bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptance of technology-based tools in a sample of Parkinson’s patients
Authors: Duroseau Nathalie , Abramson Tobi , Pergament Kathleen , Chan Vivian , Govindavari John Paul , Ciraco Christina , Tegay David , Krishnamachari Bhuma 
Published: June 2016

Objectives Parkinson’s disease is the second most common neurodegenerative movement disorder in the United States. Patients’ opinions of technology-based tools for education and communication as related to Parkinson’s disease are unclear with little documented research addressing the issue. The goal of this research was to investigate patient opinions about technology-based tools with a focus on differences between patients of different age groups. Methods A cross-sectional survey was used to assess views on using multiple different electronic methods for receiving instructions and communicating with healthcare providers in 109 Parkinson’s disease patients. Results Approximately 28% (n = 28) of the subjects reported having unmet needs related to Parkinson’s disease. Those 65 and over were less likely to believe that using technology to communicate with the healthcare center would result in themselves having a better understanding of their care (odds ratio = 0.36, 95% confidence interval: 0.14, 0.95). Those over 75 had a lower odds of being willing to use electronic methods (odds ratio = 0.33, 95% confidence interval: 0.14, 0.79), a lower odds of believing that technology would result in better self-understanding of medical needs (odds ratio = 0.27, 95% confidence interval: 0.12, 0.63) and a lower odds of believing that technology would result in their healthcare providers better understanding their needs (odds ratio = 0.32, 95% confidence interval: 0.14, 0.73). Discussion The results of this study indicate that older Parkinson’s disease patients report a less favorable view regarding the role of technology in communicating with healthcare providers and for understanding their care.
Use of the My Health Record by people with communication disability in Australia
Authors: Hemsley Bronwyn , Georgiou Andrew , Carter Rob , Hill Sophie , Higgins Isabel , van Vliet Paulette , Balandin Susan 
Published: June 2016

Background: People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. Objective: The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, ‘My Health Record’ (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. Method: The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. Research outcomes: This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. Conclusion: In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.
Evaluation of the Performance of a Novel System for Continuous Glucose Monitoring
Authors: Zschornack Eva , Schmid Christina , Pleus Stefan , Link Manuela , Klötzer Hans-Martin , Obermaier Karin , Schoemaker Michael , Strasser Monika , Frisch Gerhard , Schmelzeisen-Redeker Günther , Haug Cornelia , Freckmann Guido 
Published: June 2016

Background: The performance of a continuous glucose monitoring (CGM) system in the early stage of development was assessed in an inpatient setting that simulates daily life conditions of people with diabetes. Performance was evaluated at low glycemic, euglycemic, and high glycemic ranges as well as during phases with rapid glucose excursions. Methods: Each of the 30 participants with type 1 diabetes (15 female, age 47 ± 12 years, hemoglobin A1c 7.7% ± 1.3%) wore two sensors of the prototype system in parallel for 7 days. Capillary blood samples were measured at least 16 times per day (at least 15 times per daytime and at least once per night). On two subsequent study days, glucose excursions were induced. For performance evaluation, the mean absolute relative difference (MARD) between CGM readings and paired capillary blood glucose readings and precision absolute relative difference (PARD), i.e., differences between paired CGM readings were calculated. Results: Overall aggregated MARD was 9.2% and overall aggregated PARD was 7.5%. During induced glucose excursions, MARD was 10.9% and PARD was 7.8%. Lowest MARD (8.5%) and lowest PARD (6.4%) were observed in the high glycemic range (euglycemic range, MARD 9.1% and PARD 7.4%; low glycemic range, MARD 12.3% and PARD 12.4%). Conclusions: The performance of this prototype CGM system was, particularly in the hypoglycemic range and during phases with rapid glucose fluctuations, better than performance data reported for other commercially available systems. In addition, performance of this prototype sensor was noticeably constant over the whole study period. This prototype system is not yet approved, and performance of this CGM system needs to be further assessed in clinical studies.
Susceptibility of Interstitial Continuous Glucose Monitor Performance to Sleeping Position
Authors: Mensh Brett D. , Wisniewski Natalie A. , Neil Brian M. , Burnett Daniel R. 
Published: June 2016

