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Podolskyi V, Gemzell-Danielsson K, Maltzman LL, Marions L. Effectiveness and acceptability of home use of misoprostol for medical abortion up to 10 weeks of pregnancy. Acta Obstet Gynecol Scand 2023; 102:541-548. [PMID: 36933004 PMCID: PMC10072251 DOI: 10.1111/aogs.14549] [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: 10/24/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION The administration of mifepristone, followed by misoprostol, is widely used for medical abortion. Many studies have demonstrated home abortion to be safe in pregnancies up to 63 days of gestation, and recent data support its safety when extended to more advanced pregnancies. We studied the efficacy and acceptability of home use of misoprostol up to 70 days of gestation in a Swedish setting and compared the outcomes between pregnancies with a gestational age of up to 63 days and pregnancies with gestational age 64-70 days. MATERIAL AND METHODS This prospective cohort study was performed between November 2014 and November 2021 at Södersjukhuset and Karolinska University Hospital, Stockholm, and some patients were also recruited from Sahlgrenska University Hospital, Göteborg and Helsingborg Hospital. The primary outcome was the rate of complete abortions and was defined as complete abortion without any need for surgical or medical intervention and assessed by clinical assessment, pregnancy test and/or vaginal ultrasound. Secondary objectives were assessed by daily self-reporting in a diary and included pain, bleeding, side effects and women's satisfaction and perception of home use of misoprostol. A comparison of categorical variables was made with Fisher's exact test. The significance level was set to a p-value ≤0.05. The study was registered at Clinicaltrials.gov on July 14, 2014 (NCT02191774). RESULTS During the study period we enrolled 273 women opting for medical abortion with home use of misoprostol. In the early group, up to 63 days of gestation, 112 women were included with a mean gestational length of 45 days and in the late group, 64-70 days of gestation, 161 women with a mean gestations length of 66.3 days were included. Complete abortion occurred in 95% (95% CI 89-98) of women in the early group and in 96% (95% CI 92-99) in the late group. No differences were found regarding side effects and acceptability was similarly high in both groups. CONCLUSIONS Our results show high efficacy and acceptability of medical abortion when misoprostol is administered at home up to 70 days of gestation. This supports previous findings about maintained safety when misoprostol is administered at home even past a very early pregnancy.
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Affiliation(s)
- Volodymyr Podolskyi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Lukyanova Institute of Pediatrics, Obstetrics and Gynecology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Lena L Maltzman
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Lena Marions
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Schmitt MS, Wright JD, Triolo RJ, Charkhkar H, Graczyk EL. The experience of sensorimotor integration of a lower limb sensory neuroprosthesis: A qualitative case study. Front Hum Neurosci 2023; 16:1074033. [PMID: 36712150 PMCID: PMC9874950 DOI: 10.3389/fnhum.2022.1074033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Lower limb prosthesis users often struggle to navigate uneven terrain or ambulate in low light conditions where it can be challenging to rely on visual cues for balance and walking. Sensory feedback about foot-floor interactions may allow users to reduce reliance on secondary sensory cues and improve confidence and speed when navigating difficult terrain. Our group has developed a Sensory Neuroprosthesis (SNP) to restore sensation to people with lower limb amputation by pairing electrical stimulation of nerves in the residual limb applied via implanted neurotechnology with pressure sensors in the insole of a standard prosthesis. Stimulation applied to the nerves evoked sensations perceived as originating on the missing leg and foot. Methods This qualitative case study reports on the experiences of a 68-year-old with a unilateral trans-tibial amputation who autonomously used the SNP at home for 31 weeks. Interview data collected throughout the study period was analyzed using a grounded theory approach with constant comparative methods to understand his experience with this novel technology and its impacts on his daily life. Results A conceptual model was developed that explained the experience of integrating SNP-provided sensory feedback into his body and motor plans. The model described the requirements of integration, which were a combination of a low level of mental focus and low stimulation levels. While higher levels of stimulation and focus could result in distinct sensory percepts and various phantom limb experiences, optimal integration was associated with SNP-evoked sensation that was not readily perceivable. Successful sensorimotor integration of the SNP resulted in improvements to locomotion, a return to a more normal state, an enhancement of perceived prosthesis utility, and a positive outlook on the experience. Discussion These outcomes emerged over the course of the nearly 8 month study, suggesting that findings from long-term home studies of SNPs may differ from those of short-term in-laboratory tests. Our findings on the experience of sensorimotor integration of the SNP have implications for the optimal training of SNP users and the future deployment of clinical SNP systems for long-term home use.
