Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To as... more Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To assess its impact, we measured changes in physical activity and sleep among community-dwelling older adults, from pre-to post-pandemic declaration. Method: Physical activity and sleep in older adults (n = 10, age = 77.3 ± 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049...
About 422 million people worldwide have diabetes and approximately one-third of them have a major... more About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diab...
Introduction: Parkinson's disease (PD) progressively impairs motor and cognitive performance. The... more Introduction: Parkinson's disease (PD) progressively impairs motor and cognitive performance. The current tools to detect decline in motor and cognitive functioning are often impractical for busy clinics and home settings. To address the gap, we designed an instrumented trail-making task (iTMT) based on a wearable sensor (worn on the shin) with interactive game-based software installed on a tablet. The iTMT test includes reaching to 5 indexed circles, a combination of numbers (1-3) and letters (A&B) randomly positioned inside target circles, in a sequential order, which virtually appears on a screen kept in front of the participants, by rotating one's ankle joint while standing and holding a chair for safety. By measuring time to complete iTMT task (iTMT time), iTMT enables quantifying cognitive-motor performance. Purpose: This study's objective is to examine the feasibility of iTMT to detect early cognitive-motor decline in PDs. Method: Three groups of volunteers, including 14 cognitively normal (CN) older adults, 14 PDs, and 11 mild cognitive impaireds (MCI), were recruited. Participants completed MoCA, 20 m walking test, and 3 trials of iTMT. Results: All participants enabled to complete iTMT with <3 min, indicating high feasibility. The average iTMT time for CN-Older, PD, and MCI participants were 20.9 ± 0.9 s, 32.3 ± 2.4 s, and 40.9 ± 4.5 s, respectively. After adjusting for age and education level, pairwise comparison suggested large effect sizes for iTMT between CNolder versus PD (Cohen's d = 1.7, p = 0.024) and CN-older versus MCI (d = 1.57, p < 0.01). Significant correlations were observed when comparing iTMT time with the gait speed (r = −0.4, p = 0.011) and MoCA score (r = −0.56, p < 0.01). Conclusion: This study demonstrated the feasibility and early results supporting the potential application of iTMT to determine cognitive-motor and distinguishing individuals with MCI and PD from CN-older adults. Future studies are warranted to test the ability of iTMT to track its subtle changes over time.
Background: Dressing materials are known to influence post-operative surgical wound healing
and s... more Background: Dressing materials are known to influence post-operative surgical wound healing and scar formation (SF). A particular dressing that could promote wound hydration is essential to ensure quick epithelialization and reduce SF. This study examined the effective- ness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post cervicotomy. Methods: A randomized controlled trial was performed in patients undergoing cervicotomy, either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary outcome was > 10% of scar length reduction and %change in scar length. Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus 11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009). Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved outcomes for scar visualization in patients undergoing thyroidectomy. A larger sample is required to validate this observation.
Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To as... more Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To assess its impact, we measured changes in physical activity and sleep among communitydwelling older adults, from pre-to post-pandemic declaration. Method: Physical activity and sleep in older adults (n = 10, age = 77.3 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). Interestingly, increase in depression was significantly correlated with unbroken-prolong sitting bout ( = 0.677, p = 0.032), cadence ( = 0.70, p = 0.024), and sleep duration ( = 0.72, p = 0.019). Conclusion: This is one of the early longitudinal studies highlighting adverse effect of the pandemic on objectively assessed physical activity and sleep in older adults. Our observations showed need for timely intervention to mitigate hard to reverse consequences of decreased physical activity such as depression.
Background: Despite advances in pharmacological treatments and surgical processes, the problem of... more Background: Despite advances in pharmacological treatments and surgical processes, the problem of impaired dual-tasking persists in people with Parkinson's disease (PD). Recently, transcranial direct current stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) has shown the potential to improve dual-task walking. Research Question: Can combining left DLPFC stimulation using tDCS with dual-task performance reduce the cost of dual-tasking in individuals with PD? Methods: We conducted a sham-controlled, cross-over, and double-blind study to investigate the effect of combining tDCS with the dual-task walk and its sustained effects among people with PD. Twenty participants with PD completed two sessions (anodal or sham tDCS) with at least a 1-week gap. Stimulation involved transferring 2 mA current through the left DLPFC for 30 min. Single-and dual-task gait was assessed before, during, immediately after, 15, and 30 min after stimulation ceased. Phoneme verbal fluency task was given as the cognitive distractor during dual task. Results and Conclusion: The results of this study show that in the dual-task condition, participants walked faster at fifteen minutes (p = 0.017) and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Similarly, participants generated a higher number of words per minute at fifteen minutes (p = 0.017), and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Furthermore, the dual-task cost (DTC) associated with gait speed was significantly lower (p = 0.022) at fifteen minutes after anodal tDCS compared to sham tDCS. However, no significant effect of tDCS was observed on gait and cognitive performance under the single-task condition. In conclusion, left DLPFC stimulation can improve dual-tasking in participants with PD and the peaking of the tDCS effect was observed at fifteen minutes after stimulation ceased.