Background: Developing a round-the-clock artificial pancreas requires accurate and stable continuous glucose monitoring. The most widely used continuous glucose monitors (CGMs) are percutaneous, with the sensor residing in the interstitial space. Inaccuracies in percutaneous CGM readings during periods of lying on the devices (e.g., in various sleeping positions) have been anecdotally reported but not systematically studied. Methods: In order to assess the impact of sleep and sleep position on CGM performance, we conducted a study in human subjects in which we measured the variability of interstitial CGM data at night as a function of sleeping position. Commercially available sensors were placed for 4 days in the abdominal subcutaneous tissue in healthy, nondiabetic volunteers (four sensors per person, two per side). Nocturnal sleeping position was determined from video recordings and correlated to sensor data. Results: We observed that, although the median of the four sensor readings was typically 70–110 mg/dl during sleep, individual sensors intermittently exhibited aberrant glucose readings (>25 mg/dl away from median) and that these aberrant readings were strongly correlated with subjects lying on the sensors. We expected and observed that most of these aberrant sleep-position-related CGM readings were sudden decreases in reported glucose values, presumably due to local blood-flow decreases caused by tissue compression. Curiously, in rare cases, the aberrant CGM readings were elevated values. Conclusions: These findings highlight limitations in our understanding of interstitial fluid physiology in the subcutaneous space and have significant implications for the utilization of sensors in the construction of an artificial pancreas.
Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification
Authors: Coan Kathryn E. , Schlinkert Andrew B. , Beck Brandon R. , Haakinson Danielle J. , Castro Janna C. , Apsey Heidi A. , Schlinkert Richard T. , Cook Curtiss B. 
Published: June 2016

Objective: Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes. Methods: A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as “basal plus short acting,” “short acting only,” or “none,” and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl. Results: Among cases selected for analysis ( n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl ( p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively. Conclusions: Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen—evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.
PREDIRCAM eHealth Platform for Individualized Telemedical Assistance for Lifestyle Modification in the Treatment of Obesity, Diabetes, and Cardiometabolic Risk Prevention: A Pilot Study (PREDIRCAM 1 >
Authors: González Cintia , Herrero Pau , Cubero José M. , Iniesta José M. , Hernando M. Elena , García-Sáez Gema , Serrano Alvaro J. , Martinez-Sarriegui Iñaki , Perez-Gandia Carmen , Gómez Enrique J. , Rubinat Esther , Alcantara Valeria , Brugués Eulalia , Chico Ana , Mato Eugenia , Bell Olga , Corcoy Rosa , de Leiva Alberto 
Published: June 2016

Background: Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention. Methods: PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform. Results: The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible. Conclusions: The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.
Importance of Manually Entering Blood Glucose Readings When Wireless-Compatible Meters are Not Being Used with an Insulin Pump
Authors: Driscoll Kimberly A. , Johnson Suzanne Bennett , Wang Yuxia , Gill Elizabeth C. , Mitchell Adela , Wright Nancy , Deeb Larry C. 
Published: June 2016

Background: The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group). Methods: Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps. Results: There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings. Conclusions: Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.
A Composite Model of Glucagon-Glucose Dynamics for In Silico Testing of Bihormonal Glucose Controllers
Authors: Herrero Pau , Georgiou Pantelis , Oliver Nick , Reddy Monika , Johnston Desmond , Toumazou Christofer 
Published: June 2016

