Thursday, August 18, 2011

Doc’s device to stop amputation | Deccan Chronicle

Doc’s device to stop amputation Deccan Chronicle

In a major technological breakthrough that could prevent amputation of legs in diabetics, a city doctor has successfully patented a medical device that helps doctors to monitor and treat nerve damage or neuropathy in patients.

At present there’s no perfect medical device that could tell doctors the quantum of nerve damage (diabetic neuropathy) in the feet of diabetics.

Though glucometers tell the sugar levels in the blood, they do not inform physicians about the damage diabetes has caused to nerves. It is this damage that causes diabetic sores, gangrene, or diabetic foot, which may ultimately result in amputation.

Senior chronobiologist Dr C. Jairaj Kumar, who is currently a visiting faculty in Ludwig-Maximilians University, Germany, developed the device based on “chaos science”. Dr Jairaj’s technology was one of the seven indigenous technologies selected by the Centre for presentation before the US Secretary of State, Ms Hillary Clinton, in New Delhi earlier this week.

“High glucose levels in blood damage the blood vessels. The first to be affected are small blood vessels. Medium and large blood vessels are affected gradually. Our device helps in knowing the extent of damage caused to such nerves. The problem can be treated at initial stages, preventing amputation in case of diabetic foot, and death in case of heart muscle damage,” Dr Jairaj said.

The device works on the concept of chaos science and neuropathy. It measures the progression of diabetic neuropathy and predicts foot ulcer development. “It is a novel concept based on the theory of chaotic movement of the foci in the sole of the foot,” he added.

A diabetes patient has to stand on the device for a few minutes and the report is generated in five minutes. The equipment studies the feet in detail and identify areas prone to ulcers.

Wednesday, August 17, 2011

Healthy obese people may live as long as their slimmer counterparts

Healthy obese people may live as long as their slimmer counterparts

Can a fat body be a healthy body? Using a new grading tool that takes health issues into account in addition to body mass index, it may be possible for healthy obese people to have the same lifespan as normal-weight people.

The findings were released Monday in a study in the journal Applied Physiology, Nutrition, and Metabolism. Researchers looked at data on 6,224 obese men and women who were followed on average for about 16 years. The participants were part of the Aerobics Center Longitudinal Study who attended the Cooper Aerobics Center in Dallas. Their mortality risk was compared with that of a group of 23,309 normal-weight people.
In addition to completing surveys on health history, dietary habits, weight and weight loss, the participants also underwent a standard medical exam, had their blood pressure taken and fasting blood work done, and completed a treadmill exercise test.

Researchers used the Edmonton Obesity Staging System, a five-stage grading tool for determining who should lose weight, based on health risks from other diseases and conditions such as cancer and heart disease. Using this system, those in stages 0 or 1 may be so healthy they may not need to lose weight since their health issues are minimal.

In the study, those in stages 0 or 1 on the EOSS scale were not at a higher risk of death compared with their normal-weight counterparts. Being in stages 2 and 3 was linked with a higher risk of death from all causes, as well as death from cardiovascular disease and chronic heart disease compared with those who were normal weight.

This group also weighed more as young adults, were OK with being overweight, hadn't dieted that much during their lives and were more apt to be physically active and eat healthfully.

In the study, the authors argue that this system improves upon measures that calculate risk such as metabolic syndrome or insulin sensitivity, since those don't seem to distinguish mortality risk in obese people.

"Our findings challenge the idea that all obese individuals need to lose weight," says lead author Jennifer Kuk of York University in Toronto, Canada, in a news release.

Wednesday, August 10, 2011

Clinical warning system could change healthcare | National Nursing News

Clinical warning system could change healthcare National Nursing News

A clinical warning system that uses wireless sensors to track the vital signs of at-risk patients is undergoing a feasibility study at Barnes-Jewish Hospital in St. Louis.

