PURPOSE: To explore participant experiences for people on an arthroplasty waitlist, randomised to an exercise and behaviour-change counselling program (ENHANCE). The ENHANCE program for arthroplasty patients was led by an accredited exercise physiologist who delivered an individually tailored and structured exercise program. Included in the exercise program were up to five in-person counselling sessions, based on the Health Action Process Approach (HAPA) applied specifically to people with osteoarthritis. Nine adults (mean 69.4 years) who were on the waiting list for a total hip or knee arthroplasty and who had completed a 12-week program (ENHANCE) as part of a randomised controlled trial were recruited for this study. METHODS: Two focus groups were conducted to explore participant experiences of ENHANCE. Data were analysed using inductive thematic analysis with constructs of the HAPA (motivational and volitional factors) as a framework. RESULTS: We identified three themes (1) 'The structured program addressed inactivity and improved feelings of wellness and preparation for the operation'. The benefits were not only physical, but psychological and were contextualised in terms of preparation for the upcoming surgery. (2) 'People as enablers of participation': Participants identified that the attitude, and skill of the experienced instructor were supportive and motivating, especially in tailoring the intervention. Within the program, the support of the group was considered a positive attribute (3) 'Improved awareness changed attitudes to self-efficacy and perceived self-control'. Participants described an increased awareness of their condition and a better understanding of health expectations. They felt more control and ownership over their health journey. CONCLUSION: Goal setting and social support were identified factors in a behaviour-change counselling program, delivered in conjunction with structured exercise that led to a positive experience. Improved psychological and physical health were described. Participants were better prepared for their upcoming surgery, with increased self efficacy and mastery to support long-term physical-activity engagement.
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Adult , Humans , Counseling , Exercise Therapy , Focus Groups , Osteoarthritis, Knee/psychology , Aged
Background: In this proof-of-concept study, we evaluated if monogenic diabetes resulting from mutations of the HNF-1α gene (HNF1A-MODY) has a distinctive continuous glucose monitoring (CGM) glucotype, in comparison to type 1 diabetes (T1D). Methods: Using CGM data from 5 subjects with HNF1A-MODY and 115 subjects with T1D, we calculated multiple glucose metrics, including measures of within- and between-day variability (such as coefficient variation for each hour [CVb_1h]). Results: The MODY and T1D cohorts had minimum CVb_1h of 11.3 ± 4.4 and 18.0 ± 4.9, respectively (P = .02) and maximum CVb_1h of 33.9 ± 5.0 and 50.3 ± 10, respectively (P < .001). All subjects with HNF1A-MODY had a minimum %CVb_1h ≤ 17.3% and maximum %CVb_1h ≤ 37.1%. In contrast, only 12 of 115 subjects with T1D had both a minimum and maximum %CVb_1h below these thresholds (P < .001). Conclusion: HNF1A- MODY is characterized by a low hourly, between-day glucose variability. CGM-derived glucose metrics may have potential applicability for screening for atypical diabetes phenotypes in the T1D population.
Objective: This study aimed to determine if a novel intervention that combined individualised exercise training with behaviour change counselling based on Health Action Process Approach (HAPA) constructs could elicit long-term increase in physical activity (PA) and reduce comorbidity development among people requiring hip or knee arthroplasty. Method: A pre-registered two arm, parallel group, randomised controlled trial comparing the effect of a 12-week individualised exercise program combined with behavioural counselling delivered by accredited exercise physiologists, versus usual care to Osteoarthritis (OA) patients on public surgery waitlists. Participants were followed up at 6 months after baseline (pre-surgery) and again at 6 months post-surgery. Within and between group differences in post-surgery PA (as measured by ActivPal accelerometer), pain, function, quality of life, HAPA-based behavioural and psychological constructs, and health risk factors were analysed. Results: 63 participants (34 Female; Mean age â= â66.4 â± â7.2 âyrs) consented to participate in this study. At 6 months post baseline and 6 months post-surgery there were significant improvements in PA, pain, function, and quality of life, however there were no significant differences in the between group responses. Significant between group changes were observed in several psychological constructs related to volition at 6 months post baseline; however, these had disappeared by 6 months post-surgery. Conclusions: An exercise program and HAPA guided counselling intervention can improve psychological constructs related to exercise behaviour; however, these did not result in significant between group changes in PA at the timepoints measured. Further research with larger sample size is required.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN 12617000357358) Date of registration: 08/03/2017.
