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Sensors (Basel, Switzerland) Mar 2022Precision nutrition is a popular eHealth topic among several groups, such as athletes, people with dementia, rare diseases, diabetes, and overweight. Its implementation...
Precision nutrition is a popular eHealth topic among several groups, such as athletes, people with dementia, rare diseases, diabetes, and overweight. Its implementation demands tight nutrition control, starting with nutritionists who build up food plans for specific groups or individuals. Each person then follows the food plan by preparing meals and logging all food and water intake. However, the discipline demanded to follow food plans and log food intake results in high dropout rates. This article presents the concepts, requirements, and architecture of a solution that assists the nutritionist in building up and revising food plans and the user following them. It does so by minimizing human-computer interaction by integrating the nutritionist and user systems and introducing off-the-shelf IoT devices in the system, such as temperature sensors, smartwatches, smartphones, and smart bottles. An interaction time analysis using the keystroke-level model provides a baseline for comparison in future work addressing both the use of machine learning and IoT devices to reduce the interaction effort of users.
Topics: Diabetes Mellitus; Humans; Machine Learning; Nutritional Status; Overweight; Telemedicine
PubMed: 35408231
DOI: 10.3390/s22072617 -
Journal of Experimental Orthopaedics Oct 2020Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than... (Review)
Review
Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.
PubMed: 33044686
DOI: 10.1186/s40634-020-00294-y -
BJGP Open Mar 2022Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course...
BACKGROUND
Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach, aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women's experiences of GDM follow-up.
AIM
To elucidate women's experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes.
DESIGN & SETTING
Qualitative study in primary care in the region of Stavanger, Norway.
METHOD
Semi-structured in-depth interviews were conducted 24-30 months after delivery with 14 women aged 28-44 years, with a history of GDM. Data were analysed thematically.
RESULTS
Most women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change.
CONCLUSION
Women experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.
PubMed: 34880032
DOI: 10.3399/BJGPO.2021.0104 -
Italian Journal of Pediatrics Jan 2014Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the...
Nutritional management and follow up of infants and children with food allergy: Italian Society of Pediatric Nutrition/Italian Society of Pediatric Allergy and Immunology Task Force Position Statement.
Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the nutritional management of children with food allergies. This Consensus Position Statement focuses on the nutritional management and follow-up of infants and children with food allergy.It provides practical advices for the management of children on exclusion diet and it represents an evidence-based consensus on nutritional intervention and follow-up of infants and children with food allergy. Children with food allergies have poor growth compared to non-affected subjects directly proportional to the quantity of foods excluded and the duration of the diet. Nutritional intervention, if properly planned and properly monitored, has proven to be an effective mean to substantiate a recovery in growth. Nutritional intervention depends on the subject's nutritional status at the time of the diagnosis. The assessment of the nutritional status of children with food allergies should follow a diagnostic pathway that involves a series of successive steps, beginning from the collection of a detailed diet-history. It is essential that children following an exclusion diet are followed up regularly. The periodic re-evaluation of the child is needed to assess the nutritional needs, changing with the age, and the compliance to the diet. The follow- up plan should be established on the basis of the age of the child and following the growth pattern.
Topics: Child Nutritional Physiological Phenomena; Child, Preschool; Follow-Up Studies; Food Hypersensitivity; Global Health; Humans; Incidence; Infant; Italy; Nutrition Assessment; Nutritional Status; Practice Guidelines as Topic; Societies, Medical
PubMed: 24386882
DOI: 10.1186/1824-7288-40-1 -
Frontiers in Public Health 2021Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with...
Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.
Topics: COVID-19; Communicable Disease Control; Humans; Public Health; SARS-CoV-2; Workplace
PubMed: 35071150
DOI: 10.3389/fpubh.2021.731239 -
Cancer Cytopathology Jul 2016Although fine-needle aspiration (FNA) has an important role in evaluating thyroid nodules in adults, there is little published information regarding its utility in the...
BACKGROUND
Although fine-needle aspiration (FNA) has an important role in evaluating thyroid nodules in adults, there is little published information regarding its utility in the pediatric population.
