The use of smartphone-derived location data to evaluate participation following critical illness: A pilot observational cohort study.

BACKGROUND: Disability is common following critical illness, impacting the quality of life of survivors, and is difficult to measure. 'Participation' can be quantified as involvement in life outside of their home requiring movement from their home to other locations. Participation restriction is a key element of disability, and following critical illness, participation may be diminished. It may be possible to quantify this change using pre-existing smartphone data. OBJECTIVES: The feasibility of extracting location data from smartphones of survivors of intensive care unit (ICU) admission and assessing participation, using location-based outcomes, during recovery from critical illness was evaluated. METHODS: Fifty consecutively admitted, consenting adult survivors of non-elective admission to ICU of greater than 48-h duration were recruited to a prospective observational cohort study where they were followed up at 3 and 6 months following discharge. The feasibility of extracting location data from survivors' smartphones and creating location-derived outcomes assessing participation was investigated over three 28-d study periods: pre-ICU admission and at 3 and 6 months following discharge. The following were calculated: time spent at home; the number of destinations visited; linear distance travelled; and two 'activity spaces', a minimum convex polygon and standard deviation ellipse. RESULTS: Results are median [interquartile range] or n (%). The number of successful extractions was 9/50 (18%), 12/39 (31%), and 13/33 (39%); the percentage of time spent at home was 61 [56-68]%, 77 [66-87]%, and 67 [58-77]% (P = 0.16); the number of destinations visited was 34 [18-64], 38 [22-63], and 65 [46-88] (P = 0.02); linear distance travelled was 367 [56-788], 251 [114-323], and 747 [326-933] km over 28 d (P = 0.02), pre-ICU admission and at 3 and 6 months following ICU discharge, respectively. Activity spaces were successfully created. CONCLUSION: Limited smartphone ownership, missing data, and time-consuming data extraction limit current implementation of mass extraction of location data from patients' smartphones to aid prognostication or measure outcomes. The number of journeys taken and the linear distance travelled increased between 3 and 6 months, suggesting participation may improve over time.

An observational study investigating the use of patient-owned technology to quantify physical activity in survivors of critical illness.

BACKGROUND: Physical activity after intensive care unit (ICU) discharge is challenging to measure but could inform research and practice. A patient's smartphone may provide a novel method to quantify physical activity. OBJECTIVES: We aimed to evaluate the feasibility and accuracy of using smartphone step counts among survivors of critical illness. METHODS: We performed a prospective observational cohort study in 50 patients who had an ICU length of stay>48 h, owned a smartphone, were ambulatory before admission, and were likely to attend follow-up at 3 and 6 months after discharge. At follow-up, daily step counts were extracted from participants' smartphones and two FitBit pedometers, and exercise capacity (6-min walk test) and quality of life (European Quality of Life-5 Dimensions) were measured. RESULTS: Thirty-nine (78%) patients returned at 3 months and 33 (66%) at 6 months, the median [interquartile range] smartphone step counts being 3372 [1688-5899] and 2716 [1717-5994], respectively. There was a strong linear relationship, with smartphone approximating 0.71 (0.58, 0.84) of FitBit step counts, P < 0.0001, R-squared = 0.87. There were weak relationships between step counts and the 6-min walk test distance. CONCLUSION: Although smartphone ownership and data acquisition limit the viability of using extracted smartphone steps at this time, mean daily step counts recorded using a smartphone may act as a surrogate for a dedicated pedometer; however, the relationship between step counts and other measures of physical recovery remains unclear.

Wide Disagreement Between Alternative Assessments of Premorbid Physical Activity: Subjective Patient and Surrogate Reports and Objective Smartphone Data.