PURPOSE: Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to examine the preliminary safety and efficacy of zoledronic acid (ZOL), a potent anti-resorptive bisphosphonate, to suppress bone turnover markers (BTM) and prevent declines in bone mineral density (BMD) after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: We performed an open-label pilot study of pre-operative ZOL in postmenopausal women with obesity who were planning RYGB (n = 4). A single dose of zoledronic acid 5 mg was given intravenously prior to RYGB. Serum bone biochemistries including C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at multiple timepoints throughout the 24-week study. BMD was also obtained at the spine and hip by dual-energy x-ray absorptiometry (DXA) and at the trabecular spine by quantitative computed tomography (QCT) at pre-operative baseline and 24 weeks. Results were compared against pre-operative baseline and against changes among RYGB historical controls (n = 10). RESULTS: At 2 weeks after RYGB, there was a nonsignificant trend for CTX and P1NP levels to be lower than baseline levels in the ZOL group. By 24 weeks after RYGB, however, participants who received ZOL had a significant increase in CTX above pre-operative baseline (+0.228 ± 0.117 ng/dL, p = 0.030) but this CTX rise was less than that observed in the controls (+0.601 ± 0.307 ng/dL, p = 0.042 between groups). Despite ZOL use, participants had significant areal BMD loss at the total hip as compared to pre-operative baseline (-4.2 ± 1.5%, p = 0.012) that was similar in magnitude to total hip BMD loss in the controls (-5.5 ± 3.9%, p = 0.005). There was a suggestion that the ZOL group might be protected against trabecular spine volumetric bone loss as compared to the control group (+4.8 ± 8.0% vs. -5.9 ± 7.0%, p = 0.075 between groups). Serum calcium, 25-hydroxyvitamin D, and parathyroid hormone did not change in either group. No hypocalcemia or serious adverse events were reported after ZOL. CONCLUSION: In this proof of concept study, a single dose of ZOL prior to RYGB appeared to transiently mitigate but not fully prevent high bone turnover in the acute postoperative period. At 24 weeks after RYGB, our preliminary data suggest that ZOL was not sufficient to prevent bone loss at the hip, although it may preserve bone density at the trabecular spine. Further prospective, controlled studies are needed to confirm our findings and to identify the best strategies for preventing bone loss in bariatric patients receiving RYGB.
Roux-en-Y gastric bypass (RYGB) instigates high-turnover bone loss in the initial 5 years after surgery, whereas skeletal changes after adjustable gastric banding (AGB) are less pronounced. Long-term skeletal data are scarce, and the mechanisms of bone loss remain unclear. We sought to examine bone density and microarchitecture in RYGB and AGB patients a decade after surgery and to determine whether prior published reports of bone loss represent an appropriate adaptation to new postsurgical weight. In this cross-sectional study, 25 RYGB and 25 AGB subjects who had bariatric surgery ≥10 years ago were matched 1:1 with nonsurgical controls for age, sex, and current body mass index (BMI). We obtained bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), volumetric BMD and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular morphology by individual trabecular segmentation, and metabolic bone laboratory results. As compared with BMI-matched controls, RYGB subjects had significantly lower hip BMD, and lower total volumetric BMD at the distal radius and tibia. Substantial deficits in cortical and trabecular microarchitecture were observed in the RYGB group compared to controls, with reduced trabecular plate bone volume fraction and estimated failure load at both the radius and tibia, respectively. Bone turnover markers CTX and P1NP were 99% and 77% higher in the RYGB group than controls, respectively, with no differences in serum calcium, 25-hydroxyvitamin D, or parathyroid hormone. In contrast, the AGB group did not differ from their BMI-matched controls in any measured bone density, microarchitecture, or laboratory parameter. Thus, RYGB, but not AGB, is associated with lower than expected hip and peripheral BMD for the new weight setpoint, as well as deleterious changes in bone microarchitecture. These findings suggest that pathophysiologic processes other than mechanical unloading or secondary hyperparathyroidism contribute to bone loss after RYGB, and have important clinical implications for the long-term care of RYGB patients. © 2020 American Society for Bone and Mineral Research.