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Affiliation(s)
- Melissa S. Schmitt
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - John D. Wright
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Ronald J. Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Hamid Charkhkar
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Emily L. Graczyk
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States,*Correspondence: Emily L. Graczyk,
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Zheng Y, Abuqayyas L, Megally A, Fuhr R, Sałapa K, Downie J, Colice G. Tezepelumab Pharmacokinetics, Safety, and Tolerability After Administration via Vial-and-syringe, Accessorized Prefilled Syringe, or Autoinjector: A Randomized Trial in Healthy Volunteers. Clin Ther 2020; 43:142-155.e5. [PMID: 33380362 DOI: 10.1016/j.clinthera.2020.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Tezepelumab is an anti-thymic stromal lymphopoietin monoclonal antibody therapeutic in development for patients with severe, uncontrolled asthma. In ongoing Phase III studies, tezepelumab is administered via subcutaneous (SC) injections using a vial-and-syringe (V-S). This study compared the pharmacokinetic (PK) parameters, safety, and tolerability of tezepelumab administered subcutaneously via V-S versus via an accessorized prefilled syringe (APFS) or autoinjector (AI). METHODS This single-center, randomized, open-label, parallel-group study was conducted in healthy volunteers aged 18-65 years. Participants, stratified according to weight (50 to <70 kg, 70 to <80 kg, or 80-90 kg), were randomized evenly to 9 groups representing injections to the abdomen, thigh, or upper arm via V-S, APFS, or AI. Tezepelumab PK parameters over 113 days were evaluated after a single 210-mg SC dose. The primary end points were comparison of Cmax and AUC0-∞ between device groups. Further PK parameters, immunogenicity, safety (including injection site reactions [ISRs] and injection site pain [visual analog scale]) were also assessed. FINDINGS A total of 315 adults were randomized to treatment. Geometric mean ratios for comparisons between device groups of Cmax, AUC0-∞, and AUC0-last were close to 1, with 90% CIs all within the range of 0.8-1.25, meeting bioequivalence criteria. PK variables were also similar between devices across injection sites and weight categories. Across devices, thigh injection resulted in slightly higher exposure than upper arm injection, and abdomen injection resulted in exposure similar to or slightly lower than thigh injection; however, these differences were not clinically meaningful. Treatment-emergent anti-tezepelumab antibodies were present in 3 (2.9%), 1 (1.0%), and 0 participants in the V-S, APFS, and AI groups, respectively. Treatment-related adverse events were reported in 15.0% of participants overall (V-S, 10.7%; APFS, 18.1%; AI, 16.0%), including ISRs in 1 (1.0%), 3 (2.9%), and 3 (2.8%) participants in the V-S, APFS, and AI groups. Median visual analog scale pain score (0-100 mm scale) was 2 mm immediately after injection and was 0 mm at 30 min for all groups. IMPLICATIONS Tezepelumab PK parameters after a single 210-mg SC dose were comparable when administered via V-S, APFS, or AI. In all groups, immunogenicity rate and injection site pain were low, and ISRs were uncommon. These findings support administration of tezepelumab via APFS or AI, in addition to V-S, providing patients and physicians with greater choice and the potential convenience of at-home use. ClinicalTrials.gov identifier: NCT03989544.
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Affiliation(s)
- Yanan Zheng
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, South San Francisco, CA, USA.
| | - Lubna Abuqayyas
- Clinical Pharmacology Modeling and Simulation, Amgen, Cambridge, MA, USA
| | - Ayman Megally
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | - Kinga Sałapa
- Biometrics, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - John Downie
- Global Development Inflammation, Amgen, Thousand Oaks, CA, USA
| | - Gene Colice
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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Abstract
Production and excretion of hydrogen (H2) gas in human was reported in 1969, since then it has been regarded as non-toxic molecule. For preventive and therapeutic medical uses, a possible treatment for cancer was reported and another article was published on how H2 acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. A variety of H2 gas inhalers have been available in the market for hospital and home uses. However, H2 is odorless and flammable or explosive ignited by static electricity. We have examined the safety of a variety of H2 gas concentrations from the viewpoint of flammability and explosion. We have also measured concentrations of H2 gas inhalers in the market respectively. This paper also details how to control H2 gas concentration for preventing explosions.
