Friday, March 27, 2015

I just played with the future: PadBot and Telepresence Robots for all of us?

Greetings from SALSA. I just spent a few minutes postoperatively wandering around my friend Perry Mayer's clinic in Hamilton, Ontario. This was courtesy of Perry's very own PadBot, which allows simple controls from iPhone/Android to allow interaction and easy movement. It feels like controlling a virtual Segway, of sorts. This is just awesome. 

While telepresence robots have been around for a while, none have been this inexpensive or easy to use. 

Wednesday, March 25, 2015

Is this the single greatest promotional video for a prosthetic ever?

Thanks to SALSA's John Miller for spotting this from handiii. 

Tuesday, March 24, 2015

If you ignore your feet, they'll go away. @apmatweets @UofA #DFCon

Here's a wonderful poster from our SALSAmigo, Penn State's Prof. Jan Ulbrecht. The little model (incidentally) is Jan's granddaughter! 

Monday, March 23, 2015

From wearable robots to stem cells to 3D printed shoes: International Experts Team to Prevent Amputations at DFCon15

FOR IMMEDIATE RELEASE                                              Contact:  Pam Landaiche
March 21, 2015                                                               

Internationally renowned experts on diabetes and the diabetic foot met March 19-21, 2015, at the thirteenth Diabetic Foot Global Conference (DFCon) in Los Angeles, CA.  Specialists from 40 U.S. states and 37 foreign countries came together to collaborate and gain further insights into latest advances in preventing amputations resulting from diabetic complications.

“Fear of amputations is something many diabetic patients live with; however due to the dedication of professionals in our field, we are now able to prevent over 95 percent of amputations.  DFCon affords professionals the opportunities to advance their own understandings of these cutting-edge medical practices,” said Conference Co-Chairman George Andros, MD.  Dr. Andros is a vascular surgeon and medical director of the Amputation Prevention Center at Valley Presbyterian Hospital (Van Nuys, CA), and founding partner of Los Angeles Vascular Specialists.

Dr. Andros founded DFCon in 2005 along with fellow co-chairman David G. Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine in Tucson, AZ. They, along with course director, Joseph L. Mills, Sr, MD, brought together nearly 40 internationally renowned experts from seven countries to serve on the DFCon faculty.  Dr. Mills is professor of surgery, chief vascular and endovascular surgery, and co-director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona, College of Medicine (Tucson, AZ).

“Over the years, DFCon has become one of the leading global conferences on the diabetic foot and diabetic complications. Our multi-faceted format offers more than 50 presentations, panel discussions, symposia, video sessions, and hands-on workshops, ensuring participants leave here fully equipped to bring these insights back home and incorporate them into their practices,” said Dr. Armstrong.

Highlighting the Friday agenda, the 2015 Edward James Olmos Award for Advocacy in Amputation Prevention was presented to Nicolaas Schaper, MD, a renowned physician, educator and international expert on the diabetic foot and wound management.  The award is presented annually to physicians who have demonstrated exemplary commitment to diabetic limb salvage. Dr. Schaper is head of the Division of Endocrinology of the Maastricht University Hospital and founder and coordinator of the European Research Consortium on the Diabetic Foot.  The annual award is named after the Emmy and Golden Globe-winning and Academy Award-nominated actor, who was on hand for the presentation.

Live broadcasts of educational sessions held during the meeting were broadcast worldwide by Portal Education, and video will be streamed on the DFCon website at

Attendees also had the opportunity to experience first-hand the latest products and technologies from more than 45 pharmaceutical, medical device makers and other companies present at the meeting. An astonishing array of technologies ranging from stem cell therapy, to medical tattoos to wearable exoskeletons were presented by the world’s top researchers.

Valley Presbyterian Hospital is the presenting sponsor of the conference. International Conference Management managed and produced the meeting. CPME accreditation was provided by ICM and ACCME and ANNC accreditations were provided by Ciné-Med.

For further information, visit
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First in human results of point of care bacterial testing in wounds

PLOS ONE: Point-of-Care Autofluorescence Imaging for Real-Time Sampling and Treatment Guidance of Bioburden in Chronic Wounds: First-in-Human Results:

Diabetes Cases Surge in States That Expanded Medicaid Under ACA

Diabetes Cases Surge in States That Expanded Medicaid Under Obamacare - US News:

Patients with newly identified diabetes in expansion (blue) and nonexpansion (red) states.

 Patients with newly identified diabetes in expansion (blue) and nonexpansion (red) states.

States that chose to expand Medicaid for low-income Americans under President Barack Obama's health care law have seen a surge in diabetes diagnoses, a new study shows, particularly during the disease's earlier stages when changes in lifestyle can have a significant impact on a person's later health. 

