scholarly journals Predictive Glucose Trends From Continuous Glucose Monitoring: Friend or Foe in Clinical Decision Making?

2019 ◽  
Vol 13 (5) ◽  
pp. 963-966 ◽  
Author(s):  
Kathryn Fantasia ◽  
Katherine Modzelewski ◽  
Devin Steenkamp

In this commentary, we briefly review the currently recommended approaches to interpretation and management of continuous glucose monitor (CGM) rate of change (ROC) trend arrows and discuss the inherent difficulty in incorporating practical recommendations for their application into routine clinical care. We have limited our review and discussion to the currently available Dexcom G5 and G6 CGM systems and Abbott’s Freestyle Libre flash glucose monitor (FGM) system, as they are the most widely used and currently approved for nonadjunctive use in the United States.

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Géza Kogler ◽  
Christopher Hovorka

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education – an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals’ clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36673/28349 How To Cite: Kogler GF, Hovorka CF. Academia’s role to drive change in the orthotics and prosthetics profession. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.21. https://doi.org/10.33137/cpoj.v4i2.36673 Corresponding Author: Géza F. KoglerOrthotics and Prosthetics Unit, Kennesaw State University.E-Mail: [email protected] ID: https://orcid.org/0000-0003-0212-5520


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Marcelo Rocha Nasser Hissa ◽  
Priscilla Nogueira Gomes Hissa ◽  
Sérgio Botelho Guimarães ◽  
Miguel Nasser Hissa

Abstract Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 l (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12 g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.


2006 ◽  
Vol 1 (2) ◽  
pp. 40
Author(s):  
Suzanne Pamela Lewis

A review of: Dee, Cheryl R., Marilyn Teolis, and Andrew D. Todd. “Physicians’ use of the personal digital assistant (PDA) in clinical decision making.” Journal of the Medical Library Association 93.4 (October 2005): 480-6. Objective – To examine how frequently attending physicians and physicians in training (medical students, interns and residents) used PDAs for patient care and to explore physicians’ perceptions of the impact of PDA use on several aspects of clinical care. Design – User study via a questionnaire. Setting – Teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania in the United States. Subjects – A convenience sample of fifty-nine attending physicians and forty-nine physicians in training (108 total), spread unevenly across the five states. Methods – Subjects were recruited by librarians at teaching hospitals to answer a questionnaire which was distributed and collected at medical meetings, as well as by email, mail, and fax. The subjects were required to have and use a PDA, but prior training on PDA use was not a requirement, nor was it offered to the subjects before the study. Most of the questions required the respondent to choose from five Likert scale answers regarding frequency of PDA use: almost always, often, a few times, rarely, or never. In the reporting of results, the options ‘almost always’ and ‘often’ were combined and reported as ‘frequent’, and the options ‘a few times’ and ‘rarely’, were combined and reported as ‘occasional’. Subjects could also record comments for each question, but only for affirmative responses. Subjects were asked about their frequency of PDA use before, during, or after a patient encounter. They were also asked if PDA use had influenced one or more of five aspects of clinical care – decision making, diagnosis, treatment, test ordering, and in-patient hospital length of stay. Data analysis included chi square tests to assess differences between attending physicians and physicians in training regarding frequency of PDA use and the influence of PDA use on the five aspects of clinical care. The subject population was also divided into frequent and occasional users of PDAs, and chi square testing was used to assess differences between these two groups regarding the influence of PDA use on clinical care. A significance value of P


2021 ◽  
Author(s):  
Marcelo Rocha Nasser Hissa ◽  
Priscilla Nogueira Gomes Hissa ◽  
Sérgio Botelho Guimarães ◽  
Miguel Nasser Hissa

Abstract Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre ® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method: A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the first week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 liters (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.


2021 ◽  
Vol 14 ◽  
pp. 175628482098819
Author(s):  
Klaudia Farkas ◽  
Daniella Pigniczki ◽  
Mariann Rutka ◽  
Kata Judit Szántó ◽  
Tamás Resál ◽  
...  

The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.


2016 ◽  
Vol 3 (2) ◽  
pp. e26 ◽  
Author(s):  
Deborah J Cohen ◽  
Sara R Keller ◽  
Gillian R Hayes ◽  
David A Dorr ◽  
Joan S Ash ◽  
...  

Author(s):  
Andrew Tawfik ◽  
Karl Kochendorfer

The current case study is situated within a large, land grant hospital located in the Midwestern region of the United States. Although the physicians had seen an increase in medical related human performance technology (HPTs) within the organization (e.g. computer physician ordered entry) some challenges remained as the hospital sought to improve the productivity of the electronic health record (EHRs). Specifically, physicians had difficulty finding information embedded within the chart due to usability problems and information overload. To overcome the challenges, a semantic search within the chart was implemented as a solution for physicians to retrieve relevant results given the conceptual semantic pattern. The case study will discuss many elements of the implementation based on our experience and feedback from clinicians. The case will specifically highlight the importance of training and change agents within an organization.


Hematology ◽  
2019 ◽  
Vol 2019 (1) ◽  
pp. 194-197 ◽  
Author(s):  
Ravi Sarode

Abstract Direct oral anticoagulants (DOACs) are increasingly used in the treatment and prophylaxis of thromboembolism because of several advantages over vitamin K antagonists, including no need for laboratory monitoring. However, it has become increasingly important in certain clinical scenarios to know either actual DOAC concentration (quantitative) or presence of DOAC (qualitative). These clinical conditions include patients presenting with major bleeding or requiring urgent surgery who may need a reversal or hemostatic agent, extremes of body weight, failed therapy, etc. Prothrombin time and activated partial thromboplastin time are variably affected by factor Xa inhibitors (FXaIs) and direct thrombin inhibitor (DTI), respectively, depending on reagents’ sensitivity, and hence, they cannot be relied on confidently. Thrombin time is highly sensitive to very low amounts of DTI; thus, normal value rules out a clinically significant amount. Liquid chromatography mass spectrometry accurately measures DOAC levels but is clinically impractical. Dilute thrombin time and ecarin-based assays using appropriate calibrators/controls provide an accurate DTI level. Anti-Xa assay using corresponding FXaI calibrators/controls provides accurate drug levels. However, these assays are not readily available in the United States compared with some other parts of the world. Heparin assays using anti-Xa activity often have a linear relationship with calibrated FXaI assays, especially at the lower end of on-therapy levels, and they may provide rapid assessment of drug activity for clinical decision making. Currently, there is very limited knowledge of DOAC effect on viscoelastic measurements. Although there is uniformity in expression of DOAC concentrations in nanograms per milliliter, a universal FXaI DOAC assay is urgently needed.


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