When the full system is operational, sensors will take blood oxygenation and heart-rate readings from at-risk patients once or twice a minute. The data will be transmitted to a base station and combined with other data, such as lab test results, in the patient's electronic medical record.
The incoming vital signs and data in the medical record will be continually scrutinized by a machine-learning algorithm looking for signs of clinical deterioration. If any such signs are found, the system will call a nurse on a cell phone, alerting the nurse to check on the patient.
The idea is to create a virtual ICU where the patients are not wired to beeping machines and instead are free to move about as they please, said Chenyang Lu, PhD, a computer scientist and professor at Washington University in St. Louis, who was the principal investigator for the prototype-network trial.
The performance of the prototype network, which was installed at Barnes-Jewish Hospital from June 4, 2009, until Jan. 31, 2010, was described at the SenSys '10 conference in Zurich, Switzerland. The feasibility study of the clinical warning system now under way at the hospital will be presented at the American Medical Informatics Association Annual Symposium this October.
The clinical warning system is part of a burgeoning new field called body sensor networks or wireless health that, Lu said, will change the future of medicine.
Once they worked out the kinks, the computer scientists installed a prototype network in a cardiac step-down unit at Barnes-Jewish Hospital. Lu said he was pleased to find physicians and hospital administrators at the hospital who were technology savvy and willing to let him install the prototype network.
Clinical deterioration is a major concern in every hospital unit, said Thomas C. Bailey, MD, professor of medicine (infectious diseases) in the Washington University School of Medicine, who is collaborating with Lu on the system. Of hospitalized patients, between 4% and 17% suffer an adverse event such as myocardial infarction or respiratory arrest.
Most patients exhibit changes in their vital signs hours before an adverse event, sometimes as much as six hours before. In ICUs, vital signs continuously are monitored by wired devices, but in the step-down units, they often are measured intermittently by the unit's clinical staff. A wireless sensor network could monitor vital signs tens or hundreds of times more frequently.
According to Lu, it will not be long before any patient with a serious medical condition, such as diabetes or asthma, will wear a wireless medical device that will allow him or her to monitor his or her own vital signs on a smartphone that also will call relatives or doctors if serious problems arise.
The device for an asthma sufferer, for example, might keep track of respiration rate, air quality and pollen counts, among other features. A frail patient might wear a wireless sensor with built-in accelerometers or gyroscopes that would monitor for falls.
The possibilities are endless, Liu said, and they all promise better, more consistent care at lower cost — the primary objective of healthcare.

Thursday, August 04, 2011

Predicting the Risk of ESRD in the Population-based Setting: Abstract and Introduction

Predicting the Risk of ESRD in the Population-based Setting: Abstract and Introduction:

Background: Previous studies of predictors of end-stage renal disease (ESRD) have limitations: (1) some focused on patients with clinically recognized chronic kidney disease (CKD); (2) others identified population-based patients who developed ESRD, but lacked earlier baseline clinical measures to predict ESRD. Our study was designed to address these limitations and to identify the strength and precision of characteristics that might predict ESRD pragmatically for decision-makers--as measured by the onset of renal replacement therapy (RRT).
Methods: We conducted a population-based, retrospective case-control study of patients who developed ESRD and started RRT. We conducted the study in a health maintenance organization, Kaiser Permanente Northwest (KPNW). The case-control study was nested within the adult population of KPNW members who were enrolled during 1999, the baseline period. Cases and their matched controls were identified from January 2000 through December 2004. We evaluated baseline clinical characteristics measured during routine care by calculating the adjusted odds ratios and their 95% confidence intervals after controlling for matching characteristics: age, sex, and year.
Results: The rate of RRT in the cohort from which we sampled was 58 per 100,000 person-years (95% CI, 53 to 64). After excluding patients with missing data, we analyzed 350 cases and 2,114 controls. We identified the following characteristics that predicted ESRD with odds ratios ≥ 2.0: eGFR<60 mL/min/1.73 m2 (OR = 20.5; 95% CI, 11.2 to 37.3), positive test for proteinuria (OR = 5.0; 95% CI, 3.5 to 7.1), hypertension (OR = 4.5; 95% CI, 2.5 to 8.0), gout/positive test for uric acid (OR = 2.5; 95% CI, 1.8 to 3.5), peripheral vascular disease (OR = 2.2; 95% CI, 1.4 to 3.6), congestive heart failure (OR = 2.1; 95% CI, 1.4 to 3.3), and diabetes (OR = 2.1; 95% CI, 1.5 to 2.9).
Conclusions: The clinical characteristics needed to predict ESRD--for example, to develop a population-based, prognostic risk score--were often documented during routine care years before patients developed ESRD and required RRT.

