorded via sonomicrometry). Sinusoidal, ramp-and-hold and triangular stretches were analysed to examine potential changes in muscle spindle instantaneous firing rates (IFRs) in locomotor- and perturbation-like stretches as well as serial history dependence. Added SEEs effectively reduced overall MTU stiffness and generally reduced muscle spindle firing rates, but the effect differed across stretch types. During sinusoidal stretches, peak and mean firing rates were not reduced and IFR was best-correlated with fascicle velocity. During ramp stretches, SEEs reduced the initial burst, dynamic and static responses of the spindle. Notably, IFR was negatively related to fascicle displacement during the hold phase. During triangular stretches, SEEs reduced the mean IFR during the first and second stretches, affecting the serial history dependence of mean IFR. Overall, these results demonstrate that tendon compliance may attenuate muscle spindle feedback during movement, but these changes cannot be fully explained by reduced muscle fascicle length or velocity, or MTU force.
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Affiliation(s)
- Emily M. Abbott
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Jacob D. Stephens
- Coulter Department of Biomedical EngineeringEmory University and Georgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Surabhi N. Simha
- Coulter Department of Biomedical EngineeringEmory University and Georgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Leo Wood
- School of PhysicsGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Paul Nardelli
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Timothy C. Cope
- Coulter Department of Biomedical EngineeringEmory University and Georgia Institute of TechnologyAtlantaGeorgiaUSA
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Gregory S. Sawicki
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGeorgiaUSA
- Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Lena H. Ting
- Coulter Department of Biomedical EngineeringEmory University and Georgia Institute of TechnologyAtlantaGeorgiaUSA
- Department of Rehabilitation MedicineEmory UniversityAtlantaGeorgiaUSA
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Pirri C, Biz C, Pirri N, Macchi V, Porzionato A, De Caro R, Ruggieri P, Stecco C. Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity. J Clin Med 2023; 12:4664. [PMID: 37510779 PMCID: PMC10380358 DOI: 10.3390/jcm12144664] [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: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, 35121 Padova, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
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Abbott EM, Stephens JD, Simha SN, Wood L, Nardelli P, Cope TC, Sawicki GS, Ting LH. Attenuation of muscle spindle firing with artificially increased series compliance during stretch of relaxed muscle. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.08.539853. [PMID: 37215007 PMCID: PMC10197546 DOI: 10.1101/2023.05.08.539853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Muscle spindles relay vital mechanosensory information for movement and posture, but muscle spindle feedback is coupled to skeletal motion by a compliant tendon. Little is known about the effects of tendon compliance on muscle spindle feedback during movement, and the complex firing of muscle spindles make these effects difficult to predict. Our goal was to investigate changes in muscle spindle firing using added series elastic elements (SEEs) to mimic a more compliant tendon, and to characterize the accompanying changes in firing with respect to muscle-tendon unit (MTU) and muscle fascicle displacements (recorded via sonomicrometry). Sinusoidal, ramp-hold-release, and triangular stretches were analyzed to examine potential changes in muscle spindle instantaneous firing rates (IFRs) in locomotor- and perturbation-like stretches as well as history dependence. Added SEEs effectively reduced overall MTU stiffness and generally reduced muscle spindle firing rates, but the effect differed across stretch types. During sinusoidal stretches, peak firing rates were reduced and IFR was strongly correlated with fascicle velocity. During ramp stretches, SEEs reduced the dynamic and static responses of the spindle during lengthening but had no effect on initial bursts at the onset of stretch. Notably, IFR was negatively related to fascicle displacement during the hold phase. During triangular stretches, SEEs reduced the mean IFR during the first and second stretches, affecting the history dependence of mean IFR. Overall, these results demonstrate that tendon compliance may attenuate muscle spindle feedback during movement, but these changes cannot be fully explained by reduced muscle fascicle length and velocity.