Gastric Bypass , Gastroplasty , Absorptiometry, Photon , Bone Density , Cross-Sectional Studies , Humans , Radius , Tibia
BACKGROUND: There is intense interest about whether modulating gut microbiota can impact systemic metabolism. We investigated the safety of weekly oral fecal microbiota transplantation (FMT) capsules from healthy lean donors and their ability to alter gut microbiota and improve metabolic outcomes in patients with obesity. METHODS AND FINDINGS: FMT-TRIM was a 12-week double-blind randomized placebo-controlled pilot trial of oral FMT capsules performed at a single US academic medical center. Between August 2016 and April 2018, we randomized 24 adults with obesity and mild-moderate insulin resistance (homeostatic model assessment of insulin resistance [HOMA-IR] between 2.0 and 8.0) to weekly healthy lean donor FMT versus placebo capsules for 6 weeks. The primary outcome, assessed by intention to treat, was change in insulin sensitivity between 0 and 6 weeks as measured by hyperinsulinemic euglycemic clamps. Additional metabolic parameters were evaluated at 0, 6, and 12 weeks, including HbA1c, body weight, body composition by dual-energy X-ray absorptiometry, and resting energy expenditure by indirect calorimetry. Fecal samples were serially collected and evaluated via 16S V4 rRNA sequencing. Our study population was 71% female, with an average baseline BMI of 38.8 ± 6.7 kg/m2 and 41.3 ± 5.1 kg/m2 in the FMT and placebo groups, respectively. There were no statistically significant improvements in insulin sensitivity in the FMT group compared to the placebo group (+5% ± 12% in FMT group versus -3% ± 32% in placebo group, mean difference 9%, 95% CI -5% to 28%, p = 0.16). There were no statistically significant differences between groups for most of the other secondary metabolic outcomes, including HOMA-IR (mean difference 0.2, 95% CI -0.9 to 0.9, p = 0.96) and body composition (lean mass mean difference -0.1 kg, 95% CI -1.9 to 1.6 kg, p = 0.87; fat mass mean difference 1.2 kg, 95% CI -0.6 to 3.0 kg, p = 0.18), over the 12-week study. We observed variable engraftment of donor bacterial groups among FMT recipients, which persisted throughout the 12-week study. There were no significant differences in adverse events (AEs) (10 versus 5, p = 0.09), and no serious AEs related to FMT. Limitations of this pilot study are the small sample size, inclusion of participants with relatively mild insulin resistance, and lack of concurrent dietary intervention. CONCLUSIONS: Weekly administration of FMT capsules in adults with obesity results in gut microbiota engraftment in most recipients for at least 12 weeks. Despite engraftment, we did not observe clinically significant metabolic effects during the study. TRIAL REGISTRATION: ClinicalTrials.gov NCT02530385.
Energy Metabolism , Fecal Microbiota Transplantation , Gastrointestinal Microbiome , Insulin Resistance , Intestines/microbiology , Obesity/therapy , Adult , Biomarkers/blood , Boston , Double-Blind Method , Fecal Microbiota Transplantation/adverse effects , Female , Humans , Male , Middle Aged , Obesity/diagnosis , Obesity/metabolism , Obesity/microbiology , Pilot Projects , Time Factors , Treatment Outcome
INTRODUCTION: Controlled trials support the efficacy of exercise as a treatment modality for chronic conditions, yet effectiveness of real-world Exercise Physiology services is yet to be determined. This study will investigate the efficacy and cost-effectiveness of services provided by Accredited Exercise Physiologists (AEPs) for clients with type 2 diabetes (T2D) in clinical practice. METHODS AND ANALYSIS: A non-randomised, opportunistic control, longitudinal design trial will be conducted at ten Exercise Physiology Clinics. Participants will be individuals with T2D attending one of the Exercise Physiology Clinics for routine AEP services (exercise prescription and counselling) (intervention) or individuals with T2D not receiving AEP services (usual care) (control). The experimental period will be 6 months with measurements performed at baseline and at 6 months. Primary outcome measures will be glycosylated haemoglobin (HbA1c), resting brachial blood pressure (BP), body mass index, waist circumference, 6 min walk test, grip strength, 30 s sit to stand, Medical Outcomes Short-Form 36-Item Health Survey and Active Australia Questionnaire. Secondary outcomes will be medication usage, out-of-pocket expenses, incidental, billable and non-billable health professional encounters and work missed through ill health. Healthcare utilisation will be measured for 12 months prior to, during and 12 months after trial participation using linked data from Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data. ETHICS AND DISSEMINATION: The study is a multicentre trial comprising: University of Tasmania, University of New South Wales Lifestyle Clinic, University of Canberra, Baker Heart and Diabetes Institute (covered under the ethics approval of University of Tasmania Health and Medical Ethics Committee H0015266), Deakin University (Approval number: 2016-187), Australian Catholic University (2016-304R), Queensland University of Technology (1600000049), University of South Australia (0000035306), University of Western Australia (RA/4/1/8282) and Canberra Hospital (ETH.8.17.170). The findings of this clinical trial will be communicated via peer-reviewed journal articles, conference presentations, social media and broadcast media. TRIAL REGISTRATION NUMBER: ACTRN12616000264482.
Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/rehabilitation , Exercise Therapy/methods , Australia , Body Mass Index , Controlled Clinical Trials as Topic , Cost-Benefit Analysis , Glycated Hemoglobin/metabolism , Humans , Multicenter Studies as Topic , Quality of Life , Surveys and Questionnaires , Waist Circumference , Walk Test
Purpose: We evaluate diabetic microaneurysm (MA) features on high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) and their correlations with visual acuity (VA) and local retinal pathology on spectral domain optical coherence tomography (SDOCT). Methods: Diabetic participants underwent VA testing and AOSLO and SDOCT imaging of MAs. AOSLO images were graded for MA dimension, wall hyperreflectivity (WH), intraluminal hyperreflectivity (IH), and perfusion pattern. SDOCTs centered on each MA were graded for disorganization of the retinal inner layers (DRIL) and other neuroretinal pathology. Results: We imaged 109 MAs (30 eyes). Multivariate modeling, including statistically significant covariates from bivariate analyses, associated WH with greater MA size (P = 0.001) and DRIL (P = 0.04). IH was associated with perfusion (P = 0.003) and MA visibility on photographs (P = 0.0001), and larger MA size with partial perfusion (P = 0.03), MA ring signs (P = 0.0002), and photographic visibility (P = 0.01). Multivariate modeling revealed an association of WH and VA with DRIL. Conclusions: AOSLO imaging demonstrates associations of hyperreflective MA walls with MA size and adjacent DRIL, as well as the presence of DRIL with lower VA. This study identifies a correlation between vascular and neural pathology associated with VA decline. Further studies of MA structure and neuroretinal disorganization may enable novel approaches to assess anatomic and functional outcomes in the diabetic eye.
Diabetic Retinopathy/diagnostic imaging , Microaneurysm/diagnostic imaging , Retina/physiopathology , Retinal Vessels/diagnostic imaging , Visual Acuity/physiology , Adult , Cross-Sectional Studies , Diabetes Mellitus, Type 1/diagnostic imaging , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 2/diagnostic imaging , Diabetes Mellitus, Type 2/physiopathology , Diabetic Retinopathy/physiopathology , Female , Glycated Hemoglobin/metabolism , Humans , Male , Middle Aged , Ophthalmoscopy/methods , Optics and Photonics , Tomography, Optical Coherence/methods
BACKGROUND: Osteoarthritis often results in prolonged periods of reduced physical activity and is associated with adverse health outcomes, including increased risk of cardiovascular and metabolic diseases. Exercise interventions for patients on the waiting list for arthroplasty can reduce the risk of long-term adverse outcomes by increasing activity levels. However, uptake and ongoing positive rates of physical activity in this population are low and the impact of pre-operative behaviour counselling on exercise is not known. METHOD/DESIGN: The exercise and behaviour change counselling (ENHANCE) trial is a two-arm assessor-blind randomised controlled trial to assess the effectiveness of a 12-week exercise intervention designed to improve long-term physical activity and functional abilities for people awaiting arthroplasty. Participants on the waiting list for hip and knee arthroplasty are recruited from one clinical site in Australia. After collection of baseline data, participants are randomised to either an intervention or control group. The control group receive usual care, as recommended by evidence-based guidelines. The intervention group receive an individualised programme of exercises and counselling sessions. The 12-week exercise programme integrates multiple elements, including up to five in-person counselling sessions, supported by written materials. Participants are encouraged to seek social support among their friends and self-monitor their physical activity. The primary outcome is physical activity (daily step count and percentage of day spent in sedentary activities). Secondary outcomes include pain ratings, physical function, psychosocial factors and changes in clinical markers linked with potential common chronic diseases (diabetes and cardiovascular disease). All outcomes are assessed at baseline and 26 weeks later and again at 26 weeks post-surgery. DISCUSSION: This study seeks to address a significant gap in current osteoarthritis management practice by providing evidence for the effectiveness of an exercise programme combined with behaviour counselling for adults waiting for hip and knee arthroplasty. Theory-driven evidence-based strategies that can improve an individual's exercise self-efficacy and self-management capacity could have a significant impact on the development of secondary chronic disease in this population. Information gained from this study will contribute to the evidence base on the management of adults waiting for hip and knee arthroplasty. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617000357358 . Registered on 8 March 2017.
