Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods: A Cross-sectional study.

BACKGROUND: Less invasive and noninvasive methods are emerging for haemodynamic monitoring. Among them is Capstesia, a smartphone app that, from photographs of a patient monitor showing invasive arterial pressure, estimates advanced haemodynamic variables after digitising and analysing the pressure curves. OBJECTIVE: The aim of this study was to compare the level of agreement between the analysis of the signals obtained from the patient monitor and a photograph of the same images using the Capstesia app. DESIGN: Cross-sectional study. SETTING: Araba University hospital (Txagorritxu), Vitoria-Gasteiz, Alava, Spain, from January to February 2015. PATIENTS: Twenty patients (229 images) who had an arterial catheter (radial or femoral artery) inserted for haemodynamic monitoring. INTERVENTION: Snapshots obtained from the patient monitor and a photograph of these same snapshots using the Capstesia application were assessed with the same software (MATLAB, Mathworks, Natick, Massachusetats, USA) for evaluating the level of concordance of the following variables: pulse pressure variation (PPV), cardiac output (CO) and maximum slope of the pressure curve (dP/dt). Comparison was made using interclass correlation coefficients with corresponding 95% confidence intervals, and Bland-Altman plots with the corresponding percentages of error. MAIN OUTCOME MEASURES: (PPV). Secondary outcome: CO and maximum slope of the pressure curve [dP/dt]. RESULTS: The interclass correlation coefficients for PPV, CO and max dP/dt were 0.991 (95% confidence interval 0.988 to 0.993), 0.966 (95% confidence interval 0.956 to 0.974) and 0.962 (95% confidence interval 0.950 to 0.970), respectively. In the Bland-Altman analysis, bias and limits of agreement of PPV were (0.50% ±â€Š1.42) resulting in a percentage of error of 20% for PPV. For CO they were 0.19 ±â€Š0.341, with a 13.8% of error. Finally bias and limits of agreement for max dP/dt were 1.33 ±â€Š77.71, resulting in an error of 14.20% CONCLUSIONS: Photograph of the screenshots obtained with the Capstesia app show a good concordance with analysis of the original screenshots. Either approach could be used to monitor the haemodynamic variables assessed.

Effectiveness and efficiency of platelet rich plasma in the treatment of diabetic ulcers.

"There is a growing body of evidence suggesting that wound healing in chronic diabetic foot ulcers is growth factor dependent, and that the therapeutic delivery of these growth factors to wounds topically, has the potential ability to accelerate wound healing in conjunction with conventional wound care". There is, however, confusion about the utility of platelet rich plasma because the studies that have evaluated them use a wide range of products (different platelet and leukocyte concentrations, different techniques and frequencies of application, very heterogeneous simple, and different endpoints) making almost impossible to compare data and draw conclusions. In this study, we have analyzed the different platelet rich plasma products from a new perspective: cost-efficiency. According to our data, we observe that platelet rich plasma is a cost-effective option that allows faster healing of ulcers, and that should be taken into account in patients with long evolution ulcers.