Conducted by Quest Diagnostics and published Monday in the journal Diabetes Care, the analysis found that newly identified diabetes cases among Medicaid-enrolled patients jumped 23 percent in states that expanded the program, but increased by less than 1 percent – 0.4 percent – in states that did not.
The portion of the Affordable Care Act that deals with Medicaid has come under political and financial scrutiny, and finally resulted in a legal battle. The law originally intended for all states to expand Medicaid, but the Supreme Court ruled in 2012 that states could choose whether they wanted to do so. 
At the time of the analysis, 26 states and the District of Columbia had expanded Medicaid. Since then, two additional states have expanded the program, and more are considering the move. More than 11 million Americans have enrolled in Medicaid or the Children's Health Insurance Program – which provides coverage for children in low-income families that earn too much to qualify for Medicaid – since the first open enrollment period for Obamacare began in October 2013. 
The new study shows the direct impact Obamacare can have on people's health.

"It allowed for a very interesting natural experiment to see what coverage and access would do to the diagnosis of diabetes," says 
Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association, which publishes Diabetes Care. 
Reducing financial barriers to health care, as Obamacare aims to do, tends to lead to more use of medical care. And in diabetes cases, there is room for significant improvement regarding diagnosis and treatment: 1 in 4 Americans who have diabetes don't know it, according to the Centers for Disease Control and Prevention.
Without health insurance coverage, people are likely to delay getting care until symptoms of the disease get worse.
"Really, [the study] is telling us the primary reasons why we are not making the diagnosis: It’s access to care and coverage for care," Ratner says.
The study did not distinguish between the types of diabetes diagnosed. Type 2 diabetes is a condition in which the body doesn't use insulin properly, causing blood sugar levels to rise. It can result from lifestyle factors, such as poor diet and low physical activity. Type 1 diabetes is a condition in which the body doesn't produce insulin. It accounts for roughly 5 percent of patients with diabetes and is usually diagnosed in children. Thus, most cases included in the study were likely to be Type 2, says Dr. Harvey Kaufman, senior medical director at Quest Diagnostics and a study co-investigator.
"We looked at diabetes because of its high prevalence," he says. 
Ratner noted also that treatment for the disease is effective. "By intervening aggressively early, there is good evidence you can stabilize the disease," he says. "It doesn't deteriorate and become more difficult to treat over time."
In the U.S., 1.7 million people are diagnosed with diabetes each year, and screening for the disease is crucial in setting someone up for treatment. Diabetes typically gets worse when not treated, and can cause heart disease, blindness, kidney failure or death. Some patients also can face amputation
The Affordable Care Act pushes the expansion of Medicaid coverage for uninsured adults under 65 with incomes up to 138 percent of the federal poverty level, which is $16,243 a year for an individual and $33,465 for a family of four. 
States that have not expanded Medicaid likely have a high rate of undiagnosed diabetes, as Ratner 

says many lie in the "Diabetes Belt" – meaning primarily in the Southeastern part of the country.

"We know diabetes occurs in lower socioeconomic groups," he says. "They depend on Medicaid for insurance coverage."

Researchers analyzed test results for people between the ages of 19 and 64 who had a newly diagnosed diabetes case during the first six months of 2013 (before Medicaid expansion took effect) and the first six months of 2014 (after expansions), finding trends related to early diagnosis, age and gender. 
For example, patients newly diagnosed with diabetes were more likely to be diagnosed during earlier stages of the disease if they were in states that had expanded Medicaid than if they were in a state that had not.
"The advantage of that earlier diagnosis is that the progression of diabetes can be slowed through making lifestyle changes, such as losing weight, being more physically active or changing the food you eat," Kaufman says. 
Ratner points out that part of the reason the average diagnosis occurred in an earlier stage of the disease may have been due to people in later stages who had severe enough symptoms to land them in the emergency room before the expansion of Medicaid, even if they did not have coverage or the ability to pay. 
When breaking down the data by age, researchers found that Medicaid expansion states saw new diabetes diagnoses increase in older Medicaid patients – ages 50 to 64 – by 31 percent, while non-expansion states saw an increase of just 0.5 percent. Diabetes diagnoses in younger patients – ages 19 to 49 – increased about 15 percent in expansion states, while non-expansion states showed little change. 
Patients with newly identified diabetes in all states, Medicaid expansion states, and nonexpansion states by age group.
Patients with newly identified diabetes in all states, Medicaid expansion states, and nonexpansion states by age group.
The gender breakdown showed men had slightly higher rates of diabetes diagnosis than women. New diagnoses in Medicaid-enrolled men increased 25.5 percent in expansion states, while diagnoses for women increased 22 percent. Among Medicaid enrollees in non-expansion states, new diagnoses for men increased 4.6 percent and decreased 1.4 percent for women.
Patients with newly identified diabetes in all states, Medicaid expansion states, and nonexpansion states by gender.
Patients with newly identified diabetes in all states, Medicaid expansion states, and nonexpansion states by gender.
Researchers hypothesize that because women tend to use health services more than men, women with diabetes may have been more likely to have been previously diagnosed. Men may also be at higher risk for diabetes than women. 
Those involved in the study say they hope it will propel more research into how other chronic disease diagnoses are affected by Medicaid and Obamacare. 
"The observation likely applies to everything else, whether heart disease, kidney disease or HIV," Kaufman says. "The fact that they are going [to the doctor] most likely has broad applications to common medical conditions." 
The expansion of Medicaid was designed to fill gaps in program eligibility, which used to be determined by states. States that expand Medicaid can receive federal funding to help with the costs, though lawmakers often cite financial concerns as a reason for not making the move. Politics also are at play.
Researchers point out that the cost of health care and lost productivity associated with diabetes is estimated at about $322 billion each year. It's far more expensive to do surgery after the disease has progressed than it is to do a blood test for an earlier diagnosis, Ratner says, adding that screening costs as little as $4.
"If policymakers think that not finding diabetes saves money, they’re wrong," he says. "In essence, we are just putting our heads in the sand if we try to ignore the problems associated with diabetes and don’t want to diagnose it and deal with it.
"We need to come to some level of acceptance that what we don’t know can hurt us."

