Background The 6-minute walk test (6MWT) independently predicts congestive heart failure (CHF) severity, death and heart failure hospitalizations, but must be administered in clinic by qualified staff on a pre-measured course. As part of the Health eHeart Study we sought to develop and validate a self-administered 6MWT mobile application (SA-6MWTapp) for independent use at home by patients. Methods and Results We performed a validation study of a SA-6MWTapp in 103-participants. In phase one (n=52), we developed a distance estimation algorithm for the SA-6MWTapp by comparing step counts from an Actigraph and measured distance on a pre-measured 6MWT course to step counts and estimated distance obtained simultaneously from our SA-6MWTapp (best estimation algorithm, r = 0.89 [95% CI 0.78 – 0.99]). In phase two, 32 participants (including those with CHF and pHTN) used the SA-6MWTapp independently in clinic and the distance estimated by the SA-6MWTapp was compared to the measured distance (r = 0.83 [95% CI 0.79-0.92]). In phase three, 19 patients with CHF and pHTN consecutively enrolled from clinic, performed 3.2 ±1 SA-6MWTapp tests per week at home over 2 weeks. Distances estimated from the SA-6MWTapp during home 6MWTs were highly repeatable (coefficient of variation = 4.6%) and correlated with in-clinic measured distance (r = 0.88 [95% CI 0.87-0.89]). Usability surveys performed during the second (in-clinic) and third (at-home) phases demonstrated that the SA-6MWTapp was simple and easy to use independently. Conclusions A self-administered 6MWTapp is easy to use and yields accurate repeatable measurements in the clinic and at home.
Background: Single-suture craniosynostosis (SSC) can be associated with neurodevelopmental deficits. We examined the correlation between morphologic severity and incidence of speech-language or psychological concerns. Methods: In 62 patients (33 sagittal, 17 metopic, and 12 unicoronal), morphologic severity was determined via preoperative computed tomography (CT). Severity metrics for sagittal, metopic, and unicoronal synostosis were adjusted cephalic index (aCI), interfrontal angle (IFA), and anterior cranial fossa area ratio (ACFR), respectively. Speech-language and psychological concerns were assessed at age ≥4.5 years and defined as recommendation for therapy or monitoring. Results: Mean assessment age was 5.7 years; 32% had a speech-language concern and 44% had a psychological concern; 44% had neither. Sagittal: Mean aCI of those with a speech-language concern (0.62) and those without (0.62) were equivalent ( P = .580), as were mean aCI of those with a psychological concern (0.62) and those without (0.62; P = .572). Metopic: Mean IFA with (117.9) and without (125.2) a speech-language concern were equivalent ( P = .326), as were mean IFA with (120.2) and without (123.2) a psychological concern ( P = .711). Unicoronal: Mean ACFR with (0.65) and without (0.69) a psychological concern ( P = .423) were equivalent. However, mean ACFR with (0.74) and without (0.63) a speech-language concern were not ( P = .022*). Bivariate rank correlation showed significant association between morphologic severity and speech-language score only for unicoronal synostosis (ρ = .722; P = .008*). Conclusion: A significant portion of patients with SSC had speech-language or psychological concerns. We found no correlation between morphologic severity and incidence of speech-language or psychological concerns for patients with sagittal or metopic synostosis. Morphological severity did correlate with speech concerns in patients with unicoronal synostosis.
Autologous fat grafting, first described in the 1890s, has since undergone many modifications to optimize safety and efficacy. These changes have resulted in the technique that we now consider standard of care, one that is applied to reconstruction and cosmetic enhancement of the breast and the face both independently and in conjunction with surgical treatment. There is a growing body of evidence that this application has positive outcomes for patient satisfaction, surgeon satisfaction, and overall aesthetic appearance. This article summarizes the body of literature regarding these outcomes, reviews complications of fat grafting in the face and breast, and discusses controversies including radiologic imaging changes and longevity of grafting. Level of Evidence: 4
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