Arthralgia/therapy , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Behavior Therapy/methods , Counseling/methods , Exercise Therapy/methods , Hip Joint/surgery , Knee Joint/surgery , Osteoarthritis, Hip/therapy , Osteoarthritis, Knee/therapy , Waiting Lists , Arthralgia/diagnosis , Arthralgia/physiopathology , Arthralgia/surgery , Biomechanical Phenomena , Health Behavior , Health Knowledge, Attitudes, Practice , Hip Joint/physiopathology , Humans , Knee Joint/physiopathology , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/physiopathology , Osteoarthritis, Hip/surgery , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/physiopathology , Osteoarthritis, Knee/surgery , Pain Measurement , Randomized Controlled Trials as Topic , Recovery of Function , Tasmania , Time Factors , Treatment Outcome
PURPOSE: This study had two aims: (1) to test the feasibility, safety, and efficacy of using a wireless pedometer in a cohort of nurses; and (2) to understand if wireless pedometer use increased number of steps walked, number of flights of stairs climbed, daily activity level, and improved personal perception of health. DESIGN: This study used a nonexperimental exploratory design to test the feasibility and efficacy of using a wireless pedometer in a cohort of nurses. Pre- and posttest measures captured the number of steps walked, flights of stairs climbed, activity level, and perception of health. RESULTS: Sample characteristics: 27 females, 3 males; 90% non-Hispanic Caucasian, 3% Hispanic; 47% between the ages of 55 and 65 years. Eighty percent of the participants reported that they were caregivers of other people. There was a significant increase from baseline to the end of the study in the following measures: self-perception of steps walked ( p < .001), flights of stairs climbed ( p < .005), self-perception of daily activity ( p < .001), and although there was an improvement in self-perception of health, the change was not significant. CONCLUSIONS: The wireless pedometer was a feasible, safe, and efficacious device to use. This study may have implications for interventions aimed at improving caregiver health.
BACKGROUND: Although much is known about health literacy in concept and practice, more research is needed to understand the mechanisms that improve health literacy and result in healthy behavior change. This is particularly so for those at risk of or living with chronic conditions who reside in communities experiencing socioeconomic disadvantage. OBJECTIVE: The program aimed to improve the prevention and management of chronic conditions by responding to health literacy needs. METHODS: A health literacy program, underpinned by Ophelia principles, was developed in consultation with three Neighbourhood Houses located in areas of socioeconomic disadvantage. Four 7-week group programs were delivered by a multidisciplinary team of academic health professionals. The evaluation aimed to explain how the design, content, and approach to delivery resulted in healthy behavior change and increased health literacy for the participants. Four focus groups were conducted to elicit feedback about the participants' experience of the program and recommendations for future programs. Data were thematically analyzed. The focus groups were attended by 22 (43%) of the total 51 program participants. Most of the participants were women with one or more chronic condition and residing in an area of socioeconomic disadvantage. KEY RESULTS: Four major themes were identified including the components of self-determination theory (SDT) (autonomy and competence and relatedness) and a separate, but related theme of empowerment. Recommendations for improving future programs were categorized separately. CONCLUSIONS: The SDT framework is a useful and novel approach to explaining the evaluation outcomes, the application of the Ophelia principles' underpinning design of the program, and the contribution of a multidisciplinary team of academic health professionals. Future programs will benefit from the SDT as a planning and evaluation framework, as well as understanding the long-term effects of the program within the broader community. [Health Literacy Research and Practice. 2017;1(3):e100-e108.]. PLAIN LANGUAGE SUMMARY: A team of health professionals developed a 7-week group program that they delivered in the community setting to people who were living with or at risk of developing chronic conditions. The evaluation showed the benefit of providing health information in ways that can be understood and acted upon, as well as the value of a group program that fosters participation.
