Wearable bioimpedance for continuous and context-aware clinical monitoring

Clinical Decision ◽

Accelerometer Data ◽

Non Invasive ◽

Standardized Protocol ◽

Current Consumption ◽

Wide Range ◽

Measurement Operation ◽

Total Body ◽

Commercial Device

<div>Bioimpedance monitoring provides a non-invasive,</div><div>safe and affordable opportunity to monitor total body water for a wide range of clinical applications. However, the measurement is susceptible to variations in posture and movement. Existing devices do not account for the variations and are therefore unsuitable to perform continuous measurements to depict trend changes. We developed a wearable bioimpedance monitoring system with embedded real-time posture detection using a distributed accelerometer network. We tested the device on 14 healthy volunteers following a standardized protocol of posture change and compared the obtained measurements with an existing commercial device. The impedance measured with both systems had a high correlation (r>0.98) and a Bland-Altman analysis revealed a bias of -4.5 and limits of agreement of -30 and 21. Context-awareness was achieved with processing accelerometer data placed at the upper and lower leg with an accuracy >95%. The calculated current consumption is as low as 10 mA during continuous measurement operation, suggesting that without recharge the system can be used for multiple days. The proposed motion-aware design will enable the measurement of relevant bioimpedance parameters continuously over long periods and aid in informed clinical decision making.</div>

Wearable bioimpedance for continuous and context-aware clinical monitoring

10.36227/techrxiv.12283877 ◽

2020 ◽

Author(s):

Walter Karlen ◽

Abhilash Guru Dutt ◽

Michaela Verling

Keyword(s):

Clinical Decision ◽

Accelerometer Data ◽

Non Invasive ◽

Standardized Protocol ◽

Current Consumption ◽

Wide Range ◽

Measurement Operation ◽

Total Body ◽

Commercial Device

<div>Bioimpedance monitoring provides a non-invasive,</div><div>safe and affordable opportunity to monitor total body water for a wide range of clinical applications. However, the measurement is susceptible to variations in posture and movement. Existing devices do not account for the variations and are therefore unsuitable to perform continuous measurements to depict trend changes. We developed a wearable bioimpedance monitoring system with embedded real-time posture detection using a distributed accelerometer network. We tested the device on 14 healthy volunteers following a standardized protocol of posture change and compared the obtained measurements with an existing commercial device. The impedance measured with both systems had a high correlation (r>0.98) and a Bland-Altman analysis revealed a bias of -4.5 and limits of agreement of -30 and 21. Context-awareness was achieved with processing accelerometer data placed at the upper and lower leg with an accuracy >95%. The calculated current consumption is as low as 10 mA during continuous measurement operation, suggesting that without recharge the system can be used for multiple days. The proposed motion-aware design will enable the measurement of relevant bioimpedance parameters continuously over long periods and aid in informed clinical decision making.</div>

Religion and Medicine

10.1093/oso/9780190867355.001.0001 ◽

2020 ◽

Author(s):

Jeff Levin ◽

Stephen G. Post

Keyword(s):

Well Being ◽

Clinical Decision ◽

Religion And Medicine ◽

Physical And Mental Health ◽

Faith Based ◽

Baylor University ◽

Wide Range ◽

History Of ◽

The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

Prognostic Factors for Persistent Symptoms in Adults With Mild Traumatic Brain Injury: an Overview of Systematic Reviews

10.21203/rs.3.rs-948335/v1 ◽

2021 ◽

Author(s):

Julien Déry ◽

Béatrice Ouellet ◽

Élaine de Guise ◽

Ève-Line Bussières ◽

Marie-Eve Lamontagne

Keyword(s):

Traumatic Brain Injury ◽

Prognostic Factors ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Systematic Reviews ◽

Clinical Decision ◽

Persistent Symptoms ◽

Wide Range ◽

Overview Of Systematic Reviews

Abstract Background: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide prevention of persistent symptoms following mTBI. Prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope.Methods: We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms.Results: From the 3857 references retrieved in database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews.Conclusion: We highlighted the need of a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decision and research related to prevention and intervention regarding persistent post-concussion symptoms.Systematic review registration: PROSPERO CRD42020176676

Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820953410 ◽

2020 ◽

Vol 14 ◽

pp. 117954682095341 ◽

Cited By ~ 1

Author(s):

