ICare Health Monitor V3.9.5 FULL [Latest]
Glaucoma is a leading cause of blindness, affecting over 60 million people worldwide. Open-angle glaucoma, the most common subtype of the disease, affects over 2.5 million people in the United States. On behalf of the American Academy of Ophthalmology, Jampel et al (2011) reviewed the published literature to summarize and evaluate the effectiveness of visual function tests in diagnosing glaucoma and in monitoring progression. Literature searches of the PubMed and Cochrane Library databases were conducted last on May 7, 2010, and were restricted to citations published on or after January 1, 1994. The search yielded 1,063 unique citations. The first author reviewed the titles and abstracts of these articles and selected 185 of possible clinical relevance for further review. The panel members reviewed the full text of these articles and determined that 85 met inclusion criteria. They conducted data abstraction of the 85 studies, and the panel methodologist assigned a level of evidence to each of the selected articles. One study was rated as level I evidence. The remaining articles were classified broadly as providing level II evidence. Studies deemed to provide level III evidence were not included in the assessment. Standard white-on-white automated perimetry remains the most commonly performed test for assessing the visual field, with the Swedish interactive threshold algorithm (SITA) largely replacing full-threshold testing strategies. Frequency-doubling technology and its refinement into Matrix perimetry, as well as short-wavelength automated perimetry, now available with SITA, have been evaluated extensively. Machine learning classifiers seem to be ready for incorporation into software to help distinguish glaucomatous from non-glaucomatous fields. Other technologies, such as multi-focal visual-evoked potential and electro-retinography, which were designed as objective measures of visual function, provide testing free of patient input, but issues prevent their adoption for glaucoma management. The authors concluded that advances in technology and analytic tools over the past decade have provided us with more rapid and varied ways of assessing visual function in glaucoma, but they have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time. They stated that further research on an objective measure of visual function is needed.
iCare Health Monitor v3.9.5 FULL [Latest]
Muller et al (2022) stated that one of the most important functions of the retina -- the enabling of perception of fast movements -- is largely suppressed in standard automated perimetry (SAP) and kinetic perimetry (Goldmann) due to slow motion and low contrast between test points and environment. Rapid campimetry integrates fast motion (= 10/4.7 s at 40 cm patient-monitor distance) and high contrast into the VF examination in order to facilitate the detection of absolute scotomas. A bright test point moves on a dark background through the central 10 VF. Depending on the distance to the fixation point, the test point automatically changes diameter (approximately 0.16 to approximately 0.39). This method was compared to SAP (10-2 program) for 6 subjects with glaucoma. Rapid campimetry proved to be comparable and possibly better than 10-2 SAP in identifying macular arcuate scotomas. In 4 subjects, rapid campimetry detected a narrow arcuate absolute scotoma corresponding to the nerve fiber course, which was not identified as such with SAP. The authors concluded that the findings of this proof-of-concept study suggested that rapid campimetry has advantages in glaucoma-screening compared to SAP. However, follow-up studies with larger sample sizes of patients and healthy controls are needed to examine the value of rapid campimetry as a screening and diagnostic tool for VF defect detection in glaucoma. In short, this method appeared to be comparable to standard perimetry in the detection of central VF defects in glaucoma; and holds promise of applicability in ophthalmology as a screening and telemedicine tool.
The authors stated that this case-series study had several drawbacks that need to be addressed in a follow-up study on a larger participant cohort. The study was designed to provide proof-of-concept of rapid campimetry and was not designed to examine the sensitivity and specificity of the approach . For the latter, a systematic investigation with a greater sample size is essential, including patients with different disease states and healthy controls. Furthermore, potentially confounding effects of visual pathologies (e.g., optic media opacities) deserve attention in future studies. Finally, the quality of the fixation and its relation to the campimetry outcome has not been addressed in this study, where patients were instructed to fixate the central target during testing and repeatedly reminded of the importance of central fixation. Online tracking of eye movements and fixation monitoring would help to examine if maintaining central fixation is an issue during rapid campimetry testing.
Biochemical sensors can measure body fluid electrolytes with the use of electrochemical transducers, offering valuable information about plasma volume status and analyte concentrations30. However, the accuracy of these sensors changes with skin temperature, skin contamination with dust, dried sweat or other substances, and hair density. One example of biochemical sensors are the minimally invasive continuous glucose monitors that have been clinically validated but are difficult to embed in consumer-grade wearables and mostly function as a stand-alone product31. Non-invasive sensors of sweat and saliva might be more practical to integrate into wearables but still need to be carefully evaluated32.
Given that wearable software and hardware components are validated through evaluation frameworks and regulatory pathways, the duty of our medical community and US federal agencies, such as the Centers for Medicare and Medicaid Services, will be to agree on the best practice clinical guidelines and meaningful use criteria for these devices. For example, the Apple Heart Study sparked a debate on how a small false-positive rate can increase downstream medical testing and costs if screening is applied to the entire general population. Alternatively, false negatives can have detrimental consequences, especially in symptomatic or high-risk patients in whom false reassurance can delay anticoagulation therapy and increase the risk of stroke101. Therefore, cardiology society guidelines have not yet endorsed the use of the Apple Watch for AF screening. However, the ongoing HEARTLINE trial54 aims to further evaluate whether the newer Apple Watch models, augmented by a single-lead ECG sensor, can improve screening accuracy and clinical outcomes, which could potentially change guideline recommendations. Finally, as several colleges and postgraduate training programmes across different health-care disciplines are in the process of developing telehealth curricula to cope with the COVID-19 pandemic102, these curricula should incorporate structured learning modules about common wearables, their current clinical applications and the potential to improve remote patient care.
Reimbursement from health insurance will be crucial to narrow the financial disparity. In 2018, the American Medical Association introduced new CPT (Current Procedural Terminology) codes to incentivize the adoption of remote monitoring in clinical practice. These codes were included in the 2019 Centers for Medicare and Medicaid Services physician fee schedule and are reimbursed by private insurers. In light of COVID-19, insurers have even expanded remote monitoring to include acute as well as chronic conditions. Reimbursement for services, such as reviewing vitals, is currently more straightforward than other services such as reviewing physical activity levels or delivering wearable-guided lifestyle interventions. Payers, in the USA and around the world, should consider expanding reimbursement to include the review of various forms of wearable data and the prescription of wearable-guided BCTs. Providers might then be incentivized to use wearables regularly in their practice and even hand them to their patients for free, through loaner programmes109 or for a reasonable co-pay.
Conclusions: The selected studies suggest that both teleconsultation and videoconferencing are practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the diversity in study design and reported findings makes a strong conclusion premature. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions.
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The ORP reading is a constantly moving target, it is best practice to monitor ORP in combination with chlorine residual measured in parts per million (PPM) this will give the assistant a complete picture of the chlorine within the pool(s) to comply with prescribed health regulations. 350c69d7ab