There is a lifetime risk of 15% to 25% of development of diabetic foot ulcers (DFUs) in patients with diabetes mellitus. DFUs need to be followed up on and assessed for development of complications and/or resolution, which was traditionally performed using manual measurement. Our study aims to compare the intra-and inter-rater reliability of an artificial intelligence-enabled wound imaging mobile application (CARES4WOUNDS [C4W] system, Tetsuyu, Singapore) with traditional measurement. This is a prospective crosssectional study on 28 patients with DFUs from June 2020 to January 2021. The main wound parameters assessed were length and width. For traditional manual measurement, area was calculated by overlaying traced wound on graphical paper. Intra-and inter-rater reliability was analysed using intra-class correlation statistics. A value of <0.5, 0.5-0.75, 0.75-0.9, and >0.9 indicates poor, moderate, good, and excellent reliability, respectively. Seventy-five wound episodes from 28 patients were collected and a total of 547 wound images were analysed in this study. The median wound area during the first clinic consultation and all wound episodes was 3.75 cm 2 (interquartile range[IQR] 1.40-16.50) and 3.10 cm 2 (IQR 0.60-14.84), respectively. There is excellent intra-rater reliability of C4W on three different image captures of the same wound (intra-rater reliability ranging 0.933-0.994). There is also excellent inter-rater reliability between three C4W devices for length (0.947), width (0.923), and area (0.965). Good inter-rater reliability for length, width, and area (range 0.825-0.934) was obtained between wound nurse measurement and each of the C4W devices. In conclusion, we obtained good inter-rater and intra-rater reliability of C4W measurements against traditional wound measurement. The C4W is a useful adjunct in monitoring DFU wound progress.

Chronic venous insufficiency is a chronic disease of the venous system with a prevalence of 25% to 40% in females and 10% to 20% in males. Venous leg ulcers (VLUs) result from venous insufficiency. VLUs have a prevalence of 0.18% to 1% with a 1‐year recurrence of 25% to 50%, bearing significant socioeconomic burden. It is therefore important for regular assessment and monitoring of VLUs to prevent worsening. Our study aims to assess the intra‐ and inter‐rater reliability of a machine learning‐based handheld 3‐dimensional infrared wound imaging device (WoundAide [WA] imaging system, Konica Minolta Inc, Tokyo, Japan) compared with traditional measurements by trained wound nurse. This is a prospective cross‐sectional study on 52 patients with VLUs from September 2019 to January 2021 using three WA imaging systems. Baseline patient profile and clinical demographics were collected. Basic wound parameters (length, width and area) were collected for both traditional measurements and measurements taken by the WA imaging systems. Intra‐ and inter‐rater reliability was analysed using intra‐class correlation statistics. A total of 222 wound images from 52 patients were assessed. There is excellent intra‐rater reliability of the WA imaging system on three different image captures of the same wound (intra‐rater reliability ranging 0.978‐0.992). In addition, there is excellent inter‐rater reliability between the three WA imaging systems for length (0.987), width (0.990) and area (0.995). Good inter‐rater reliability for length and width (range 0.875‐0.900) and excellent inter‐rater reliability (range 0.932‐0.950) were obtained between wound nurse measurement and each of the WA imaging system. In conclusion, high intra‐ and inter‐rater reliability was obtained for the WA imaging systems. We also obtained high inter‐rater reliability of WA measurements against traditional wound measurement. The WA imaging system is a useful clinical adjunct in the monitoring of VLU wound documentation.

Chronic wounds are associated with significant clinical, economic and quality‐of‐life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5‐week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter‐rater and intra‐rater reliability between clinical and TA‐based measurements were analysed using intra‐class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5‐week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter‐rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799‐0.919, P < 0.001). Separate measurements of intra‐rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967‐0.985 and range 0.977‐0.984 respectively, P < 0.001). Inter‐rater reliability between TA used on the iOS and Android systems was also excellent (0.987‐0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity.

Background Post-operative upper extremity exercise is recommended to patients with arteriovenous fistulas. It is postulated that increased blood flow to vessels improves maturation and patency rates. Recent studies favour pre-operative exercise therapy to improve the outcomes of arteriovenous fistula creation. Objectives To investigate if pre-operative exercise therapy increases vessel diameter and maturation in patients undergoing distal arteriovenous fistula creation. Methods 34 patients planned for radiocephalic arteriovenous fistula creation were recruited at a tertiary university hospital Vascular Surgery Unit. Patients underwent a 6-week period of self-directed daily upper extremity exercises before surgery. Patients were reviewed up to 6 months post-surgery. The primary outcome investigated was change in venous and arterial diameters following exercise intervention. The secondary outcome investigated was the primary failure rate of the newly created arteriovenous fistulas. Results After exercise therapy, mean hand grip strength increased from 20.3 ± 6.62 kg to 21.9 ± 7.16 kg ( p=.01). There was a statistically significant increase in basilic vein diameter amongst those who demonstrated strict compliance to at least 42 days of pre-operative exercise therapy by 0.51 mm from 3.23 ± 1.09 mm to 3.74 ± 1.31 mm ( p=.03). Primary failure rate of newly created radiocephalic arteriovenous fistulas was 25% (7 of 28), comparable to our previous series of 436 distal arteriovenous fistulas created which had a failure rate of 26%. Conclusions There was a trend of increase in vein diameters after pre-operative exercise therapy. Although not statistically significant, patients with successful arteriovenous fistula creation had longer mean completion of exercise days.