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Affiliation(s)
| | | | | | - Goh Matsuo
- MiZ Company Limited, Kamakura, Kanagawa, Japan
| | - Yoshiyasu Takefuji
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
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5
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Gavish L, Houreld NN. Therapeutic Efficacy of Home-Use Photobiomodulation Devices: A Systematic Literature Review. Photobiomodul Photomed Laser Surg 2020; 37:4-16. [PMID: 31050938 DOI: 10.1089/photob.2018.4512] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Perform systematic literature review on photobiomodulation (PBM) devices used at home for nonesthetic applications. Background: Home-use PBM devices have been marketed for cosmetic and therapeutic purposes. This is the first systematic literature review for nonesthetic applications. Methods: A systematic literature search was conducted for PBM devices self-applied at home at least thrice a week. Two independent reviewers screened the articles and extracted the data. Treatment dosage appropriateness was compared to the World Association for Laser Therapy (WALT) recommendations. The efficacy was evaluated according to the relevant primary end-point for the specific indication. Results: Eleven studies were suitable. Devices were applied for a range of indications, including pain, cognitive dysfunction, wound healing, diabetic macular edema, and postprocedural side effects, and were mostly based on near-infrared, pulsed light-emitting diodes with dosages within WALT recommendations. Regarding efficacy, studies reported mostly positive results. Conclusions: Home-use PBM devices appear to mediate effective, safe treatments in a variety of conditions that require frequent applications. Conclusive evaluation of their efficacy requires additional, randomized controlled studies.
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Affiliation(s)
- Lilach Gavish
- 1 Department of Medical Neurobiology, Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nicolette Nadene Houreld
- 2 Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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6
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Merigo E, Rocca JP, Pinheiro ALB, Fornaini C. Photobiomodulation Therapy in Oral Medicine: A Guide for the Practitioner with Focus on New Possible Protocols. Photobiomodul Photomed Laser Surg 2019; 37:669-680. [PMID: 31589560 DOI: 10.1089/photob.2019.4624] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Photobiomodulation (PBM) is the term to define the wide range of laser applications using low-energy densities and based on photochemical mechanisms where the energy is transferred to the intracellular mitochondrial chromophores and respiratory chain components. In literature, a great number of works are reported showing the advantages of PBM use in many oral diseases such as recurrent aphthous stomatitis, herpes infections, mucositis, and burning mouth syndrome. Different factors may explain the increasing reported use of PBM in oral medicine: the absence of side effects, the possibility of safely treating compromised patients such as oncologic patients, the possibility of a noninvasive approach not associated with pain or discomfort, and the possibility of performing short sessions. The review's aim is to describe the possible applications of PBM in oral medicine, giving practitioners simple guide for practice together with the information of a new treatment possibility "at home" performed by the patient himself under supervision.
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Affiliation(s)
- Elisabetta Merigo
- Micoralis Research Laboratory EA 7354, Faculty of Dentistry, University of Côte d'Azur, Nice, France.,Dentistry, Special Needs and Maxillo-Facial Surgery Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Jean-Paul Rocca
- Micoralis Research Laboratory EA 7354, Faculty of Dentistry, University of Côte d'Azur, Nice, France
| | | | - Carlo Fornaini
- Micoralis Research Laboratory EA 7354, Faculty of Dentistry, University of Côte d'Azur, Nice, France.,Dentistry, Special Needs and Maxillo-Facial Surgery Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy.,GAEM, Group of Applied ElectroMagnetics, Department of Engineering and Architecture, University of Parma, Parma, Italy
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Cuberovic I, Gill A, Resnik LJ, Tyler DJ, Graczyk EL. Learning of Artificial Sensation Through Long-Term Home Use of a Sensory-Enabled Prosthesis. Front Neurosci 2019; 13:853. [PMID: 31496931 PMCID: PMC6712074 DOI: 10.3389/fnins.2019.00853] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022] Open
Abstract
Upper limb prostheses are specialized tools, and skilled operation is learned by amputees over time. Recently, neural prostheses using implanted peripheral nerve interfaces have enabled advances in artificial somatosensory feedback that can improve prosthesis outcomes. However, the effect of sensory learning on artificial somatosensation has not been studied, despite its known influence on intact somatosensation and analogous neuroprostheses. Sensory learning involves changes in the perception and interpretation of sensory feedback and may further influence functional and psychosocial outcomes. In this mixed methods case study, we examined how passive learning over 115 days of home use of a neural-connected, sensory-enabled prosthetic hand influenced perception of artificial sensory feedback in a participant with transradial amputation. We examined perceptual changes both within individual days of use and across the duration of the study. At both time scales, the reported percept locations became significantly more aligned with prosthesis sensor locations, and the phantom limb became significantly more extended toward the prosthesis position. Similarly, the participant’s ratings of intensity, naturalness, and contact touch significantly increased, while his ratings of vibration and movement significantly decreased across-days for tactile channels. These sensory changes likely resulted from engagement of cortical plasticity mechanisms as the participant learned to use the artificial sensory feedback. We also assessed psychosocial and functional outcomes through surveys and interviews, and found that self-efficacy, perceived function, prosthesis embodiment, social touch, body image, and prosthesis efficiency improved significantly. These outcomes typically improved within the first month of home use, demonstrating rapid benefits of artificial sensation. Participant interviews indicated that the naturalness of the experience and engagement with the prosthesis increased throughout the study, suggesting that artificial somatosensation may decrease prosthesis abandonment. Our data showed that prosthesis embodiment was intricately related to naturalness and phantom limb perception, and that learning the artificial sensation may have modified the body schema. As another indicator of successfully learning to use artificial sensation, the participant reported the emergence of stereognosis later in the study. This study provides the first evidence that artificial somatosensation can undergo similar learning processes as intact sensation and highlights the importance of sensory restoration in prostheses.