METHODS
A retrospective analysis of thyroid FNAs for patients who were 18 years old or younger at 2 institutions was conducted. Aspirates were retrospectively categorized with the Bethesda System for Reporting Thyroid Cytopathology. These diagnoses were then correlated with either final histopathology or clinical follow-up.
RESULTS
A total of 186 thyroid FNA samples from 154 patients (122 females and 32 males), who ranged in age from 9 months to 18 years (median, 16 years; mean, 14 years), were identified. FNA was performed to evaluate 1 to 3 nodules for each patient. Aspirates were classified as follows: nondiagnostic (n = 27), benign (n = 114), atypia of undetermined significance (AUS; n = 21), follicular neoplasm (FN; n = 8), suspicious for malignancy (n = 3), and malignant (n = 13). Sixty-one samples had a histologic correlation, 68 were followed clinically for ≥2 years, and 57 either had no follow-up or were followed for <2 years. For statistical purposes, FNA diagnoses of suspicious and malignant were considered positive, and benign lesions were considered negative. The accuracy was 99%, and the sensitivity and specificity were 94% and 100%, respectively. The risk of malignancy, not including papillary microcarcinoma, was 2% for benign aspirates, 21% for AUS, 57% for FN, and 100% for suspicious or malignant aspirates.
CONCLUSIONS
This analysis demonstrates that FNA is a sensitive and highly specific modality for evaluating thyroid nodules in pediatric patients. Each diagnostic category can facilitate communication and guide appropriate management. Cancer Cytopathol 2016;124:467-71. © 2016 American Cancer Society.
Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Biopsy, Fine-Needle; Child; Child, Preschool; Female; Humans; Infant; Male; Prognosis; Retrospective Studies; Thyroid Neoplasms; Thyroid Nodule
PubMed: 26970342
DOI: 10.1002/cncy.21713 -
Orthopaedic Journal of Sports Medicine Sep 2022Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these... (Review)
Review
BACKGROUND
Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases.
PURPOSE
To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures.
RESULTS
Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy.
CONCLUSION
There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.
PubMed: 36147793
DOI: 10.1177/23259671221121633 -
Annals of the Royal College of Surgeons... Mar 2020Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time...
INTRODUCTION
Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time implications associated with regular clinic appointments. Assessment through virtual means has been suggested as an alternative.
MATERIALS AND METHODS
At the West Suffolk Hospital, following arthroplasty surgery of the lower limb, patients are followed-up via a questionnaire at one and five years postoperatively, then subsequently at five-yearly intervals. Patients are recalled based on the outcome of these assessments. Using a locally compiled data base we identified all patients reviewed between 2011 and 2015 using this virtual assessment process and examined their outcomes.
RESULTS
During the five years of follow-up, 5,380 patients were eligible for assessment. Compliance varied from 77% follow up for hips and 83% for knees. Ten patients were recalled following total hip replacement, eight for x-ray changes and one for a poor satisfaction score. Five went on to undergo revision surgery. Some 56 recalls to clinic following knee arthroplasty were seen; 42 due to a poor Oxford Knee Score, 6 with associated x-ray abnormalities and 6 isolated abnormal x-rays. Five subsequently underwent revision surgery; 30 (54%) were discharged after initial review and 18 (32%) were referred to different subspecialties.As a result of the virtual review process, 4,219 clinic appointments were avoided, with no documented admissions as a result of a missed complication from virtual review.
DISCUSSION
A virtual arthroplasty clinic significantly reduces the number of patients attending regular follow-up clinics, without compromising safe practice.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Follow-Up Studies; Hip Joint; Hospitals, District; Hospitals, General; Humans; Knee Joint; Patient Satisfaction; Reoperation; Surveys and Questionnaires; Treatment Outcome; United Kingdom
PubMed: 31755733
DOI: 10.1308/rcsann.2019.0139 -
Arquivos Brasileiros de Cardiologia Jun 2021Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of...
BACKGROUND
Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients.
OBJECTIVE
To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry.
METHODS
Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05.
RESULTS
Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005).
CONCLUSIONS
Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.
Topics: Aortic Valve; Aortic Valve Stenosis; Brazil; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Mitral Valve Insufficiency; Severity of Illness Index; Stroke Volume; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Function, Left
PubMed: 34133587
DOI: 10.36660/abc.20190772