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Gluck S, Andrawos A, Summers MJ, Lange J, Chapman MJ, Finnis ME, Deane AM. The use of smartphone-derived location data to evaluate participation following critical illness: A pilot observational cohort study. Aust Crit Care 2021; 35:225-232. [PMID: 34373172 DOI: 10.1016/j.aucc.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Disability is common following critical illness, impacting the quality of life of survivors, and is difficult to measure. 'Participation' can be quantified as involvement in life outside of their home requiring movement from their home to other locations. Participation restriction is a key element of disability, and following critical illness, participation may be diminished. It may be possible to quantify this change using pre-existing smartphone data. OBJECTIVES The feasibility of extracting location data from smartphones of survivors of intensive care unit (ICU) admission and assessing participation, using location-based outcomes, during recovery from critical illness was evaluated. METHODS Fifty consecutively admitted, consenting adult survivors of non-elective admission to ICU of greater than 48-h duration were recruited to a prospective observational cohort study where they were followed up at 3 and 6 months following discharge. The feasibility of extracting location data from survivors' smartphones and creating location-derived outcomes assessing participation was investigated over three 28-d study periods: pre-ICU admission and at 3 and 6 months following discharge. The following were calculated: time spent at home; the number of destinations visited; linear distance travelled; and two 'activity spaces', a minimum convex polygon and standard deviation ellipse. RESULTS Results are median [interquartile range] or n (%). The number of successful extractions was 9/50 (18%), 12/39 (31%), and 13/33 (39%); the percentage of time spent at home was 61 [56-68]%, 77 [66-87]%, and 67 [58-77]% (P = 0.16); the number of destinations visited was 34 [18-64], 38 [22-63], and 65 [46-88] (P = 0.02); linear distance travelled was 367 [56-788], 251 [114-323], and 747 [326-933] km over 28 d (P = 0.02), pre-ICU admission and at 3 and 6 months following ICU discharge, respectively. Activity spaces were successfully created. CONCLUSION Limited smartphone ownership, missing data, and time-consuming data extraction limit current implementation of mass extraction of location data from patients' smartphones to aid prognostication or measure outcomes. The number of journeys taken and the linear distance travelled increased between 3 and 6 months, suggesting participation may improve over time.
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Affiliation(s)
- Samuel Gluck
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Alice Andrawos
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Matthew J Summers
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia.
| | - Jarrod Lange
- Hugo Centre for Population and Housing, University of Adelaide, Napier Building, North Terrace, Adelaide, SA 5000, Australia.
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Mark E Finnis
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Adam M Deane
- Intensive Care Unit, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, VIC 3010, Australia; The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia, VIC 3050.
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Andrawos A, Saeed H, Delaney C. A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access. J Vasc Surg Venous Lymphat Disord 2021; 9:1302-1311. [PMID: 33667742 DOI: 10.1016/j.jvsv.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access. METHODS An extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts. RESULTS There were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients. CONCLUSIONS Although both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required.
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Affiliation(s)
- Alice Andrawos
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia; Department of Medical Imaging, Flinders Medical Centre, Bedford Park, Australia; Department of Medical Imaging, Royal Melbourne Hospital, Melbourne, Australia; University of Edinburgh and Royal College of Surgeons, Edinburgh, Australia.
| | - Hani Saeed
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - Christopher Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford, Australia
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Gluck S, Summers MJ, Finnis ME, Andrawos A, Goddard TP, Hodgson CL, Iwashyna TJ, Deane AM. An observational study investigating the use of patient-owned technology to quantify physical activity in survivors of critical illness. Aust Crit Care 2019; 33:137-143. [PMID: 30879879 DOI: 10.1016/j.aucc.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Physical activity after intensive care unit (ICU) discharge is challenging to measure but could inform research and practice. A patient's smartphone may provide a novel method to quantify physical activity. OBJECTIVES We aimed to evaluate the feasibility and accuracy of using smartphone step counts among survivors of critical illness. METHODS We performed a prospective observational cohort study in 50 patients who had an ICU length of stay>48 h, owned a smartphone, were ambulatory before admission, and were likely to attend follow-up at 3 and 6 months after discharge. At follow-up, daily step counts were extracted from participants' smartphones and two FitBit pedometers, and exercise capacity (6-min walk test) and quality of life (European Quality of Life-5 Dimensions) were measured. RESULTS Thirty-nine (78%) patients returned at 3 months and 33 (66%) at 6 months, the median [interquartile range] smartphone step counts being 3372 [1688-5899] and 2716 [1717-5994], respectively. There was a strong linear relationship, with smartphone approximating 0.71 (0.58, 0.84) of FitBit step counts, P < 0.0001, R-squared = 0.87. There were weak relationships between step counts and the 6-min walk test distance. CONCLUSION Although smartphone ownership and data acquisition limit the viability of using extracted smartphone steps at this time, mean daily step counts recorded using a smartphone may act as a surrogate for a dedicated pedometer; however, the relationship between step counts and other measures of physical recovery remains unclear.
