XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Methods for Staging Non-small Cell Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Acquiring gait parameters from usual walking is important to predict clinical outcomes, including life expectancy, risk of fall, and neurocognitive performance, in older people. For comprehensive gait analysis, instruments such as marker-based motion analysis systems and walkways with pressure sensor arrays are necessary. Traditional instruments are bulky, complex, expensive, and intrinsically intrusive. Requirements of dedicated spaces for installation and specialized staff make it difficult to utilize traditional gait analysis instruments in most outpatient clinics. We present a novel gait analysis tool that is small, highly accurate, easy-to-use, and non-intrusive and is based on two-dimensional light detection and ranging technology. Using an object-tracking algorithm, we conducted a validation study of spatiotemporal tracking of ankle locations of subjects by comparing our tool with a gold standard modality. Our tool showed successful acquisition of gait parameters from usual walking motions and trackability with multiple targets in noisy conditions, including typical clinical environments.

/pdf/development-and-validation-of-2d-lidar-based-gait-analysis-3kyn0ely3j.pdf

Development and validation of 2D-LiDAR-based gait analysis instrument and algorithm

Chul-Kee Park, M.D., Sung Kyun Hwang, M.D., Ho-Shin Gwak, M.D., Heon Yoo, M.D., Young Seob Chung, M.D., Sun Ha Paek, M.D., Dong Gyu Kim, M.D., Hee-Won Jung, M.D., Seong Yeon Kim, M.D., Seung Kuan Hong, M.D. Department of Neurosurgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea Department of Neurosurgery, Kangwon National University College of Medicine, Choonchun, Korea

/pdf/treatment-outcome-and-prognostic-factors-of-cushing-s-10o537nc2l.pdf

Treatment Outcome and Prognostic Factors of Cushing's Disease in Adults

Height loss as an indicator of ageing through its association with frailty and sarcopenia: An observational cohort study.

Objective:The authors analyze the clinical characteristics of the long-term survivors and elucidate the biological factors responsible for long-term survival. Methods:The 166 cases of histologically confirmed glioblastoma from Jan 1983 to Aug 1999 were included. Medical records and radiological findings were reviewed to analyze age, performance status, location and number of the tumor, the amount of peri-tumoral edema, the extent of surgical resection and history of radiation and/or chemotherapy. The overall survival was 13.6 months and the 1-year survival rate was 59%. The thirteen patients(6.9%), lived more than three years after diagnosis, defined as the longterm survivors. Results:Performance status(KPS≥70), number of masses(single with no CSF seeding), and hemispheric location(not involving basal ganglia and/or brain stem) showed favorable influence on the patient survival in univariate analysis. Also post-operative radiation and chemotherapy resulted in significant improvement of the survival. However, in multivariate analysis, age(under 40 years) was the most significant prognostic factor. All the other factors which was significant in univariate analysis except the location of the tumor, also verified as significant prognostic factors in multivariate analysis. The long-term survivors had at least more than five out of seven significant prognostic factors in multivariate analysis. And these factors occurred more frequently and showed significances in the long-term survivors than the other patient group except the debulking surgery. Conclusion:The age at the diagnosis and invasiveness resulted in multiple tumor and/or CSF seeding were the most significant prognostic factors.

Hee-Won Jung

Papers

Development and validation of 2D-LiDAR-based gait analysis instrument and algorithm

Treatment Outcome and Prognostic Factors of Cushing's Disease in Adults

Height loss as an indicator of ageing through its association with frailty and sarcopenia: An observational cohort study.

Prognostic Factors in Long-Term Survivors with Glioblastoma

Neurenteric Cyst of the Posterior Cranial Fossa: Case Report.