Purpose: To determine whether cone density, spacing, or regularity in eyes with and without diabetes (DM) as assessed by high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) correlates with presence of diabetes, diabetic retinopathy (DR) severity, or presence of diabetic macular edema (DME). Methods: Participants with type 1 or 2 DM and healthy controls underwent AOSLO imaging of four macular regions. Cone assessment was performed by independent graders for cone density, packing factor (PF), nearest neighbor distance (NND), and Voronoi tile area (VTA). Regularity indices (mean/SD) of NND (RI-NND) and VTA (RI-VTA) were calculated. Results: Fifty-three eyes (53 subjects) were assessed. Mean ± SD age was 44 ± 12 years; 81% had DM (duration: 22 ± 13 years; glycated hemoglobin [HbA1c]: 8.0 ± 1.7%; DM type 1: 72%). No significant relationship was found between DM, HbA1c, or DR severity and cone density or spacing parameters. However, decreased regularity of cone arrangement in the macular quadrants was correlated with presence of DM (RI-NND: P = 0.04; RI-VTA: P = 0.04), increasing DR severity (RI-NND: P = 0.04), and presence of DME (RI-VTA: P = 0.04). Eyes with DME were associated with decreased density (P = 0.04), PF (P = 0.03), and RI-VTA (0.04). Conclusions: Although absolute cone density and spacing don't appear to change substantially in DM, decreased regularity of the cone arrangement is consistently associated with the presence of DM, increasing DR severity, and DME. Future AOSLO evaluation of cone regularity is warranted to determine whether these changes are correlated with, or predict, anatomic or functional deficits in patients with DM.
Diabetic Retinopathy/diagnosis , Macular Edema/diagnosis , Ophthalmoscopy/methods , Optics and Photonics , Retinal Cone Photoreceptor Cells/pathology , Visual Acuity , Adult , Aged , Diabetic Retinopathy/physiopathology , Female , Fluorescein Angiography , Fundus Oculi , Humans , Macular Edema/physiopathology , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Tomography, Optical Coherence/methods , Young Adult
PURPOSE/OBJECTIVES: To identify whether rates of accidental falls are greater for cancer survivors living in the community during or post-treatment than people with no history of cancer.â©. DATA SOURCES: In a systematic literature review that was conducted in December 2013, MEDLINE®, EMBASE, PubMed, and Web of Science were searched for cancer or oncology and accidental falls in prospective and retrospective cohort and case-controlled studies. Studies were included if they were conducted in a community-dwelling adult population and excluded if they were conducted in acute hospitals and hospice.â©. DATA SYNTHESIS: Of 484 articles initially identified, 10 were included in the review. Of these, three included a control or comparator group and had comparable outcome measures to include in a meta-analysis. The risk ratio for falls for the group with cancer was 1.11.â©. CONCLUSIONS: Accidental fall rates in community-dwelling adults with a cancer diagnosis are greater than rates of falls in adults without cancer; this elevated rate remains after acute care is finished. Patients undergoing active treatment have greater rates of falls. Pain, fatigue, and deconditioning may affect fall rates in the longer term. â©. IMPLICATIONS FOR NURSING: Nurses have the capacity to reduce risk of falls in community-dwelling cancer survivors during or post-treatment through provision of information, advocacy, and support around pain and fatigue management and promotion of physical activity.
Accidental Falls/prevention & control , Accidental Falls/statistics & numerical data , Independent Living/statistics & numerical data , Neoplasms/complications , Neoplasms/nursing , Survivors/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Oncology Nursing/methods , Prospective Studies , Retrospective Studies , Risk Factors
The spatial distribution of macular birefringence was modeled to examine the contribution from the foveal Henle fiber layer, particularly cone axons. The model was tested in 20 normal subjects, age 17-55yr. Phase retardance due to Henle fibers was modeled for rings increasing in radius around the fovea, using a sinewave of two periods (2f). The 2f sinewave amplitude increased linearly with eccentricity for each individual, (p<0.004) in 19 of 20 subjects. A good fit to linearity implies regular cone distribution and radial symmetry, and the uniformly excellent fits indicate no effect of age in our sample. The peak of the 2f sinewave amplitude varied across subjects from 1.06 to 2.46deg. An increasingly eccentric peak with increasing age would indicate a relative decrease of cone axons in the central fovea, but the location of the peak was not associated with age for our sample, which did not include elderly subjects.