Background: The utility of simulation environments in the development of an artificial pancreas for type 1 diabetes mellitus (T1DM) management is well established. The availability of a simulator that incorporates glucagon as a counterregulatory hormone to insulin would allow more efficient design of bihormonal glucose controllers. Existing models of the glucose regulatory system that incorporates glucagon action are difficult to identify without using tracer data. In this article, we present a novel model of glucagon-glucose dynamics that can be easily identified with standard clinical research data. Methods: The minimal model of plasma glucose and insulin kinetics was extended to account for the action of glucagon on net endogenous glucose production by incorporating a new compartment. An existing subcutaneous insulin absorption model was used to account for subcutaneous insulin delivery. The same model of insulin pharmacokinetics was employed to model the pharmacokinetics of subcutaneous glucagon absorption. Finally, we incorporated an existing gastrointestinal absorption model to account for meal intake. Data from a closed-loop artificial pancreas study using a bihormonal controller on T1DM subjects were employed to identify the composite model. To test the validity of the proposed model, a bihormonal controller was designed using the identified model. Results: Model parameters were identified with good precision, and an excellent fitting of the model with the experimental data was achieved. The proposed model allowed the design of a bihormonal controller and demonstrated its ability to improve glycemic control over a single-hormone controller. Conclusions: A novel composite model, which can be easily identified with standard clinical data, is able to account for the effect of exogenous insulin and glucagon infusion on glucose dynamics. This model represents another step toward the development of a bihormonal artificial pancreas.
Analysis of Intravenous Glucose Tolerance Test Data Using Parametric and Nonparametric Modeling: Application to a Population at Risk for Diabetes
Authors: Marmarelis Vasilis Z. , Shin Dae C. , Zhang Yaping , Kautzky-Willer Alexandra , Pacini Giovanni , D'Argenio David Z. 
Published: June 2016

Background: Modeling studies of the insulin-glucose relationship have mainly utilized parametric models, most notably the minimal model (MM) of glucose disappearance. This article presents results from the comparative analysis of the parametric MM and a nonparametric Laguerre based Volterra Model (LVM) applied to the analysis of insulin modified (IM) intravenous glucose tolerance test (IVGTT) data from a clinical study of gestational diabetes mellitus (GDM). Methods: An IM IVGTT study was performed 8 to 10 weeks postpartum in 125 women who were diagnosed with GDM during their pregnancy [population at risk of developing diabetes (PRD)] and in 39 control women with normal pregnancies (control subjects). The measured plasma glucose and insulin from the IM IVGTT in each group were analyzed via a population analysis approach to estimate the insulin sensitivity parameter of the parametric MM. In the nonparametric LVM analysis, the glucose and insulin data were used to calculate the first-order kernel, from which a diagnostic scalar index representing the integrated effect of insulin on glucose was derived. Results: Both the parametric MM and nonparametric LVM describe the glucose concentration data in each group with good fidelity, with an improved measured versus predicted r2 value for the LVM of 0.99 versus 0.97 for the MM analysis in the PRD. However, application of the respective diagnostic indices of the two methods does result in a different classification of 20% of the individuals in the PRD. Conclusions: It was found that the data based nonparametric LVM revealed additional insights about the manner in which infused insulin affects blood glucose concentration.
Evaluation of a Blood Glucose Monitoring System with Automatic High- and Low-Pattern Recognition Software in Insulin-Using Patients: Pattern Detection and Patient-Reported Insights
Authors: Grady Mike , Campbell Denise , MacLeod Kirsty , Srinivasan Aparna 
Published: June 2016