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Affiliation(s)
| | - Jacob D Stephens
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology
| | - Surabhi N Simha
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology
| | - Leo Wood
- School of Physics, Georgia Institute of Technology
| | - Paul Nardelli
- School of Biological Sciences, Georgia Institute of Technology
| | - Timothy C Cope
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology
- School of Biological Sciences, Georgia Institute of Technology
| | - Gregory S Sawicki
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology
| | - Lena H Ting
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology
- Department of Rehabilitation Medicine, Emory University
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Kurze C, Farn CJ, Siow J. The Interdisciplinary Approach: Preventive and Therapeutic Strategies for Diabetic Foot Ulcers. Foot Ankle Clin 2022; 27:529-543. [PMID: 36096550 DOI: 10.1016/j.fcl.2022.03.001] [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: 02/02/2023]
Abstract
The appropriate treatment of the common diabetic foot ulcers (DFUs) in diabetic patients demands enormous human, organizational and financial resources that are finite. Interdisciplinary teams of medical and surgical specialists, as well as allied health professionals, can help to reduce the consumption of these resources, optimize treatment, and prevent DFUs. They consist primarily of vascular surgeons, endocrinologists, and orthopedic foot and ankle surgeons and are closely supported when required by infectious diseases specialists, plastic surgeons, wound care specialist nurses, podiatrists, and orthotists. A timely interdisciplinary team review in each clinic session decreases the number of hospital visits for the oftentimes-handicapped diabetic patients significantly. The interdisciplinary team clinic setup has also been shown to reduce the risk of amputations, length of hospital staz and mortality rates.
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Affiliation(s)
- Christophe Kurze
- Department of Orthopedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010 Berne, Switzerland.
| | - Chui Jia Farn
- Department of Orthopedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010 Berne, Switzerland; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - James Siow
- Department of Orthopedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010 Berne, Switzerland; Department of Orthopedic Surgery, Woodlands Health, Singapore
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Leung MSH, Yick KL, Sun Y, Chow L, Ng SP. 3D printed auxetic heel pads for patients with diabetic mellitus. Comput Biol Med 2022; 146:105582. [PMID: 35588678 DOI: 10.1016/j.compbiomed.2022.105582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
Abstract
More than 422 million people worldwide suffered from diabetes mellitus (DM) in 2021. Diabetic foot is one the most critical complications resultant of DM. Foot ulceration and infection are frequently arisen, which are associated with changes in the mechanical properties of the plantar soft tissues, peripheral arterial disease, and sensory neuropathy. Diabetic insoles are currently the mainstay in reducing the risk of foot ulcers by reducing the magnitude of the pressure on the plantar Here, we propose a novel pressure relieving heel pad based on a circular auxetic re-entrant honeycomb structure by using three-dimensional (3D) printing technology to minimize the pressure on the heel, thus reducing the occurrence of foot ulcers. Finite element models (FEMs) are developed to evaluate the structural changes of the developed circular auxetic structure upon exertion of compressive forces. Moreover, the effects of the internal angle of the re-entrant structure on the peak contact force and the mean pressure acting on the heel as well as the contact area between the heel and the pads are investigated through a finite element analysis (FEA). Based on the result from the validated FEMs, the proposed heel pad with an auxetic structure demonstrates a distinct reduction in the peak contact force (∼10%) and the mean pressure (∼14%) in comparison to a conventional diabetic insole (PU foam). The characterized result of the designed circular auxetic structure not only provides new insights into diabetic foot protection, but also the design and development of various impact resistance products.
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Affiliation(s)
- Matthew Sin-Hang Leung
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Kit-Lun Yick
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China.
| | - Yue Sun
- School of Fashion Design & Engineering, Zhejiang Sci-Tech University, Hangzhou City, Zhejiang Province, China
| | - Lung Chow
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sun-Pui Ng
- Hong Kong Community College, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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Reeves J, Jones R, Liu A, Bent L, Martinez-Santos A, Nester C. No change in foot soft tissue morphology and skin sensitivity after three months of using foot orthoses that alter plantar pressure. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1961880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joanna Reeves
- School of Health Sciences, University of Salford, Salford, United Kingdom
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Richard Jones
- School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Anmin Liu
- School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Leah Bent
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | | | - Christopher Nester
- School of Health Sciences, University of Salford, Salford, United Kingdom
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