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Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes
In this randomized study, patients undergoing intensive therapy for type 1 diabetes mellitus who had glycated hemoglobin levels of 7.0 to 10.0% were stratified into three prespecified age groups and were assigned to receive continuous glucose monitoring or usual monitoring. The primary outcome was the change in glycated hemoglobin levels after 26 weeks. Continuous glucose monitoring was associated with improved glycemic control in adults but not in children and adolescents with type 1 diabetes.
Continuous glucose monitoring was associated with improved glycemic control in adults but not in children and adolescents with type 1 diabetes.
Despite the increased use of insulin pumps and multiple-injection regimens and the introduction of insulin analogues, intensive treatment of type 1 diabetes mellitus often does not achieve the target glycated hemoglobin levels recommended by the Diabetes Control and Complications Trial (DCCT) more than 15 years ago.
1
Although self-monitoring of blood glucose plays an important role in achieving target glycated hemoglobin levels, few patients with type 1 diabetes measure glucose levels after meals or overnight. Consequently, postprandial hyperglycemia and asymptomatic nocturnal hypoglycemia are commonly seen, even in patients with well-controlled type 1 diabetes who measure blood glucose several times daily with . . .
Journal Article
Recent Phenomenal and Investigational Subsurface Landslide Monitoring Techniques: A Mixed Review
Landslides are a common and challenging geohazard that may be caused by earthquakes, rainfall, or manmade activity. Various monitoring strategies are used in order to safeguard populations at risk from landslides. This task frequently depends on the utilization of remote sensing methods, which include the observation of Earth from space, laser scanning, and ground-based interferometry. In recent years, there have been notable advancements in technologies utilized for monitoring landslides. The literature lacks a comprehensive study of subsurface monitoring systems using a mixed review approach that combines systematic and scientometric methods. In this study, scientometric and systematic analysis was used to perform a mixed review. An in-depth analysis of existing research on landslide-monitoring techniques was conducted. Surface-monitoring methods for large-scale landslides are given first. Next, local-scale landslide subsurface monitoring methods (movement, forces and stresses, water, temperature, and warning signs) were examined. Next, data-gathering techniques are shown. Finally, the physical modeling and prototype field systems are highlighted. Consequently, key findings about landslide monitoring are reviewed. While the monitoring technique selection is mainly controlled by the initial conditions of the case study, the superior monitoring technique is determined by the measurement accuracy, spatiotemporal resolution, measuring range, cost, durability, and applicability for field deployment. Finally, research suggestions are proposed, where developing a superior distributed subsurface monitoring system for wide-area monitoring is still challenging. Interpolating the complex nonlinear relationship between subsurface monitoring readings is a clear gap to overcome. Warning sign systems are still under development.
Journal Article
Structural health monitoring of large civil engineering structures
A critical review of key developments and latest advances in Structural Health Monitoring technologies applied to civil engineering structures, covering all aspects required for practical application Structural Health Monitoring (SHM) provides the facilities for in-service monitoring of structural performance and damage assessment, and is a key element of condition based maintenance and damage prognosis. This comprehensive book brings readers up to date on the most important changes and advancements in the structural health monitoring technologies applied to civil engineering structures.
Book
Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review
PurposeGlycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.MethodsWe systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.ResultsWe identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM.ConclusionsIn this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.
Journal Article
Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives
Purpose
Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only.
Methods
This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.
Results
After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient–ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm.
Conclusions
Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist’s clinical armamentarium may enhance treatment to improve clinical outcomes.
Journal Article
Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
AbstractObjectiveThe HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management.DesignUnmasked randomised controlled trial with automated ascertainment of primary endpoint.Setting76 general practices in the United Kingdom.Participants622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet.InterventionsParticipants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines.Main outcome measuresThe primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values.ResultsAfter one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction.ConclusionsThe HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded.Trial registrationISRCTN13790648.
Journal Article