About 422 million people worldwide have diabetes and approximately one-third of them
have a major... more About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and “hospital-at-home” care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.
Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To as... more Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To assess its impact, we measured changes in physical activity and sleep among community-dwelling older adults, from pre-to post-pandemic declaration. Method: Physical activity and sleep in older adults (n = 10, age = 77.3 ± 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049...
About 422 million people worldwide have diabetes and approximately one-third of them have a major... more About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diab...
Introduction: Parkinson's disease (PD) progressively impairs motor and cognitive performance. The... more Introduction: Parkinson's disease (PD) progressively impairs motor and cognitive performance. The current tools to detect decline in motor and cognitive functioning are often impractical for busy clinics and home settings. To address the gap, we designed an instrumented trail-making task (iTMT) based on a wearable sensor (worn on the shin) with interactive game-based software installed on a tablet. The iTMT test includes reaching to 5 indexed circles, a combination of numbers (1-3) and letters (A&B) randomly positioned inside target circles, in a sequential order, which virtually appears on a screen kept in front of the participants, by rotating one's ankle joint while standing and holding a chair for safety. By measuring time to complete iTMT task (iTMT time), iTMT enables quantifying cognitive-motor performance. Purpose: This study's objective is to examine the feasibility of iTMT to detect early cognitive-motor decline in PDs. Method: Three groups of volunteers, including 14 cognitively normal (CN) older adults, 14 PDs, and 11 mild cognitive impaireds (MCI), were recruited. Participants completed MoCA, 20 m walking test, and 3 trials of iTMT. Results: All participants enabled to complete iTMT with <3 min, indicating high feasibility. The average iTMT time for CN-Older, PD, and MCI participants were 20.9 ± 0.9 s, 32.3 ± 2.4 s, and 40.9 ± 4.5 s, respectively. After adjusting for age and education level, pairwise comparison suggested large effect sizes for iTMT between CNolder versus PD (Cohen's d = 1.7, p = 0.024) and CN-older versus MCI (d = 1.57, p < 0.01). Significant correlations were observed when comparing iTMT time with the gait speed (r = −0.4, p = 0.011) and MoCA score (r = −0.56, p < 0.01). Conclusion: This study demonstrated the feasibility and early results supporting the potential application of iTMT to determine cognitive-motor and distinguishing individuals with MCI and PD from CN-older adults. Future studies are warranted to test the ability of iTMT to track its subtle changes over time.
Background: Dressing materials are known to influence post-operative surgical wound healing
and s... more Background: Dressing materials are known to influence post-operative surgical wound healing and scar formation (SF). A particular dressing that could promote wound hydration is essential to ensure quick epithelialization and reduce SF. This study examined the effective- ness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post cervicotomy. Methods: A randomized controlled trial was performed in patients undergoing cervicotomy, either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary outcome was > 10% of scar length reduction and %change in scar length. Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus 11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009). Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved outcomes for scar visualization in patients undergoing thyroidectomy. A larger sample is required to validate this observation.
Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To as... more Background: Social isolation during COVID-19 may negatively impact older adults’ wellbeing. To assess its impact, we measured changes in physical activity and sleep among communitydwelling older adults, from pre-to post-pandemic declaration. Method: Physical activity and sleep in older adults (n = 10, age = 77.3 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). Interestingly, increase in depression was significantly correlated with unbroken-prolong sitting bout ( = 0.677, p = 0.032), cadence ( = 0.70, p = 0.024), and sleep duration ( = 0.72, p = 0.019). Conclusion: This is one of the early longitudinal studies highlighting adverse effect of the pandemic on objectively assessed physical activity and sleep in older adults. Our observations showed need for timely intervention to mitigate hard to reverse consequences of decreased physical activity such as depression.