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Affiliation(s)
- Ivana Cuberovic
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Anisha Gill
- Providence VA Medical Center, Providence, RI, United States
| | - Linda J Resnik
- Providence VA Medical Center, Providence, RI, United States.,Department of Health Services, Policy, and Practice, Brown University, Providence, RI, United States
| | - Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
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Platais I, Tsereteli T, Maystruk G, Kurbanbekova D, Winikoff B. A prospective study of mifepristone and unlimited dosing of sublingual misoprostol for termination of second-trimester pregnancy in Uzbekistan and Ukraine. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200167. [PMID: 31164394 DOI: 10.1136/bmjsrh-2018-200167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 04/16/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION We aimed to assess the feasibility and acceptability of a second-trimester medical abortion regimen using mifepristone and sublingual misoprostol with no maximum number of misoprostol doses in Uzbekistan and Ukraine. METHODS This prospective open-label study enrolled 306 women with pregnancies of 13-22 weeks in Uzbekistan (n=134) and Ukraine (n=172). Women took 200 mg mifepristone at a place of their choosing, and 24-48 hours later received 400 μg sublingual misoprostol every 3 hours until the expulsion of both fetus and placenta. Study staff interviewed women about the intensity of pain, side effects, and satisfaction with the procedure. The primary outcome was the rate of complete uterine evacuation without surgical intervention or oxytocin at 15 hours after the first dose of misoprostol. RESULTS The median gestational age was 18.1 weeks, and half of the women (n=149, 48.9%) chose to take mifepristone at home. The majority of women (n=266, 86.9%, 95% CI 82.6% to 90.5%) expelled by 15 hours after the start of misoprostol treatment, and by 48 hours complete uterine evacuation was achieved in 296 (96.7%) women. Most women found pain (76.1%) and side effects (89.0%) to be acceptable or very acceptable, and reported high satisfaction (89.8%) with the procedure. CONCLUSION Medical abortion in pregnancies of 13-22 weeks with 200 mg mifepristone followed 24-48 hours later by 400 μg sublingual misoprostol administered every 3 hours until complete expulsion is effective, safe and acceptable to women. Women can be given the option to take mifepristone at home and return to the hospital. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov, www.clinicaltrials.gov, NCT02415894, NCT02235155.
