Ambulatory EEG to Classify the Epilepsy Syndrome.

SUMMARY: Recording of interictal epileptiform discharges to classify the epilepsy syndrome is one of the most common indications for ambulatory EEG. Ambulatory EEG has superior sampling compared with standard EEG recordings and advantages in terms of cost-effectiveness and convenience compared with a prolonged inpatient EEG study. Ambulatory EEG allows for EEG recording in all sleep stages and transitional states, which can be very helpful in capturing interictal epileptiform discharges. In the absence of interictal epileptiform discharges or in patients with atypical events, the characterization of an epilepsy syndrome may require recording of the habitual events. Diagnostic ambulatory EEG can be a useful alternative to inpatient video-EEG monitoring in a selected number of patients with frequent events who do not require medication taper or seizure testing for surgical localization.

[Advanced classification for cardiovascular devices]. / Erweiterte Klassifikation für kardiovaskuläre Geräte.

Increasing complexity and many technical solutions for cardiovascular devices make it reasonable to introduce an advanced classification. The proposed classification has three levels. The first level distinguishes between implantable and wearable devices and the second level between therapeutic and diagnostic devices. The third level describes group-specific characteristics for each of the four subgroups. The aim of the classification is to differentiate the devices from each other and to easily describe interactions between two or more different devices. In addition, the classification should facilitate communication about these devices.

Inertial sensor based gait analysis discriminates subjects with and without visual impairment caused by simulated macular degeneration.

Macular degeneration is the third leading cause of blindness worldwide and the leading cause of blindness in the developing world. The analysis of gait parameters can be used to assess the influence of macular degeneration on gait. This study examines the effect of macular degeneration on gait using inertial sensor based 3D spatio-temporal gait parameters. We acquired gait data from 21 young and healthy subjects during a 40 m obstacle walk. All subjects had to perform the gait trial with and without macular degeneration simulation glasses. The order of starting with or without glasses alternated between each subject in order to test for training effects. Multiple 3D spatio-temporal gait parameters were calculated for the normal vision as well as the impaired vision groups. The parameters trial time, stride time, stride time coefficient of variation (CV), stance time, stance time CV, stride length, cadence, gait velocity and angle at toe off showed statistically significant differences between the two groups. Training effects were visible for the trials which started without vision impairment. Inter-group differences in the gait pattern occurred due to an increased sense of insecurity related with the loss of visual acuity from the simulation glasses. In summary, we showed that 3D spatio-temporal gait parameters derived from inertial sensor data are viable to detect differences in the gait pattern of subjects with and without a macular degeneration simulation. We believe that this study provides the basis for an in-depth analysis regarding the impact of macular degeneration on gait.

Comparision and analysis of top 10 exercise android Apps in mainland China.

Medical guidelines highly recommend physical activity and aerobic exercise in the prevention of primary and secondary cardiovascular disease. The use of exercise-promoting application software may improve clinical outcomes for cardiovascular disease (CVD) patients. The study aimed to compare and analyze the functions of the top 10 exercise Android Apps which had more than 1,000,000 downloads from the main four Android App stores in mainland China. The results showed that most of these popular apps had pedometer, exercise plan preset, user data presentation, user encouragement and community sharing functions while a few of them had exercise video clips or animation support and wearable devices. Given these data, the conclusion is that these popular apps fulfill some of the functions recommended by medical guidelines, however, lack of some functions such as pre-exercise risk assessment, the exercise intensity recording, specific instructions by professionals, and monitoring functions for CVD patients.

Rett syndrome: establishing a novel outcome measure for walking activity in an era of clinical trials for rare disorders.