Background: This study aimed to evaluate the performance of a glucose pattern recognition tool incorporated in a blood glucose monitoring system (BGMS) and its association with clinical measures, and to assess user perception and understanding of the pattern messages they receive. Methods: Participants had type 1 or type 2 diabetes mellitus and were self-adjusting insulin doses for ≥1 year. During a 4-week home testing period, participants performed ≥6 daily self-tests, adjusted their insulin regimen based on BGMS results, and recorded pattern messages in the logbook. Participants reflected on usability of the pattern tool in a questionnaire. Results: Study participants ( n = 101) received a mean ± standard deviation of 4.5 ± 1.9 pattern messages per week (3.6 ± 1.8 high glucose patterns and 0.9 ± 1.3 low glucose patterns). Most received ≥1 high (96.5%) and/or ≥1 low (46.0%) pattern message per week. The average number of high- and low-pattern messages per week was associated with higher and lower, respectively, baseline hemoglobin A1c ( p < .01) and fasting plasma glucose ( p < .05). Participants found high- and low-pattern messages clear and easy to understand (84.2% and 83.2%, respectively) and considered the frequency of low (82.0%) and high (63.4%) pattern messages about right. Overall, 71.3% of participants indicated they preferred to use a meter with pattern messages. Conclusions: The on-device Pattern tool identified meaningful blood glucose patterns, highlighting potential opportunities for improving glycemic control in patients who self-adjust their insulin.
Advancement of the Artificial Pancreas through the Development of Interoperability Standards
Authors: Picton Peter E. , Yeung Melanie , Hamming Nathaniel , Desborough Lane , Dassau Eyal , Cafazzo Joseph A. 
Published: June 2016

Despite advancements in the development of the artificial pancreas, barriers in the form of proprietary data and communication protocols of diabetes devices have made the integration of these components challenging. The Artificial Pancreas Standards and Technical Platform Project is an initiative funded by the JDRF Canadian Clinical Trial Network with the goal of developing device communication standards for the interoperability of diabetes devices. Stakeholders from academia, industry, regulatory agencies, and medical and patient communities have been engaged in advancing this effort. In this article, we describe this initiative along with the process involved in working with the standards organizations and stakeholders that are key to ensuring effective standards are developed and adopted. Discussion from a special session of the 12th Annual Diabetes Technology Meeting is also provided. Conclusion This session provided the project team an excellent opportunity to interact with a diverse group of stakeholders and brought a number of new collaborators to the table who will contribute to the initiative. Starting in January 2013, the project team has convened regular meetings with collaborating researchers and industry representatives to discuss the direction of the standards development, focusing on the IEEE-11073 PHD standards for the insulin pump and CGM. Through this ongoing collaboration, the barriers to the interoperability of diabetes devices will eventually be eliminated, fostering greater innovation in the development of the AP and other diabetes management tools.
The impact of the DoH Commissioning for Quality and Innovation incentive on the success of venous thromboembolism risk assessment in hospitalised patients. A single institution experience in a quality outcome improvement over a 4-year cycle
Authors: Shlebak Abdul , Sandhu Polly , Ali Vernisha , Jones Garth , Baker Christopher 
Published: June 2016

Objectives To i) demonstrate compliance with the Commissioning for Quality and Innovation for venous thromboembolism risk assessment ii) to undertake root cause analysis of Hospital Acquired Thrombosis and to investigate its impact on quality of care. Design Prospective monitoring of all admissions. Setting Imperial College Healthcare Hospitals, London. Participants All Hospital Provider Spells as defined on the NHS Data Model and Dictionary. Main outcome measures i) Percentage of patients undergoing Venous Thromboembolism Risk Assessment (VTE-RA) at and 24-hours after admission ii) root cause analysis of Hospital Acquired Thrombosis up to 90 days following discharge. Results Over a 48-month cycle 83% were overall VTE-RA assessed with 36% in the first 12 months but with significant improvement to ≥95% between April 2013 and April 2015, achieving compliance target since April 2012 involving a massive 633, 850 Spells over the 4 year period. We undertook root cause analysis of all VTE episodes from April 2013 to March 2014, to ascertain Hospital Acquired Thrombosis (HAT), we analysed 433, 174 inpatient days and found a HAT rate of 1 per 1000 with 23% and 24% for DVTs and PEs potentially avoidable respectively. We further analysed VTE risk stratification (n = 1000) and found 37.0% at high risk, 44.4% at medium risk and 18.6 % at low risk, indicating the need of thromboprophylaxis in 81.4% (high and medium) of whom 33.6% were excluded. Conclusions We achieved 95% RA compliance which has favourably impacted on our daily practice and improved the quality of the clinical care.