Tuesday, March 17, 2015

The Global Economic Burden of #Diabetes

This synopsis of the manuscript (link below) from

Around 382 people worldwide have diabetes. By 2035, this figure is estimated to rise to 592 million, with type 2 diabetes accounting for around 90% of all cases. It goes without saying that diabetes prevalence is putting a huge strain on health care. But what is the global economic impact of the disease? This is a question that is addressed in a study by researchers from the University of East Anglia in the UK.
Published in the journal PharmacoEconomics, the research drew data from 109 studies that assessed the economic effects of type 2 diabetes among low-, high- and middle-income countries.
Lead researcher Till Seuring, of the Norwich Medical School at the University of East Anglia (UEA), and colleagues note that while the worldwide increase in type 2 diabetes prevalence is recognized, information on the economic burden of the disease is sparse.
As such, the team set out to conduct a rigorous review of all studies investigating this issue that have been published since 2001.
In particular, the researchers analyzed the direct costs associated with type 2 diabetes - including doctor and hospital visits, medication and laboratory costs for tests - and indirect costs, such as income losses as a result of early retirement and lost work hours due to illness.

US has highest diabetes-associated lifetime health care costs

The results of the analysis revealed that around two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt.
Perhaps unsurprisingly, people with diabetes in low- and middle-income countries were found to have a higher cost burden as a result of the condition, compared with those in high-income countries.
The team notes that people with health insurance coverage were most protected against out-of-pocket expenditures as a result of type 2 diabetes, but this was most likely to be the case for people with higher incomes.
"In high-income countries the burden often affects government or public health insurance budgets, while in poorer countries, a large part of the burden falls on the person with diabetes and their family due to very limited health insurance coverage," explains Seuring.
Compared with countries that have similar average income levels, people with type 2 diabetes in the US were found to have the highest lifetime health care costs related to the disease, at $283,000.
What is more, American women with type 2 diabetes were found to have the highest annual income loss worldwide, losing $21,392 per year. In the US, the condition also reduces a woman's chance of employment by 50%, the researchers found.
In all other countries, however, men with type 2 diabetes were found to have the worst employment opportunities. In Taiwan, for example, men with the condition were found to have a 19% reduced chance of employment.
Last month, Medical News Today reported on a study published in The BMJ, in which researchers detailed the creation of a "precision medicine" model that they say could help prevent diabetes in populations at high risk for the condition.
Written by 

The economic costs of type 2 diabetes: a global systematic review, Till Seuring, et al., PharmacoEconomics, doi: 10.1007/s40273-015-0268-9, published online 17 March 2015, abstract.

Young vascular and podiatric surgeons bring the "Toe and Flow" together in collaborative white paper. @APMAtweets #DFCon15

From APMA News:
The APMA Young Physicians’ Program and the Young Surgeons Committee of SVS collaborated on a practice memo, “Building Effective Partnerships between Vascular Surgeons and Podiatrists in the Effective Management of Diabetic Foot Ulcers.” Read the memo in the March issue of APMA News. 

It includes everything from exploration of development of inpatient "Diabetic Rapid Response Foot Teams (DRRAFT)" to joint guideline and referral practices. We at SALSA are so very proud of these men and women. Particular congratulations go to Nichol Salvo, Timothy Wu and Rabih Chaer from APMA and SVS Young Physicians and Surgeons.