BACKGROUND: Rett syndrome is a pervasive neurological disorder with impaired gait as one criterion. This study investigated the capacity of three accelerometer-type devices to measure walking activity in Rett syndrome. METHODS: Twenty-six participants (mean 18 years, SD 8) wore an Actigraph, ActivPAL and StepWatch Activity Monitor (SAM) during a video-taped session of activities. Agreement was determined between step-counts derived from each accelerometer and observation. Repeatability of SAM-derived step counts was determined using pairs of one-minute epochs during which the same participant was observed to walk with the same cadence. RESULTS: The mean difference (limit of agreement) for the Actigraph, ActivPAL and SAM were -41 (SD 33), -16 (SD 21) and -1 (SD 16) steps/min, respectively. Agreement was influenced by a device/cadence interaction (p < 0.001) with greater under-recording at higher cadences. For SAM data, repeatability of step-count pairs was excellent (intraclass correlation coefficient 0.91, 95% CI 0.79-0.96). The standard error of measurement was 6 steps/min and we would be 95% confident that a change ≥17 steps/min would be greater than within-subject measurement error. CONCLUSIONS: The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials. Implications for Rehabilitation Many girls and women with Rett syndrome are able to walk on their own or with assistance but with altered movement patterns. Validated measures of physical activity, such as step counts, have potential to monitor function during daily life. Compared with other forms of accelerometer-type devices, such as ActiGraph and ActivPAL, the StepWatch Activity Monitor (SAM) measured step counts with good accuracy and repeatability. The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials.

Setting the scene: taxonomy of personal health monitoring.

In order to provide a systematic basis for communication in trans-disciplinary research projects, there is a need for taxonomies and ontologies. Our developed taxonomy of personal health monitoring (PHM) is based on a systematic literature review and an iterative adaption process with trans-disciplinary partners. The construction method of the taxonomy is an ongoing process and need regularly updates.

Medical devices; general hospital and personal use monitoring devices; classification of the ingestible event marker. Final order.

: The Food and Drug Administration (FDA) is classifying the ingestible event marker into class II (special controls). The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Coding and billing for home (out-of-center) sleep testing.

Obstructive sleep apnea is increasingly recognized as a comorbidity in many medical illnesses. This has resulted in an increasing need for sleep testing, which is not entirely met by the currently available sleep laboratory facilities. Home, or out-of-center, sleep testing is an alternative to in-laboratory studies. However, coding and billing for home studies is not as straightforward as it is for in-laboratory studies. This article reviews the process of coding and billing for sleep studies done in an unattended setting.

Autotransfusión en emergencias extrahospitalarias / Autotransfusion in extrahospitalary emergencies

La autotransfusión es una técnica conocida desde hace tiempo que consiste básicamente en la recuperación y transfusión al propio paciente de sangre autóloga. En el medio hospitalario se usa frecuentemente en sangrados intra operatorios o postquirúrgicos en intervenciones ortopédicas, cardiacas y vasculares. En Medicina de Urgencias se ha empleado principalmente en conflictos bélicos en casos de hemotórax o hemoperitoneos cuantiosos, recogiendo la sangre de estas cavidades corporales y reinfundiéndola, en pacientes en situación de hipovolemia crítica. Pensamos que es una técnica valiosa que adaptada a nuestro medio y en el contexto de una indicación cuidadosa en medicina de emergencia extrahospitalaria puede ser de enorme utilidad. Hay equipos comerciales relativamente sencillos para realizar esta técnica con eficacia y seguridad. Nosotros, ante la dificultad de acceso real que hoy día tenemos a estos sistemas proponemos un sistema de recogida y reinfusión sencillo partiendo de materiales básicos que podría permitirnos realizar una autotransfusión extrahospitalaria a la espera de contar con medios estándar más adecuados (AU)

Autotransfusion is a long-known technique basically comprising recovery from the patient and later transfusion to the same patient of autologous blood. In the hospitalary environment it is often used in intra or postoperative bleeding in orthopaedic, cardiac and vascular surgery. In the context of emergency medicine it has been used mainly in war in cases of severe haemothorax or haemoperitoneum, recovering the blood from these body cavities and reinfusing it to patients in critical hypovolaemia situations. We consider it to be a valuable technique which might be highly useful in the context of extrahospitalary emergencies, if adapted to our own environment and in the context of a careful indication. Thre are relatively simple commerciallyavailale kits for carrying out this technique with efficacy and safety. Considering the real difficulties in acceding to such kits we are at present faced with, we propose a simple recovery and reinfusion system based on basic material which might allow us to carry out extrahospitalary autotransfusion while awaiting the availability of more adequate standard equipment (AU)