OBJECTIVES: Surrogate-decision maker and patient self-reported estimates of the distances walked prior to acute illness are subjective and may be imprecise. It may be possible to extract objective data from a patient's smartphone, specifically, step and global position system data, to quantify physical activity. The objectives were to 1) assess the agreement between surrogate-decision maker and patient self-reported estimates of distance and time walked prior to resting and daily step-count and 2) determine the feasibility of extracting premorbid physical activity (step and global position system) data from critically ill patients. DESIGN: Prospective cohort study. SETTING: Quaternary ICU. PATIENTS: Fifty consecutively admitted adult patients who owned a smartphone, who were ambulatory at baseline, and who remained in ICU for more than 48 hours participated. MEASURMENTS AND MAIN RESULTS: There was no agreement between patients and surrogates for all premorbid walking metrics (mean bias 108% [99% lower to 8,700% higher], 83% [97% to 2,100%], and 71% [96% to 1,080%], for distance, time, and steps, respectively). Step and/or global position system data were successfully extracted from 24 of 50 phones (48%; 95% CI, 35-62%). Surrogate-decision makers, but not patient self-reported, estimates of steps taken per day correlated with smartphone data (surrogates: n = 13, ρ = 0.56, p < 0.05; patients: n = 13, ρ = 0.30, p = 0.317). CONCLUSION: There was a lack of agreement between surrogate-decision maker and patient self-reported subjective estimates of distance walked. Obtaining premorbid physical activity data from the current-generation smartphones was feasible in approximately 50% of patients.

A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access.

OBJECTIVE: This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access. METHODS: An extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts. RESULTS: There were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients. CONCLUSIONS: Although both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required.

Variation of surface temperatures of different ground materials on hot days: Burn risk for the neuropathic foot.

The purpose of this study is to assess the relationship between ambient temperature and surface temperatures of commonly used building/ground materials, in order to estimate the risk of contact thermal injury. It is an observational study where the air ambient temperature and the surface temperatures of slate, metal, cement, sand, brick and bitumen, were measured, in shaded and unshaded conditions, on cloudy and cloudless days in summer in Adelaide, South Australia. All unshaded surfaces reached temperatures capable of causing significant sole of foot burns given requisite exposure time in both clear and overcast conditions, even with a relatively low ambient temperature. Shade imparted total protection from irreversible thermal injury for all of the ambient temperatures assessed. Although surface temperatures were reduced in overcast conditions, the temperatures recorded were still capable of causing thermal injury. Peripheral neuropathy prolongs heat exposure times, often resulting in significant and complex injury, requiring lengthy treatment and generating potentially poor functional outcomes. This study provides a reference point for the enactment of preventative measures for at risk population groups such a diabetics.

Applied anatomy of the lingual nerve: relevance to dental anaesthesia.

OBJECTIVES: (1) to classify the external morphology of the lingual nerve and investigate any relationship between its external and internal morphology, (2) to explore the fascicular structure, nerve tissue density and capillary density of the lingual nerve, and (3) to provide an anatomical explanation as to why adverse clinical outcomes more commonly affect the lingual nerve following local dental anaesthesia. Where possible, comparisons were made between the lingual and inferior alveolar nerves. MATERIALS AND METHODS: The lingual and inferior alveolar nerves were examined in 23 hemi-sectioned heads macroscopically and microscopically 2mm above the lingula. The lingual nerve was also examined in the regions of the third and second molars. Specimens underwent histological processing and staining with Haematoxylin & Eosin, Masson's Trichrome, anti-GLUT-1 and anti-CD 34. RESULTS: The lingual nerve became flatter as it traversed through the pterygomandibular space. There was an increase in the connective tissue and a decrease in nerve tissue density along the lingual nerve (p<0.001). At 2mm above the lingula, the lingual nerve was uni-fascicular in 39% of cases, whilst the inferior alveolar nerve consistently had more fascicles (p<0.001). The lingual nerve fascicles had thicker perineurium but the endoneurial vascular density was not significantly different in the two nerves. CONCLUSIONS: The greater susceptibility of lingual nerve dysfunction during inferior alveolar nerve blocks may be due to its uni-fascicular structure and the thicker perineurium, leading to increased endoneurial pressure and involvement of all axons if oedema or haemorrhage occurs due to trauma.