Todd C Villines ◽

Mark J Cziraky ◽

Alpesh N Amin

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Real World ◽

Randomized Clinical Trials ◽

Clinical Decision ◽

The Body ◽

Representative Sampling ◽

Real World Evidence ◽

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

Myocarditis

The EACVI Textbook of Cardiovascular Magnetic Resonance ◽

10.1093/med/9780198779735.003.0027 ◽

2018 ◽

pp. 290-308

Author(s):

Vanessa M Ferreira ◽

Juliano L Fernandes ◽

Cristina Basso ◽

Matthias G Friedrich

Keyword(s):

Clinical Decision ◽

Myocardial Inflammation ◽

Aged Patients ◽

Non Invasive ◽

Quantitative Mapping ◽

Patients With Heart Failure ◽

High Prevalence ◽

Mapping Techniques

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.

Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

Journal of Clinical Medicine ◽

10.3390/jcm9072237 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2237

Author(s):

Nicola Galea ◽

Francesco Bandera ◽

Chiara Lauri ◽

Camillo Autore ◽

Andrea Laghi ◽

...

Keyword(s):

Electronic Device ◽

Multimodality Imaging ◽

Nuclear Imaging ◽

Clinical Decision ◽

Cardiac Device ◽

Systemic Complications ◽

Advantages And Disadvantages ◽

Clinical Scenarios ◽

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

Interpreting the Wide Range of NT-proBNP Concentrations in Clinical Decision Making

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.01.056 ◽

2018 ◽

Vol 71 (11) ◽

pp. 1201-1203 ◽

Cited By ~ 7

Author(s):

Peter A. McCullough ◽

Aaron Y. Kluger

Keyword(s):

Decision Making ◽

Clinical Decision ◽

Development of Antibody Immuno-PET/SPECT Radiopharmaceuticals for Imaging of Oncological Disorders—An Update

Cancers ◽

10.3390/cancers12071868 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1868

Author(s):

Jonatan Dewulf ◽

Karuna Adhikari ◽

Christel Vangestel ◽

Tim Van Den Wyngaert ◽

Filipe Elvas

Keyword(s):

Single Photon ◽

Imaging Techniques ◽

Photon Emission ◽

Therapy Response ◽

High Specificity ◽

Clinical Decision ◽

Disease Diagnosis ◽

Emission Computed Tomography ◽

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are molecular imaging strategies that typically use radioactively labeled ligands to selectively visualize molecular targets. The nanomolar sensitivity of PET and SPECT combined with the high specificity and affinity of monoclonal antibodies have shown great potential in oncology imaging. Over the past decades a wide range of radio-isotopes have been developed into immuno-SPECT/PET imaging agents, made possible by novel conjugation strategies (e.g., site-specific labeling, click chemistry) and optimization and development of novel radiochemistry procedures. In addition, new strategies such as pretargeting and the use of antibody fragments have entered the field of immuno-PET/SPECT expanding the range of imaging applications. Non-invasive imaging techniques revealing tumor antigen biodistribution, expression and heterogeneity have the potential to contribute to disease diagnosis, therapy selection, patient stratification and therapy response prediction achieving personalized treatments for each patient and therefore assisting in clinical decision making.

Complete and Voluntary Starvation of 50 Days

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s39776 ◽

2016 ◽

Vol 9 ◽

pp. CCRep.S39776 ◽

Cited By ~ 2

Author(s):

Bradley Elliott ◽

Michelle Mina ◽

Chrystalla Ferrier

Keyword(s):

Decision Making ◽

Body Mass ◽

Clinical Decision ◽

Activity Levels ◽

Total Body Mass ◽

Total Body ◽

Linear Loss ◽

Obese Male ◽

Evidence Based Decision Making

A 34-year-old obese male (96.8 kg; BMI, 30.2 kg m−1) volitionally undertook a 50-day fast with the stated goal of losing body mass. During this time, only tea, coffee, water, and a daily multivitamin were consumed. Severe and linear loss of body mass is recorded during these 50 days (final 75.4 kg; BMI, 23.5 kg mT 1 ). A surprising resilience to effects of fasting on activity levels and physical function is noted. Plasma samples are suggestive of early impairment of liver function, and perturbations to cardiovascular dynamics are also noted. One month following resumption of feeding behavior, body weight was maintained (75.0 kg; BMI, 23.4 kg m−1). Evidence-based decision-making with the fasting or hunger striking patient is limited by a lack of evidence. This case report suggests that total body mass, not mass lost, may be a key observation in clinical decision-making during fasting and starvation.