Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free-living environments.

The aims of our study were to investigate multiple daily activity outcomes in patients with diabetic foot ulcers (DFU) compared to diabetic peripheral neuropathy (DPN) and diabetes (DM) controls in their free-living environments. We examined daily activity outcomes of 30 patients with DFU, 23 DPN and 20 DM. All patients wore a validated multi-sensor device for > 5 days (>22 hours per day) to measure their daily activity outcomes: steps, energy expenditure (kJ), average metabolic equivalent tasks (METs), physical activity (>3·0 METs) duration and energy expenditure, lying duration, sleep duration and sleep quality. We found that DFU patients recorded fewer median (interquartile ranges, IQR) daily steps [2154 (1621-4324)] than DPN [3660 (2742-7705)] and DM [5102 (4011-7408)] controls (P < 0·05). In contrast, DFU patients recorded more mean ± SD daily energy expenditure (kJ) (13 006 ± 3559) than DPN (11 085 ± 1876) and DM (11 491 ± 1559) controls (P < 0·05). We found no other differences in daily activity outcomes (P > 0·1). We conclude that DFU patients typically take fewer steps but expend more energy during their normal daily activity than DPN and DM controls. We hypothesise that the increased energy expenditure for DFU patients may be due to wound healing or an inefficient gait strategy. Further investigations into this energy imbalance in DFU patients may improve healing in future.

Attracting orthodontic patients via the Internet: A 20-year evolution.

A generation ago, attracting new patients to an orthodontic practice was often done simply by cultivating a few good referral sources. General dentists, including some who might have provided orthodontic treatment out of necessity, were generally glad to have a trusted specialist they could recommend to their patients. Although general dentists remain an important source of new patients today, many consumers now turn to the Internet for help selecting their own specialists. As orthodontists face more competition from various sources, successful clinicians will make it easy for search engines--and patients--to find their Web sites on the Internet.

Social media basics for orthodontists.

One of the most common buzz words in today's online world is "social media." This article defines social media, explains why it is important to practicing orthodontists, and provides information about how doctors can incorporate it into their practices. Five of the most useful social media tools are described in detail, outlining the strengths, weaknesses, opportunities, and risks inherent in each.

Confirmatory factor analysis of the Epworth Sleepiness Scale (ESS) in patients with obstructive sleep apnoea.

BACKGROUND: The Epworth Sleepiness Scale (ESS [Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540-5]) has been used frequently to assess daytime sleepiness, particularly in the context of clinical sleep disorders. Its psychometric properties are still unclear, particularly when used to evaluate sleep propensity in patients with obstructive sleep apnoea. METHODS: The present study used confirmatory factor analysis (CFA) to investigate a potential single-factor structure of the ESS in a sample of 759 Australian patients with a diagnosis of obstructive sleep apnoea by the treating physicians. RESULTS: CFA results from showed that the original single-factor structure proposed by Johns [Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992;15(4):376-81] did not adequately fit the data. A re-specified single-factor solution provided a good fit for data, and this improved fit was confirmed on a second CFA. CONCLUSIONS: The findings suggest that standard scoring of the ESS should be interpreted cautiously for patients with obstructive sleep apnoea.

Measuring leg movements during sleep using accelerometry: comparison with EMG and piezo-electric scored events.

Periodic Limb Movements during Sleep (PLMS) can cause significant disturbance to sleep, resulting in daytime sleepiness and reduced quality of life. In conventional clinical practice, PLMS are measured using overnight electromyogram (EMG) of the tibialis anterior muscle, although historically they have also been measured using piezo-electric gauges placed over the muscle. However, PLMS counts (PLM index) do not correlate well with clinical symptomology. In this study, we propose that because EMG and piezo derived signals measure muscle activation rather than actual movement, they may count events with no appreciable movement of the limb and therefore no contribution to sleep disturbance. The aim of this study is thus to determine the percentage of clinically scored limb movements which are not associated with movement of the great toe measured using accelerometry. 9 participants were studied simultaneously with an overnight diagnostic polysomnogram (including EMG and piezo instrumentation of the right leg) and high temporal resolution accelerometry of the right great toe. Limb movements were scored, and peak acceleration during each scored movement was quantified. Across the participant population, 54.9% (range: 26.7-76.3) and 39.0% (range: 4.8-69.6) of limb movements scored using piezo and EMG instrumentation respectively, were not associated with toe movement measured with accelerometry. If sleep disturbance is the consequence of the limb movements, these results may explain why conventional piezo or EMG derived PLMI is poorly correlated with clinical symptomology.

Intention to exercise in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common and serious health issue that is strongly associated with excess weight. Exercise may be an effective mechanism for reducing the severity of OSA both in association with, and independent of, reduction in body weight. As such, increased exercise has been suggested as a potential intervention for OSA, particularly for patients with mild to moderate clinical severity. However, it is unknown how ready to engage in exercise patients with OSA are. Self-reported exercise intention was assessed in 206 consecutive patients attending a large tertiary sleep disorders service in Australia. Classification of the patients by Stage of Change, a construct of the Transtheoretical Model of behavior change, was supported by differences between the groups in level of habitual self-reported exercise. Cluster analysis identified 4 potential patient types, with differing profiles in perceived costs and benefits of exercise, and exercise-related self-efficacy. The validity of these patient clusters was also supported by differences between the groups in current self-reported exercise levels. The results may help to identify patients who are more likely to engage in increased exercise, and to identify barriers to exercise in patients less inclined to increase their exercise.