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Affiliation(s)
- Samuel Gluck
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Matthew James Summers
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000.
| | - Mark Edward Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Alice Andrawos
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Thomas Paul Goddard
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000.
| | - Carol Lynette Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia, VIC 3800; Physiotherapy Department, The Alfred Hospital, 55 Commercial Rd, Melbourne, Australia, VIC 3004.
| | - Theodore John Iwashyna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Adam Michael Deane
- Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000; Intensive Care Unit, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia, VIC 3050; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia, VIC 3050.
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Clifton T, Khoo TW, Andrawos A, Thomson S, Greenwood JE. Variation of surface temperatures of different ground materials on hot days: Burn risk for the neuropathic foot. Burns 2016; 42:453-6. [PMID: 26797153 DOI: 10.1016/j.burns.2015.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 10/22/2022]
Abstract
The purpose of this study is to assess the relationship between ambient temperature and surface temperatures of commonly used building/ground materials, in order to estimate the risk of contact thermal injury. It is an observational study where the air ambient temperature and the surface temperatures of slate, metal, cement, sand, brick and bitumen, were measured, in shaded and unshaded conditions, on cloudy and cloudless days in summer in Adelaide, South Australia. All unshaded surfaces reached temperatures capable of causing significant sole of foot burns given requisite exposure time in both clear and overcast conditions, even with a relatively low ambient temperature. Shade imparted total protection from irreversible thermal injury for all of the ambient temperatures assessed. Although surface temperatures were reduced in overcast conditions, the temperatures recorded were still capable of causing thermal injury. Peripheral neuropathy prolongs heat exposure times, often resulting in significant and complex injury, requiring lengthy treatment and generating potentially poor functional outcomes. This study provides a reference point for the enactment of preventative measures for at risk population groups such a diabetics.
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Affiliation(s)
- Thomas Clifton
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia.
| | - Teng-Wei Khoo
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - Alice Andrawos
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - Sumana Thomson
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - John Edward Greenwood
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
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Clifton T, Khoo TW, Andrawos A, Thomson S, Greenwood JE. Variation of surface temperatures of different ground materials on hot days: Burn risk for the neuropathic foot. Burns 2016. [PMID: 26797153 DOI: 10.1016/j.burns.2015.08.026.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this study is to assess the relationship between ambient temperature and surface temperatures of commonly used building/ground materials, in order to estimate the risk of contact thermal injury. It is an observational study where the air ambient temperature and the surface temperatures of slate, metal, cement, sand, brick and bitumen, were measured, in shaded and unshaded conditions, on cloudy and cloudless days in summer in Adelaide, South Australia. All unshaded surfaces reached temperatures capable of causing significant sole of foot burns given requisite exposure time in both clear and overcast conditions, even with a relatively low ambient temperature. Shade imparted total protection from irreversible thermal injury for all of the ambient temperatures assessed. Although surface temperatures were reduced in overcast conditions, the temperatures recorded were still capable of causing thermal injury. Peripheral neuropathy prolongs heat exposure times, often resulting in significant and complex injury, requiring lengthy treatment and generating potentially poor functional outcomes. This study provides a reference point for the enactment of preventative measures for at risk population groups such a diabetics.
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Affiliation(s)
- Thomas Clifton
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia.
| | - Teng-Wei Khoo
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - Alice Andrawos
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - Sumana Thomson
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | - John Edward Greenwood
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
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Tan VL, Andrawos A, Ghabriel MN, Townsend GC. Applied anatomy of the lingual nerve: relevance to dental anaesthesia. Arch Oral Biol 2013; 59:324-35. [PMID: 24581856 DOI: 10.1016/j.archoralbio.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/05/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) to classify the external morphology of the lingual nerve and investigate any relationship between its external and internal morphology, (2) to explore the fascicular structure, nerve tissue density and capillary density of the lingual nerve, and (3) to provide an anatomical explanation as to why adverse clinical outcomes more commonly affect the lingual nerve following local dental anaesthesia. Where possible, comparisons were made between the lingual and inferior alveolar nerves. MATERIALS AND METHODS The lingual and inferior alveolar nerves were examined in 23 hemi-sectioned heads macroscopically and microscopically 2mm above the lingula. The lingual nerve was also examined in the regions of the third and second molars. Specimens underwent histological processing and staining with Haematoxylin & Eosin, Masson's Trichrome, anti-GLUT-1 and anti-CD 34. RESULTS The lingual nerve became flatter as it traversed through the pterygomandibular space. There was an increase in the connective tissue and a decrease in nerve tissue density along the lingual nerve (p<0.001). At 2mm above the lingula, the lingual nerve was uni-fascicular in 39% of cases, whilst the inferior alveolar nerve consistently had more fascicles (p<0.001). The lingual nerve fascicles had thicker perineurium but the endoneurial vascular density was not significantly different in the two nerves. CONCLUSIONS The greater susceptibility of lingual nerve dysfunction during inferior alveolar nerve blocks may be due to its uni-fascicular structure and the thicker perineurium, leading to increased endoneurial pressure and involvement of all axons if oedema or haemorrhage occurs due to trauma.
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Affiliation(s)
- Vui Leng Tan
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia
| | - Alice Andrawos
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Mounir N Ghabriel
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Grant C Townsend
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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