More death certificates cite diabetes as underlying cause of death

More death certificates cite diabetes as underlying cause of death

Death certificates now list diabetes as the underlying cause of death more often than in previous years, data from the Translating Research into Action for Diabetes trial suggest.

Of 2,261 participants enrolled in the study who died from 2000 to 2007, 41% had diabetes listed on their death certificates and 13% cited the disease as the underlying cause of death. These findings indicated increased reporting of diabetes as the underlying cause of death over time, the researchers said, although the frequency of the disease’s appearance on death certificates in general remained unchanged.
In contrast, the listing of cardiovascular disease as an underlying cause of death declined significantly throughout the study period, a factor that may have played a role in the increased reporting of diabetes as an underlying cause of death, the researchers said. They attributed this trend to a decrease in the reporting of cardiac causes of death for men and cerebrovascular causes of death for women. Diabetes was more likely to be recorded anywhere on the death certificate in decedents with CVD cited as the underlying cause of death.

“Although diabetes listed as any cause of death was stable over time, we have observed a statistically significant increase in reporting of diabetes as the underlying cause of death on death certificates between 2001 and 2008 independent of age at death and duration of diabetes at death,” the researchers wrote. “If this trend is indeed occurring on a national level, it may complicate the interpretation of mortality rates ascertained from death certificates.”

Disclosure: The researchers report no relevant financial disclosures

Wednesday, August 03, 2011

Diabetic patients using Web and mobile computing tools lowered their blood glucose levels more during a one-year study

Diabetic patients using Web and mobile computing tools lowered their blood glucose levels more during a one-year study

Diabetic patients using Web and mobile computing tools lowered their blood glucose levels more during a one-year study than patients in a control group receiving usual care.
The test at the University of Maryland School of Medicine tested the effectiveness of combining regular patient checking and documentation of their glucose levels with coaching via computing devices. The test included use of the Diabetes Manager System from Baltimore-based WellDoc Inc., which received Food and Drug Administration approval in July 2010 and will be commercially available this fall.
The application enables Type 2 diabetic patients to enter their blood sugar readings into a secure Web site via a computer or their mobile phone and receive real-time feedback on what they should eat and other ways they can help stabilize their blood sugar. The software also can alert patients when they need to test their levels.

The Diabetes Manager System also enables analysis of the data and access by a patient's physicians and disease management case workers. It supports glucose meters that can send data via Bluetooth wireless technology.
In the test, the mean decline in glucose was 1.9 percent in the group using the Web and mobile technology and 0.7 percent in the control group. A one percent drop in glucose levels can reduce risk factors by 37 percent, according to research previously published in the British Medical Journal.
The new study, "Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control," is published in the August issue of Diabetes Care.

Tuesday, August 02, 2011

ACOG Statement: Begin Annual Mammograms at Age 40 Years

ACOG Statement: Begin Annual Mammograms at Age 40 Years: "ACOG Statement: Begin Annual Mammograms at Age 40 Years"

Mammography screening should be offered annually to women beginning at age 40 years, according to new breast cancer screening guidelines issued by ACOG. The new Practice Bulletin, entitled "Breast Cancer Screening," is published in the August 2011 issue of Obstetrics & Gynecology. These guidelines replace the 2003 ACOG recommendations, which were that women should have mammograms every 1 to 2 years beginning at age 40 years, and every year beginning at age 50 years.....