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Affiliation(s)
| | | | - Galyna Maystruk
- Woman Health & Family Planning Charity Foundation, Kiev, Ukraine
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Reyzelman AM, Koelewyn K, Murphy M, Shen X, Yu E, Pillai R, Fu J, Scholten HJ, Ma R. Continuous Temperature-Monitoring Socks for Home Use in Patients With Diabetes: Observational Study. J Med Internet Res 2018; 20:e12460. [PMID: 30559091 PMCID: PMC6315272 DOI: 10.2196/12460] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022] Open
Abstract
Background Over 30 million people in the United States (over 9%) have been diagnosed with diabetes. About 25% of people with diabetes will experience a diabetic foot ulcer (DFU) in their lifetime. Unresolved DFUs may lead to sepsis and are the leading cause of lower-limb amputations. DFU rates can be reduced by screening patients with diabetes to enable risk-based interventions. Skin temperature assessment has been shown to reduce the risk of foot ulceration. While several tools have been developed to measure plantar temperatures, they only measure temperature once a day or are designed for clinic use only. In this report, wireless sensor-embedded socks designed for daily wear are introduced, which perform continuous temperature monitoring of the feet of persons with diabetes in the home environment. Combined with a mobile app, this wearable device informs the wearer about temperature increases in one foot relative to the other, to facilitate early detection of ulcers and timely intervention. Objective A pilot study was conducted to assess the accuracy of sensors used in daily wear socks, obtain user feedback on how comfortable sensor-embedded socks were for home use, and examine whether observed temperatures correlated with clinical observations. Methods Temperature accuracy of sensors was assessed both prior to incorporation in the socks, as well as in the completed design. The measured temperatures were compared to the reference standard, a high-precision thermostatic water bath in the range 20°C-40°C. A total of 35 patients, 18 years of age and older, with diabetic peripheral neuropathy were enrolled in a single-site study conducted under an Institutional Review Board–approved protocol. This study evaluated the usability of the sensor-embedded socks and correlated the observed temperatures with clinical findings. Results The temperatures measured by the stand-alone sensors were within 0.2°C of the reference standard. In the sensor-embedded socks, across multiple measurements for each of the six sensors, a high agreement (R2=1) between temperatures measured and the reference standard was observed. Patients reported that the socks were easy to use and comfortable, ranking them at a median score of 9 or 10 for comfort and ease of use on a 10-point scale. Case studies are presented showing that the temperature differences observed between the feet were consistent with clinical observations. Conclusions We report the first use of wireless continuous temperature monitoring for daily wear and home use in patients with diabetes and neuropathy. The wearers found the socks to be no different from standard socks. The temperature studies conducted show that the sensors used in the socks are reliable and accurate at detecting temperature and the findings matched clinical observations. Continuous temperature monitoring is a promising approach as an early warning system for foot ulcers, Charcot foot, and reulceration.
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Affiliation(s)
- Alexander M Reyzelman
- California School of Podiatric Medicine, Samuel Merritt University, San Francisco, CA, United States
| | | | | | - Xuening Shen
- Siren Care (Shanghai) Information Technology Co Ltd, Shanghai, China
| | - E Yu
- Siren Care (Shanghai) Information Technology Co Ltd, Shanghai, China
| | - Raji Pillai
- Medical Affairs Consulting Inc, Menlo Park, CA, United States
| | - Jie Fu
- Siren Care (Shanghai) Information Technology Co Ltd, Shanghai, China
| | | | - Ran Ma
- Siren Care Inc, San Francisco, CA, United States
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10
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Abstract
OBJECTIVE Perform systematic literature review on photobiomodulation (PBM) devices used at home for nonesthetic applications. BACKGROUND Home-use PBM devices have been marketed for cosmetic and therapeutic purposes. This is the first systematic literature review for nonesthetic applications. METHODS A systematic literature search was conducted for PBM devices self-applied at home at least thrice a week. Two independent reviewers screened the articles and extracted the data. Treatment dosage appropriateness was compared to the World Association for Laser Therapy (WALT) recommendations. The efficacy was evaluated according to the relevant primary end-point for the specific indication. RESULTS Eleven studies were suitable. Devices were applied for a range of indications, including pain, cognitive dysfunction, wound healing, diabetic macular edema, and postprocedural side effects, and were mostly based on near-infrared, pulsed light-emitting diodes with dosages within WALT recommendations. Regarding efficacy, studies reported mostly positive results. CONCLUSIONS Home-use PBM devices appear to mediate effective, safe treatments in a variety of conditions that require frequent applications. Conclusive evaluation of their efficacy requires additional, randomized controlled studies.
