James Wrobel

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OBJECTIVE To describe geographic variation in rates of lower-limb major amputation in Medicare patients with and without diabetes. RESEARCH DESIGN AND METHODS This cross-sectional population-based study used national fee-for-service Medicare claims from 1996 through 1997. The unit of analysis was 306 hospital referral regions (HRRs) representing health(More)
The objective of this investigation was to compare the health-related quality of life (QoL) among persons participating in a randomized clinical trial of pressure-offloading modalities to heal diabetic foot wounds and diabetic neuropathic foot ulcers. In this prospective clinical trial, 63 patients with superficial noninfected, non-ischemic plantar(More)
Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order(More)
BACKGROUND The purpose of this study is to evaluate whether dietary supplementation with the carotenoid zeaxanthin (Zx) raises macula pigment optical density (MPOD) and has unique visual benefits for patients with early atrophic macular degeneration having visual symptoms but lower-risk National Institute of Health/National Eye Institute/Age-Related Eye(More)
INTRODUCTION Currently, diagnosis of patients with postural instability relies on a rudimentary clinical examination. This article suggests an innovative, portable, and cost-effective prototype to evaluate balance control objectively. METHODS The proposed system uses low-cost, microelectromechanical sensor, body-worn sensors (BalanSens) to measure the(More)
OBJECTIVE Identifying individuals most at risk for diabetic retinopathy progression and intervening early can limit vision loss and reduce the costs associated with managing more advanced disease. The purpose of this study was to identify factors associated with progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic(More)
OBJECTIVE Despite the high cumulative plantar stress associated with standing, previous physical activity reports of diabetic patients at risk of foot ulceration have not taken this activity into account. This study aimed to monitor spontaneous daily physical activity in diabetic peripheral neuropathy (DPN) patients and examine both walking and standing(More)
Charcot arthropathy places individuals at risk of developing diabetic foot ulcers and potentially subsequent limb amputation by means of altering the anatomy of the foot and ankle. Physical trauma is an important component to the etiology of the condition. The physical management of the Charcot foot is concerned with minimizing the stress applied to the(More)
Until recently, many gait studies explored potential gait alteration due to various disorders in the gait lab and using camera based systems and force platforms. However, these strategies may not replicate normal outdoor walking. Using this equipment, it is more difficult to measure the variability of walking which is important for maintaining balance and(More)