Background: Despite advances in pharmacological treatments and surgical processes, the problem of... more Background: Despite advances in pharmacological treatments and surgical processes, the problem of impaired dual-tasking persists in people with Parkinson's disease (PD). Recently, transcranial direct current stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) has shown the potential to improve dual-task walking. Research Question: Can combining left DLPFC stimulation using tDCS with dual-task performance reduce the cost of dual-tasking in individuals with PD? Methods: We conducted a sham-controlled, cross-over, and double-blind study to investigate the effect of combining tDCS with the dual-task walk and its sustained effects among people with PD. Twenty participants with PD completed two sessions (anodal or sham tDCS) with at least a 1-week gap. Stimulation involved transferring 2 mA current through the left DLPFC for 30 min. Single-and dual-task gait was assessed before, during, immediately after, 15, and 30 min after stimulation ceased. Phoneme verbal fluency task was given as the cognitive distractor during dual task. Results and Conclusion: The results of this study show that in the dual-task condition, participants walked faster at fifteen minutes (p = 0.017) and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Similarly, participants generated a higher number of words per minute at fifteen minutes (p = 0.017), and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Furthermore, the dual-task cost (DTC) associated with gait speed was significantly lower (p = 0.022) at fifteen minutes after anodal tDCS compared to sham tDCS. However, no significant effect of tDCS was observed on gait and cognitive performance under the single-task condition. In conclusion, left DLPFC stimulation can improve dual-tasking in participants with PD and the peaking of the tDCS effect was observed at fifteen minutes after stimulation ceased.
About 422 million people worldwide have diabetes and approximately one-third of them
have a major... more About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and “hospital-at-home” care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.
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Papers by Ram Mishra
and scar formation (SF). A particular dressing that could promote wound hydration is
essential to ensure quick epithelialization and reduce SF. This study examined the effective-
ness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post
cervicotomy.
Methods: A randomized controlled trial was performed in patients undergoing cervicotomy,
either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or
intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts
Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary
outcome was > 10% of scar length reduction and %change in scar length.
Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients
were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar
reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus
11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A
sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using
CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009).
Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved outcomes for scar visualization in patients undergoing thyroidectomy. A larger sample is required to validate this observation.
older adults (n = 10, age = 77.3 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined
by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). Interestingly, increase in depression was significantly correlated with unbroken-prolong sitting bout ( = 0.677, p = 0.032), cadence ( = 0.70, p = 0.024), and sleep duration ( = 0.72, p = 0.019). Conclusion: This is one of the early longitudinal studies highlighting adverse effect of the pandemic on objectively assessed physical activity and sleep in older adults. Our observations showed need for timely intervention to mitigate hard to reverse consequences of decreased physical activity such
as depression.
have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral
neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare
ecosystem, which is centered on the treatment of established foot disease, often fails to adequately
control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot
disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions.
Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority
from siloed hospital treatments to innovative integrated community prevention is now critical to
address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable
and digital health technologies provide a means to timely monitor major risk factors associated with
diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and
multi-disciplinary prevention needed for those at-risk people and address the health care access
disadvantage that people living in remote areas. This narrative review paper summarizes some of
the latest innovations in three specific areas, including technologies supporting triaging high-risk
patients, technologies supporting care in place, and technologies empowering self-care. While many
of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease
2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will
see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies,
and “hospital-at-home” care delivery model. These technologies will be quickly adopted at scale to
improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in
outpatient or inpatient clinics, and supporting acute or subacute care at home.
and scar formation (SF). A particular dressing that could promote wound hydration is
essential to ensure quick epithelialization and reduce SF. This study examined the effective-
ness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post
cervicotomy.
Methods: A randomized controlled trial was performed in patients undergoing cervicotomy,
either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or
intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts
Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary
outcome was > 10% of scar length reduction and %change in scar length.
Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients
were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar
reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus
11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A
sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using
CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009).
Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved outcomes for scar visualization in patients undergoing thyroidectomy. A larger sample is required to validate this observation.
older adults (n = 10, age = 77.3 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. Results: Compared to pre-pandemic, post-pandemic time spent in standing declined
by 32.7% (Cohen’s d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). Interestingly, increase in depression was significantly correlated with unbroken-prolong sitting bout ( = 0.677, p = 0.032), cadence ( = 0.70, p = 0.024), and sleep duration ( = 0.72, p = 0.019). Conclusion: This is one of the early longitudinal studies highlighting adverse effect of the pandemic on objectively assessed physical activity and sleep in older adults. Our observations showed need for timely intervention to mitigate hard to reverse consequences of decreased physical activity such
as depression.
have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral
neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare
ecosystem, which is centered on the treatment of established foot disease, often fails to adequately
control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot
disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions.
Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority
from siloed hospital treatments to innovative integrated community prevention is now critical to
address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable
and digital health technologies provide a means to timely monitor major risk factors associated with
diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and
multi-disciplinary prevention needed for those at-risk people and address the health care access
disadvantage that people living in remote areas. This narrative review paper summarizes some of
the latest innovations in three specific areas, including technologies supporting triaging high-risk
patients, technologies supporting care in place, and technologies empowering self-care. While many
of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease
2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will
see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies,
and “hospital-at-home” care delivery model. These technologies will be quickly adopted at scale to
improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in
outpatient or inpatient clinics, and supporting acute or subacute care at home.