Macula Lutea/anatomy & histology , Retinal Cone Photoreceptor Cells/cytology , Adolescent , Adult , Aging/pathology , Aging/physiology , Axons/physiology , Axons/ultrastructure , Birefringence , Diagnostic Techniques, Ophthalmological , Fovea Centralis/cytology , Fovea Centralis/physiology , Humans , Macula Lutea/physiology , Middle Aged , Nerve Fibers/physiology , Nerve Fibers/ultrastructure , Retinal Cone Photoreceptor Cells/physiology , Young Adult
We evaluated a polarimetry method to enhance retinal blood vessels masked by the epiretinal membrane. Depolarized light images were computed by removing the polarization retaining light reaching the instrument and were compared with parallel polarized light images, average reflectance images, and the corresponding images at 514 nm. Contrasts were computed for retinal vessel profiles for arteries and veins. Contrasts were higher in the 514 nm images in normal eyes but higher in the depolarized light image in the eyes with epiretinal membranes. Depolarized light images were useful for examining the retinal vasculature in the presence of retinal disease.
Epiretinal Membrane/pathology , Image Enhancement/methods , Microscopy, Polarization/methods , Retinal Vessels/pathology , Retinoscopy/methods , Aged , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity
Imaging polarimetry was used to examine different components of neovascular membranes in age-related macular degeneration. Retinal images were acquired with a scanning laser polarimeter. An innovative pseudocolor scale, based on cardinal directions of color, displayed two types of image information: relative phases and magnitudes of birefringence. Membranes had relative phase changes that did not correspond to anatomical structures in reflectance images. Further, membrane borders in depolarized light images had significantly higher contrasts than those in reflectance images. The retinal birefringence in neovascular membranes indicates optical activity consistent with molecular changes rather than merely geometrical changes.
Macular Degeneration/pathology , Microscopy, Confocal/methods , Microscopy, Polarization/methods , Ophthalmoscopy/methods , Refractometry/methods , Retinal Neovascularization/pathology , Aged , Female , Humans , Male , Reproducibility of Results , Sensitivity and Specificity
PURPOSE: To evaluate a noninvasive technique to detect the leakage point of central serous chorioretinopathy (CSR), using a polarimetry method. DESIGN: Prospective cohort study. SETTING: Institutional practice. PATIENTS: We examined 30 eyes of 30 patients with CSR. MAIN OUTCOME MEASURES: Polarimetry images were recorded using the GDx-N (Laser Diagnostic Technologies). We computed four images that differed in their polarization content: a depolarized light image, an average reflectance image, a parallel polarized light image, and a birefringence image. Each polarimetry image was compared with abnormalities seen on fluorescein angiography. RESULTS: In all eyes, leakage area could be clearly visualized as a bright area in the depolarized light images. Michelson contrasts for the leakage areas were 0.58 +/- 0.28 in the depolarized light images, 0.17 +/- 0.11 in the average reflectance images, 0.09 +/- 0.09 in the parallel polarized light images, and 0.11 +/- 0.21 in the birefringence images from the same raw data. Michelson contrasts in depolarized light images were significantly higher than for the other three images (P < .0001, for all tests, paired t test). The fluid accumulated in the retina was well-visualized in the average and parallel polarized light images. CONCLUSIONS: Polarization-sensitive imaging could readily localize the leakage point and area of fluid in CSR. This may assist with the rapid, noninvasive assessment of CSR.
Diagnostic Imaging/methods , Diagnostic Techniques, Ophthalmological , Retinal Diseases/diagnosis , Retinal Vessels/pathology , Adult , Birefringence , Capillary Permeability , Female , Fluorescein Angiography , Humans , Lasers , Male , Middle Aged , Prospective Studies , Serum
Visualization of medical image information can be achieved by using color scales to enhance aspects of the data. We have used the cardinal directions of color to make a continuous and representation of phase data that wraps around every 360 deg, and added in another dimension using luminance to illustrate amplidute.
Color Perception , Diagnostic Imaging , Adult , Algorithms , Humans , Middle Aged
We applied a polarimetric analysis to retinal imaging, to examine the potential improvement in characterizing blood vessels. To minimize the reflection artifact of the superficial wall of the blood vessel, we computed depolarized light images by removing the polarization retaining light reaching the instrument. These depolarized light images were compared to images from the average of all the light. Michelson contrast was computed for the vessel profiles across arteries and veins, and was higher for the depolarized light images. Depolarized light images provide one step towards improving the characterization of retinal blood vessels.