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Affiliation(s)
- Lilach Gavish
- 1 Department of Medical Neurobiology, Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem , Jerusalem, Israel
| | - Nicolette Nadene Houreld
- 2 Laser Research Centre, Faculty of Health Sciences, University of Johannesburg , Johannesburg, South Africa
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11
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Steijlen AS, Jansen KM, Albayrak A, Verschure DO, Van Wijk DF. A Novel 12-Lead Electrocardiographic System for Home Use: Development and Usability Testing. JMIR Mhealth Uhealth 2018; 6:e10126. [PMID: 30061094 PMCID: PMC6090173 DOI: 10.2196/10126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 01/23/2023] Open
Abstract
Background Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Early diagnosis is of pivotal importance for patients with cardiac arrhythmias and ischemia to minimize the consequences like strokes and myocardial infarctions. The chance of capturing signals of arrhythmias or ischemia is substantially high when a 12-lead electrocardiogram (ECG) can be recorded at the moment when a patient experiences the symptoms. However, until now, available diagnostic systems (Holter monitors and other wearable ECG sensors) have not enabled patients to record a reliable 12-lead ECG at home. Objective The objective of this project was to develop a user-friendly system that enables persons with cardiac complaints to record a reliable 12-lead ECG at home to improve the diagnostic process and, consequently, reduce the time between the onset of symptoms and adequate treatment. Methods Using an iterative design approach, ECGraph was developed. The system consists of an ECG measurement system and a mobile app, which were developed with the help of several concept tests. To evaluate the design, a prototype of the final design was built and a final technical performance test and usability test were executed. Results The ECG measurement system consists of a belt and 4 limb straps. Ten wet Ag/AgCl electrodes are placed in the belt to optimize skin-electrode contact. The product is controlled via an app on the mobile phone of the user. Once a person experiences symptoms, he or she can put on the belt and record ECGs within a few minutes. Short instructions, supported by visualizations, offer guidance during use. ECGs are sent wirelessly to the caregiver, and the designated expert can quickly interpret the results. Usability tests with the final prototype (n=6) showed that the participants were able to put on the product within 8 minutes during first-time use. However, we expect that the placement of the product can be executed faster when the user becomes more familiar with the product. Areas of improvement focus mainly on confidence during product use. In the technical performance test, a 12-lead ECG was made and reproduced 6 times. Conclusions We developed a new 12-lead ECG system for home use. The product is expected to be more user-friendly than current hospital ECG systems and is designed to record more reliable data than current ECG systems for home use, which makes it suitable for expert interpretation. The system has great potential to be incorporated into an outpatient practice, so that arrhythmias and ischemia can be diagnosed and treated as early as possible.
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Affiliation(s)
- Annemarijn Sm Steijlen
- Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Kaspar Mb Jansen
- Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Armagan Albayrak
- Applied Ergonomics and Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Derk O Verschure
- Department of Cardiology, Zaans Medisch Centrum, Zaandam, Netherlands
| | - Diederik F Van Wijk
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
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12
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Zheng J, Yu X, He J, Gao S, Li W, Zhuo Y, Zhang Y, Qi L, Zhang Y, Qian X, Han X, Rong S. [Research on Standard System of Home Use Electronic Medical Devices]. Zhongguo Yi Liao Qi Xie Za Zhi 2017; 41:369-370. [PMID: 29862728 DOI: 10.3969/j.issn.1671-7104.2017.05.015] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medical device going home is an inevitable trend, however, using these devices has potential safety risks. Through introducing the home use electronic medical device products and related medical device standards, this paper provides recommendations on construction of standard system for home use electronic medical devices, to improve the advancement of existing medical device standard system and guide future medical standardization work, to fully utilize standars's guiding and security role in the scientific and technological innovation, industrial development.
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Affiliation(s)
- Jia Zheng
- National Institutes for Food and Drug Control, Institute for Medical Device Standardization Administration, Beijing, 100050
| | - Xinhua Yu
- National Institutes for Food and Drug Control, Institute for Medical Device Standardization Administration, Beijing, 100050
| | - Jun He
- Shanghai Testing & Inspection Institute for Medical Devices, Shanghai, 201318
| | - Shan Gao
- Tianjin Medical Device Quality Supervision and Testing Center, Tianjin, 300384
| | - Wen Li
- Beijing Institute of Medical Device Testing, Beijing, 101111
| | - Yue Zhuo
- Shanghai Testing & Inspection Institute for Medical Devices, Shanghai, 201318
| | - Yidong Zhang
- Shanghai Testing & Inspection Institute for Medical Devices, Shanghai, 201318
| | - Lijing Qi
- Tianjin Medical Device Quality Supervision and Testing Center, Tianjin, 300384
| | - Yun Zhang
- Tianjin Medical Device Quality Supervision and Testing Center, Tianjin, 300384
| | - Xuebo Qian
- Tianjin Medical Device Quality Supervision and Testing Center, Tianjin, 300384
| | - Xiaopeng Han
- Beijing Institute of Medical Device Testing, Beijing, 101111
| | - Shankui Rong
- National Institutes for Food and Drug Control, Institute for Medical Device Standardization Administration, Beijing, 100050
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